Heavenly Haven Assisted Living Home LLC

Based on document review, record review and interview, the manager of an assisted living center who contacted an emergency responder on behalf of a resident failed to provide to the emergency responder a written document that included all required documentation, for one of two residents sampled. Findings include: 1. A review of facility documentation revealed one incident report involving R3 in which 9-1-1 was called and R3 was ultimately "transported to the hospital." 2. A review of R3's medical record revealed evidence of the standardized form provided to the emergency responder. However, the form did not contain evidence of documentation of why emergency medical services were contacted. Further, evidence of documentation of R3's health insurance portability and accountability act release, advanced directives and medications, including dosages and frequency of administration, provided to the emergency responders was not available for review. 3. In an interview, advised being aware of the implementation of A.R.S. 36-420.02. E1 reported providing all of the required documentation to the emergency responders, however E1 acknowledged they did not copy all the documentation provided, to include the standardized form or required information.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of two personnel members sampled. The deficient practice posed a risk if E3 was a danger to a vulnerable population. Findings include: 1. A review of E3's personnel record revealed E3 was hired as a caregiver on February 2, 2022. The record included a copy of a fingerprint clearance card, which was issued in October 2016 and expired in October 2022. In addition, the record included verification of E3's current fingerprint clearance card, which indicated the fingerprint clearance card was issued in January 2023. 2. A review of E3's application for employment revealed evidence of E3's consistent employment between 2016 and 2020. However, evidence of E3's employment history after 2020 was not available for review. 3. In an interview E1 reported E3 "came out of retirement," and had a valid fingerprint clearance card when hired to work for E1 as a caregiver. E1 acknowledged E3's employment history contained more than a six month gap in employment prior to being hired as a caregiver.

Based on documentation review, record review and interview the manager failed to ensure a caregiver provides current documentation of first aid training and cardiopulmonary resuscitation training certification specific to adults, prior to providing assisted living services to a resident for one of two personnel members sampled. Findings include: 1. A review of facility staffing schedules for May 2023, revealed E3 was scheduled to work as a caregiver on May 4, 5, 6, 11, 12, 13, 18, 19, 20, 25, 26 and 27, 2023. 2. A review of E3's personnel record revealed E3 was hired as a Caregiver on February 2, 2022. Further review revealed documentation indicating E3 completed cardiopulmonary resuscitation training on November 10, 2022. However, evidence of documentation E3 completed first aid training was not available for review. 3. In an interview, E2 acknowledged E3's personnel record did not contain evidence indicating E3 completed first aid training prior to providing assisted living services to a resident.

Based on documentation review and interview the manager failed to ensure when a resident has an accident, emergency, or injury resulting in the resident needing medical services, a caregiver documents the date, time and description of the accident, emergency or injury, the names of any witnesses, actions taken by the caregiver, individuals notified and any action taken to prevent the accident, emergency or injury in the future. Findings include: 1. A review of facility policies and procedures (reviewed May 14, 2020), revealed "Quality Management Policy and Procedures," which stated the following: "Policy 1. The manager shall ensure that all employees are oriented to appropriate measures to identify, evaluate and document all events or incidents identifying: d. Incident reports involving contacting 911, medical services, PCP, Hospice Nurse according to R9-10-818.D.2" "Procedure 4. Incidents involving contacting medical services...will be documented on a written incident form. The incident report shall include the type of incident, the resident's name, date and time of incident, description of the incident, who was involved and/or observed the incident...who was contacted...what immediate action will be taken to prevent the injury from reoccurring. 2. In an interview E1 reported there were no incident reports or Quality Management reports available for review. E1 advised there had been one event in the past year where a resident fell and required medical services, and the event was documented as a case note. 3. A review of facility documents revealed a case note, dated "Sun. 3/19/23 & Mon 3/20/23 6am - 6 pm," documenting an event in which a resident received medical services. The case note did include a description of an injury to R1 and individuals notified, however it did not include a specific time or date of the event, a description of the event or any action taken to prevent the event in the future. 4. In an interview E1 acknowledged they did not ensure the caregiver documented the event as required per R9-10-818.D.2 or per facility policy.