Hope Haven Assisted Living Home

Based on record review and interview, the manager failed to ensure the assisted living home maintained a standardized form for each resident that included the information prescribed in subsection A of this section for two of two residents reviewed. Findings include: 1. Review of R1's and R2's medical record revealed a document titled "Resident Face Sheet". This document contained information required in subsection A of ARS 36-420.04, however it was missing the following: The name, address and telephone number of the resident's current pharmacy; A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge; and The reason or reasons the emergency responder was requested on behalf of the resident. 2. A review of the facility's emergency documentation revealed a form titled "Assisted Living Resident Transfer Checklist." However, the form was blank at the time of review and was not completed for each individual resident. 3. In an exit interview, E1 reported the "Assisted Living Resident Transfer Checklist" was filled out when emergency responders were contacted. E1 acknowledged the assisted living home did not maintain a standardized form for each resident.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's personnel schedule revealed the facility had two staff shifts. 2. A review of the facility's disaster drill documentation revealed a disaster drill conducted on the following dates and shifts: January 3, 2025 at 10:34 indicated as the AM shift; April 4, 2025 at 10:05A indicated as the AM shift; July 14, 2025 during the AM and PM shifts; and October 8, 2025 with no shift indicated. However, no documentation of disaster drills for each shift was available for review. 3. In an interview, E1 acknowledged a disaster drill for employees was not conducted at least once every three months on each shift and documented.

Based on record review and interview the health care institution failed to develop a training program for all staff regarding fall prevention and fall recovery as required in A.R.S. \'a7 36-420.01. The training program shall include initial training and continued competency training as identified in facility training program documentation. Findings include: 1. Review of facility documentation failed to reveal that the health care institution had developed a fall prevention and recovery training program as required in A.R.S. \'a7 36-420.01. The training program shall indicate that initial training and continued competency training will be conducted. 2. During an interview, E1 acknowledged the required documentation was not available for review.

Based on documentation review and interview, the manager failed to ensure that a quality management plan is established, documented and implemented that includes the frequency of submitting a documented report to the governing authority. Findings include: 1. The facility quality management plan did not include the frequency of submitting a documented report to the governing authority. 2. During an interview, E1 acknowledged the required documentation was not included in the facility quality management plan.

Based on record review and interview, the manager failed to ensure for three of three sample records, that before providing services to a resident, a manager or caregiver provides documentation of first aid training. Findings include: 1. The record for E3 (hired August 14, 2023), failed to reveal documentation of first aid certification. 2. During an interview, E1 acknowledged that the caregiver provided services to residents without documentation of first aid training certification.

Based on record review and interview for one of one sample directed care resident record, the manager failed to obtain the following documentation: documentation reflecting that the resident or resident's representative requested that the resident remain in the facility and a signed and dated statement from a medical practitioner at least once every six months throughout the duration of the resident's condition, indicating that the resident's needs were being met. Findings include: 1. During an interview, E1 indicated that R1 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted. 2. The resident's record did not contain a request from the resident or their representative to remain in the facility and the last statement from the medical practitioner that the resident's needs were being met as per the facility's scope of services, was dated March 29, 2023. Based on the resident's date of acceptance this documentation was required. 3. During an interview, E1 acknowledged that the required documentation was not in the resident's medical record.

Based on record review and interview, the manager failed to ensure that three of three sample records for each volunteer included the starting dates of volunteer service. Findings include: 1. The records for volunteers O1, O2, and O3 did not contain the volunteers' starting dates of service. 2. During an interview, E1 acknowledged the records did not include their starting dates of service.

Based on documentation review and interview, the manager failed to ensure that documentation is maintained of the caregivers working each day. Findings Include: 1. Twelve months of employee work schedules were reviewed. The schedules failed to indicate the names of the caregivers who worked each shift for the following months: December 2022, January - May 2023 and July 2023. 2. During an interview, E1 acknowledged the required documentation was not available for review.

Based on record review and interview, the manager failed to ensure that two of two sample resident medical records contained documentation of notification to the resident of the availability of vaccination for pneumonia. Findings include: 1. The medical record for R2 contained no documentation indicating that the resident had been notified of the availability of the pneumonia vaccination on a yearly basis. No additional documentation indicating when the resident had been offered, refused or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 2. The medical record for R3 contained no documentation indicating that the resident had been notified of the availability of the pneumonia vaccination on a yearly basis. No additional documentation indicating when the resident had been offered, refused or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged that the required documentation was not available for review.

Based on documentation review and interview, the manager failed to ensure that the disaster plan was reviewed at least once every 12 months. Findings include: 1. Review of facility disaster plan review documentation indicated that the last review was conducted on April 3, 2022. 2. During an interview, E1 acknowledged that the documentation failed to reflect that a review had been conducted at least once every 12 months.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials are stored in a locked area inaccessible to residents. Findings include: 1. Observation of the under sink cabinet in the common hallway bathroom revealed the following poisonous or toxic materials: Liquid Swabby Toilet Bowl Cleaner, HDX Disinfectant, Great Value Toilet Bowl Cleaner. The cabinet doors were equipped with child-proof latches that were not secured. No staff were observed near the materials at the time. 2. During an interview, E1 acknowledged that poisonous or toxic materials were not stored in a locked area, inaccessible to residents.