Hellens Adult Care Home

Based on documentation review, record review, and interview, the facility failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. § 36-420.04.A, for two of two residents sampled. The deficient practiced posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A.R.S. § 36-420.04.A states, "A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. 7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. A copy of the resident's health insurance portability and accountability act (HIPAA) release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. 9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives." 2. A review of R1's and R2's medical records revealed no documentation of a standardized form that included all information prescribed in A.R.S. 36-420.04.A. 3. In an interview, E3 acknowledged the facility failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04.A.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for four of four employees reviewed. The deficient practice posed a safety risk to residents. Findings include: 1. ARS § 36-411(C)(3-4) states: "C. Each residential care institution, nursing care institution, and home health agency shall make documented, good faith efforts to: 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution, or home health agency may not hire the potential employee. 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution, or home health agency shall take action to terminate the employment of that employee." 2. A review of E1's, E2's, E3's, and E4's personnel records revealed no documentation of good faith efforts to verify that each employee was not on the adult protective services registry pursuant to section 46-459. 3. In an interview, E3 reported being unaware of the regulation. E3 acknowledged that good faith efforts to verify that each employee was not on the adult protective services registry were not available.

Based on documentation review, observation, and interview, for a facility that provided directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area that controlled or alerted 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. A review of the license issued by the Department revealed the facility was licensed at the directed care level. 2. The Compliance Officers observed multiple ambulatory residents. 3. During the environmental tour the Compliance Officers observed a sliding door leading out to the backyard. However, the door did not control or alert employees of the egress of a resident from the facility. 4. During an interview, E3 acknowledged that a means of exiting the facility to an outside area did not control or alert employees of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure that medication stored by the facility was stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental tour, the Compliance Officers observed Latanoprost 0.005 eye drops stored in an unlocked medication box in the facility refrigerator. The box had a locking device, however, it was unlocked. 2. In an interview, E3 acknowledged medication stored by the facility was not stored locked.

Based on documentation review, observation, and interview, the manager failed to ensure the premises at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential dangers to residents. Findings include: 1. A review of the Department records revealed the facility was licensed to provide directed care services. 2. The Compliance Officers observed multiple ambulatory residents. 3. During the environmental tour, the Compliance Officers observed an unlocked bedroom door that belonged to E2, which led to a bathroom that was unlocked, which led to a closet door that was unlocked, which contained the following: -Natural Made C extra strength 1000mg -INNO CLEANSE Digestive Aid -Natrol Melatonin 5mg -Nature’s Bounty Zinc 50mg -Magnesium Glycinate 300mg -pH-D Feminine Health -Nature Made Iron 65mg 325mg Ferrous Sulfate -Miracle Trim LIPO EXTREM -Vital Vitamin Collagen Complex -Organics Certified Organic Vitamins -Vitamin CODE Raw Zinc 4. In an interview, E3 acknowledged that the premises at the assisted living facility were not free from a condition or situation that may cause a resident or other individual to suffer physical injury.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident if toxic materials were accessible. Findings include: 1. During the environmental tour, the Compliance Officers observed an unlocked caregiver's room contained the following: Febreze Air Mist Refresh & Home Bright Disinfectant Spray Lysol Disinfecting Wipes Clorox Disinfecting Wipes 2. During an interview, E3 acknowledged the toxic materials were not stored in a locked manner and inaccessible to residents.

Based on documentation review and interview, the manager failed to ensure a pest control program that complied with A.A.C. R3-8-201(C)(4) was implemented and documented. Findings include: 1. During an environmental tour, the Compliance Officers requested to review the facility's pest control program. Documentation of the facility's pest control program was not available for review at the time of inspection. 2. In an interview, E3 reported E1 had been spraying the facility and was not a licensed applicator. E3 acknowledged the facility did not have a pest control program that complied with A.A.C. R3-8-20l(C)(4).