Happy and Healthy Assisted Living

Based on documentation review, record review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not available during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of facility documentation revealed an undated document titled "FALL PREVENTION AND RECOVERY." The document included a training program for fall prevention and fall recovery. 3. A review of E3's personnel record revealed the record did not include documentation of initial training or continued competency training in fall prevention and fall recovery. 5. In an interview, E1 acknowledged that documentation of initial training or continued competency training in fall prevention and fall recovery for E3 was not available during this inspection. This is a repeat deficiency from the compliance inspection conducted on December 5, 2022.

Based on record review and interview, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statute (A.R.S.) \'a7 36-420.04(A)(1) through (9), for two of two sampled residents. Findings include: 1. A review of R1's and R2's medical records revealed standardized emergency responder forms; however, the forms did not include the following: - The name, address, and telephone number of R1's and R2's current pharmacies; - The point-of-contact information for the assisted living home, including the email address; - Copies (or mention of attached copies) of R1's and R2's health insurance portability and accountability act releases authorizing a receiving hospital to communicate with the assisted living home to plan for R1's and R2's discharges; and - Copies (or mention of attached copies) of R1's and R2's advance directives. 3. In an interview, E1 acknowledged the standardized forms did not include all items required by this statute.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by an assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed a document titled, "DETERMINATION FOR RESIDENCY OR CONTINUED RESIDENCY" signed by a physician on November 10, 2021 revealed that R1 required continuous medical and continuous nursing services. 2. A review of R1's medical record revealed a document titled, "DETERMINATION FOR RESIDENCY OR CONTINUED RESIDENCY" signed by a physician on May 10, 2024 revealed that R1 required continuous medical and continuous nursing services. 3. In an interview, E1 reported the boxes were marked in error and R1 receives intermittent nursing services from hospice. Technical assistance was previously provided during the compliance inspection on December 5, 2022.

Based on record review and interview, the manager failed to ensure a resident medical record contained documentation of notification of the residents of the availability of vaccination for influenza and pneumonia, according to A.R.S. \'a7 36-406(1)(d), for one of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A review of R1's medical record revealed no documentation of notification of the availability or R1's refusal of vaccination for pneumonia was available for review. 2. In an interview, E1 acknowledged R1's medical record did not include documentation of notification of the availability or R1's refusal of vaccination for pneumonia.

Based on observation and interview, the manager failed to ensure there was a means of exiting the facility to control or alert employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. The Compliance Officers observed that the laundry room door led to the garage which led to a caregiver room with a door leading to the outside of the facility; none of the doors were locked. The laundry room door was alarmed; however, the alarm was not engaged. 2. In an interview, E1 acknowledged that the means of exiting the facility was not controlled to alert employees of the egress of a resident from the facility. 3. In an interview, E1 reported that the laundry room door and doors beyond the laundry room door leading to an outside exit are never locked; however, there is a sign on the laundry room door permitting only authorized personnel access beyond the laundry room.

Based on documentation review, record review, and interview, the manager failed to ensure policies and procedures for medication administration were implemented for the documentation of a resident's refusal to take prescribed medication in the resident's medical record. The deficient practice posed a health and safety risk. Findings include: 1. Review of the facility's policies and procedures revealed a policy titled "MEDICATIONS". Section 4. D. of the policy stated, "Any time the resident refuses medications the MAR will be recorded with a letter "R" (Refusal). 2. Review of R2's September 2024 medication administration record (MAR) revealed a blank box instead of an "R" (Refusal) on September 13, 2024 for the 6:00 PM dose of Losartan 25 MG. 3. During an interview, E1 reported that R2 had refused the medication on September 13, 2024, and acknowledged the medication policies and procedures were not implemented for a resident's refusal to take a prescribed medication.

Based on observation, documentation review and interview, the manager failed to ensure policies and procedures were implemented for discarding medications. The deficient practice posed a risk as the standards expected of employees were not followed. Findings include: 2. The Compliance Officers observed the following expired medications for R2: "Guaifenesin 400 mg, expired: 12/23", "Aspirin 81mg, expired: 8/20", and "Nauzene Chewables, expired: 1/2011". 3. A review of facility documentation revealed a policy titled "MEDICATIONS". Section 6. B. of this policy stated, "any resident medication which is discontinued or expired by physician's order, shall be offered back to the resident's representative, resident family member, returned to the pharmacy, returned to Hospice, or disposal of medications will be performed according to Arizona's Department of Environmental Quality brochure. Written proof of discarding of all medications will be documented using the Medication Disposal Record form." 4. In an interview, E1 acknowledged the expired medications for R2 were not discarded per the policies and procedures.

Based on documentation review and interview, the manager failed to ensure a pest control program compliant with Arizona Administrative Code (A.A.C.) R3-8-201(C)(4) was implemented. Findings include: 1. A.A.C. R3-8-201(C)(4) states: "4. An individual may not provide pest management services at a...health care institution...unless the individual is a certified applicator in the certification category for which services are being provided." 2. A review of facility documentation revealed no documentation was available to reflect pest control service was conducted by a certified applicator. 3. In an interview, E1 reported pest control services were completed by a certified applicator; however, documentation was not available for review.