Helen Assisted Living Home, LLC

Based on record review and interview, the manager failed to ensure a written service plan included the level of service the resident is expected to receive, for one of two residents sampled. Findings include: 1 . A review of R1's medical record revealed a service plan dated March 3, 2025. However, the service plan did not include the level of service the resident was expected to receive. 2 . In an interview, E4 acknowledged R1's service plan did not include the level of service the resident was expected to receive.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers and are inaccessible to residents. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed a cabinet under the kitchen sink held closed with a white mechanism. The Compliance Officer was able to disengage the mechanism and access the cabinet. Inside the cabinet were magnetic locks, however they turned off, and the Compliance Officer was able to access the following: -A bottle of "Great Value" window cleaner; -A can of "Lysol" disinfectant spray; -A bottle of "Home Store" fabric refresher; -A bottle of "Windex" filled with a water and soap mixture; and -A bottle of yellow liquid in a spray bottle, confirmed to be bleach by E2. 2 . In an interview, E4 acknowledged poisonous or toxic materials stored by the assisted living facility were not maintained in labeled containers and inaccessible to residents.

Based on documentation review, record review and interview, the manage failed to ensure that a caregiver's or assistant a caregiver's skills and knowledge are verified and documented, according to policies and procedures for two of two personnel members sampled. Findings include: 1. A review of facility documentation revealed a policy titled "Verifying caregiver's skills and knowledge." The policy states "The manager will interview and assess the staff and test on caregiver skills... the manager will put the information gathered from the interview and information from previous employers in the employee's files." 2. A review of E2's and E3's personnel record revealed documentation of skills and knowledge verification was not available for review at the time of inspection. 3. In an interview, E1 acknowledged E2's and E3's skills and knowledge were not verified and documented according to policies and procedures.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, was only assigned to provide the assisted living services the caregiver or assistant caregiver had the documented skills and knowledge to perform, and documented the services provided in the resident's medical record, for one of two residents sampled. The deficient practice posed a risk if a resident did not receive required services from a qualified employee to meet their needs, and services could not be verified as provided against a service plan. Findings include: 1. A review of E2's and E3's personnel record revealed documentation of verification of skills and knowledge was not available for review at the time of inspection. 2. A review of R2's medical record revealed a service plan which listed the following services and frequency of service: -Partial Bath on days when a complete bath is not given; -Oral Care daily; -Nail Care check daily and clean as needed; and -Comb hair daily. However a review of R2's Activities of Daily Living (ADL) sheet revealed no documentation of the services provided on the following dates: -Partial Bath from August 24, 2024 to August 26, 2024; -Oral Care from August 24, 2024 to August 26, 2024; -Nail Care from August 24, 2024 to August 26, 2024; and -Comb hair from August 24, 2024 to August 26, 2024. 3. In an interview, E1 acknowledged services provided to R2 had not been documented.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for one of two residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration. Findings include: 1. In an interview, E1 reported all residents receive medication administration. 2. A review of R2's medical record revealed a signed medication list with the following medications: -Omeprazole 20mg two caps once a day; -Senna 8.6mg one tablet once a day; and -Quetiapine 12.5mg 1/2 tablet twice a day. However, a review of R2's Medication Administration Record (MAR) sheet for August 2024 revealed medications not documented as administered on the following dates: -Omeprazole from August 24, 2024 to August 26, 2024; -Senna 8.6mg from August 24, 2024 to August 26, 2024; and -Quetiapine 12.5mg from August 24, 2024 to August 26, 2024. 3. In an interview, E1 reported unsure why the medications were not marked as administered, and reports they were administered to the resident. 4. In an interview, E1 acknowledged medication was not administered to a resident in compliance with a medication order.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver provided documentation of completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board), for one of three sampled caregivers. The deficient practice posed a risk if the employee was not qualified to provide required services to meet the needs of a resident. Findings include: 1. A review of facility documentation revealed a document titled "Work schedule" dated March 2024. The schedule reflected E4 worked alone as a caregiver at the facility on March 2, 3, 9, 10, 16, 17, 23, 24, 30, and 31, 2024. 2. A review of E4's personnel record revealed a caregiver certificate issued from "Platinum Training Services" with training number ALTP0152 dated February 25, 2012. 3. A review of the NCIA Board website revealed ALTP0152 was assigned to "Comprehensive Training Services, LLC", not "Platinum Training Services", and "Platinum Training Services" was assigned ALTP0185. 4. A review of Department documentation revealed "ALTP0185 Platinum Training Services" was not in operation on February 25, 2012, the date the certificate was issued. 5. In an interview, E1 reported being unaware E4's caregiver certificate could not be verified.

Based on record review and interview, the manager failed to ensure a caregiver documented the services provided to a resident in the resident's medical record, for one of two sampled residents. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed a service plan dated August 11, 2023. The service plan reflected R1 required assistance with showers twice a week and a partial bath on all other days. R1's record also contained a document titled "Activities of Daily Living" (ADL sheet) dated January 2024. The ADL sheet reflected R1 was provided assistance with showers and partial baths everyday from January 27, 2024 through January 31, 2024. There was no other documentation to reflect R1 was provided any other showers or baths for the month of January 2024. 2. In an interview, E1 reviewed and acknowledged R1's documentation of services provided did not reflect R1 was provided required services according to R1's service plan.

Based on record review and interview, the manager failed to ensure an entry in a resident's medical record was authenticated, for two of two residents sampled. The deficient practice posed a risk as the Department was unable to ensure the facility's compliance. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(26) states "Authenticate means to establish authorship of a document or an entry in a medical record by: a. A written signature; b. An individual's initials, if the individual's written signature appears on the document or in the medical record; c. A rubber-stamp signature; or d. An electronic signature code." 2. A review of R1's medical record revealed a document titled "Activities of Daily Living" (ADL sheet) dated January 2024. R1's ADL sheet contained the initials "G" and "Sn" to reflect the services were provided to R1. However, the entries on the ADL sheets were not assigned to signatures, and therefore were unable to authenticated. 3. A review of R2's medical record revealed documents titled "Activities of Daily Living" (ADL sheets) dated January 2024 and February 2024. R2's ADL sheets contained the initials "G" and "Sn" to reflect the services were provided to R2. However, the entries on the ADL sheets were not assigned to signatures, and therefore were unable to be authenticated. 4. In an interview, E1 reviewed and acknowledged entries on R1's and R2's ADL sheets were not authenticated.

Based on record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the the facility obtained a written determination from a medical practitioner every six months stating the resident's needs were met by the facility and the resident's needs were within the facility's scope of services, for one of two sampled residents. The deficient practice posed a risk if the facility was unable to meet the needs of the resident. Findings include: 1. In an interview, E1 reported R2 was bed bound and non-ambulatory. 2. During the environmental inspection of the facility, the Compliance Officer observed R2 laying in bed. 3. A review of R2's medical record revealed a service plan dated January 20, 2024. The service plan reflected R2 was non-ambulatory and bed bound. However, there was no current documentation indicating R2's medical practitioner examined R2 and reviewed the facility's scope of services at least once every six months, and signed and dated a determination stating R2's needs could be met by the facility. 4. In an interview, E1 reviewed and acknowledged R2's record did not contain documentation of a determination stating R2's needs could be met by the facility, signed by R2's medical practitioner. This is a repeat citation from the previous compliance inspection conducted on February 7, 2023.

Based on record review and interview, the manager failed to ensure when a resident had an accident, emergency, or injury resulting in the resident needing medical services, a caregiver immediately notified the resident's primary care provider and emergency contact. The deficient practice posed a risk of potential re-injury if the resident did not receive adequate follow-up care. Findings include: 1. In an interview, E1 reported R1 went to the hospital via emergency services in February 2024. 2. A review of R1's medical record revealed a document titled "Incident Report" dated February 3, 2024, which reflected "[R1] is having coughing and chest pain." The form did not indicate R1's primary care provider was notified. 3. In an interview, E1 acknowledged the "Incident Report" documentation did not reflect R1's primary care provider was immediately notified.