Integrity Adult Care Home

Based on record review and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of two residents reviewed. The deficient practice posed a health and safety risk to the resident if a caregiver did not know if a medication was administered. Findings include: 1. Review of R2’s medical record revealed R2’s a current service plan dated December 23, 2024. This service plan revealed R2 received medication administration. 2. Review of R2’s medical record revealed a document titled, “Verbal Order Form” which was signed by a physician on May 13, 2025, and signed again on another verbal order form dated May 27, 2025. These orders stated, “Metoprolol 25 MG 1 TAB PO BID”. 3. Review of R2’s medical record revealed a medication administration record (MAR) for the month of May 2025. This MAR did not include documentation Metoprolol 25 MG was administered. 4. Review of R2’s medical record revealed a verbal order form that was received by the facility on May 22, 2025 and signed May 27, 2025. This order stated “Ceptaroxine 500 MG 1 TAB PO BID for 10 days than D/C”. 5. Review of R2’s medical record revealed a MAR for the month of May 2025. This MAR did not include documentation Ceptaroxine 500 MG was administered. 6. In an interview, E2 reported R2 received Metoprolol 25 MG and Ceptaroxine 500 MG, however, E2 did not document the medication administration in May 2025’s MAR. 7. In an interview, E2 acknowledged R2’s medical record did not include documentation that the medications were administered as ordered.

Based on record review and interview, the manager failed to ensure when a resident had an incident that resulted in the resident needing medical services, a caregiver documented any action taken to prevent the incident from occurring in the future, for two of two residents reviewed who had an incident that resulted in the resident needing medical services. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1’s medical record revealed an incident reported dated November 14, 2023 and another incident report dated December 27, 2023. The November 2023 incident report stated, “... to be taking to the hospital… the HP advice to sent [R1] because of history of C-Dif.” The December 2023 incident report stated, “Called the H.P and decided to send [R1] to ER”. 2. Review of R1’s medical record revealed the incident reports dated November 14, 2023 and December 24, 2023 did not document any action taken to prevent the accident, emergency, or injury from occurring in the future. 3. Review of R2’s medical record revealed two incident reports dated May 5, 2025 and May 27, 2025. The incident report dated May 5, 2025 stated, “Called [R2’s family member] and decide to send [R2] to ER.” The incident report dated May 27, 2025 stated, “... call [R2’s family member] and advise to send [R2] to ER.” 4. Review of R2’s medical record revealed the incident reports dated May 5, 2025 and May 27, 2025 did not document any action taken to prevent the accident, emergency, or injury from occurring in the future. 5. In an interview, E2 acknowledged R1’s and R2’s medical records did not include documentation of any action to prevent the incidents from occurring in the future.

Based on observation, documentation review, 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. Findings include: 1. The Compliance Officer observed a lock on the kitchen sink cabinet, however, the lock did not work as the cabinet door was able to be opened. The following was found under the kitchen sink cabinet: A spray canister of Weiman Stainless Steel Cleaner & Polish A Spray bottle of Windex A Spray Canister of Raid Ant & Roach Killer A bottle of Member’s Mark Commercial Oven, Grill & Fryer Cleaner A bottle of Ajax with bleach 2. The Compliance Officer observed a spray bottle of Odo Ban in a bathroom. 3. The Compliance Officer observed an open door that led into the laundry room. The laundry room door had a lock, however, the door was left open. Located inside the laundry room was a black cabinet that had the key inside the keyhole. The following was found inside of the black cabinet: A spray bottle of Shout Advanced Action Gel A bottle of Lysol Power Clinging Gel Two spray bottles of Windex Two canisters of Hot Shot insect killer A bottle of Pine-Sol 4. Review of the facility’s policies and procedures revealed a policy titled, “Environmental and Physical Plant Safety” which stated, “12. Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation and food storage areas, dining areas and medication and are inaccessible to residents.” 5. In an interview, E2 acknowledged toxic materials were stored unlocked.

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 four employees reviewed. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "A... as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work...C. Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution..." 2. Review of E4's personnel record revealed E4 worked as a facility assistant caregiver and had a hire date of April 26, 2023. However, the personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E4's fitness to work in a residential care institution. 3. In an interview, E1 acknowledged documentation was not available showing E4's work references were obtained upon hire at the facility. E1 reported E4 provided housekeeping services in resident rooms, cooking and cleaning duties.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed documentation of a skin test to rule out infectious TB on July 5, 2023. However, there was no documentation of the results. There was no further documention to review. 2. In an interview, E1 acknowledged R2's medical record did not include current documentation of evidence of freedom from infectious TB as required.

Based on record review and interview, the manager failed to ensure a resident had a written service plan that was developed with assistance and review from the resident or resident's representative, for one of two sampled residents. The deficient practice posed a risk if the resident or resident's representative were unable to participate in the development or review the service plan to provide essential information. Findings include: 1. A review of R2's medical record contained a service plan update dated July 26 2023, for personal care services. The service plan revealed no signature of the resident or the resident's representative to show the service plan was developed with assistance and reviewed by the resident or residen's representative. 2. In an interview, E1 acknowledged the service plan for R2 was not signed to indicate the service plan was developed with assistance of the resident or the resident's representative.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for two of two residents reviewed receiving personal care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. Review of R1's medical record revealed a current written service plan for personal care services dated January 18, 2023. However, a service plan after January 18, 2023 was not available for review. 2. In an interview, E1 acknowledged R1 received personal care services and documentation was not available showing the service plan was updated at least once every six months.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance of the date the activity was provided. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed the posted activity calendar. The activity calendar was dated July 1, 2023 - July 31, 2023. 2. In an interview, E1 acknowledged a calendar of planned activities was not prepared at least one week in advance.

Based on record review, documentation review, observation and interview, the manager failed to ensure the resident's medical record included documentation of medication administration, for two of two residents sampled who received medication administration. The deficient practice posed a risk as medication administered could not be verified against a medication order. Findings include: 1. A review of R1's (admitted in 2023) medical record revealed a service plan (dated in January 2023). The service plan revealed R1 received medication administration. 2. A review of R1's medical record revealed medication orders. 3. A review of facility documentation revealed a medication administration record (MAR) for R1 for August 1- 8, 2023. However, documentation of medication administered to R1 from August 1, 2023 to August 8, 2023 was not available for review. 4. The Compliance Officer observed medications for R1 on the premises. 5. A review of R2's (admitted in 2023) medical record revealed a service plan (dated in July 2023). The service plan revealed R2 received medication administration. 6. A review of R2's medical record revealed medication orders. 7. A review of facility documentation revealed a medication administration record (MAR) for R2 for August 1- 8, 2023.. However, documentation of medication administered to R1 from August 1, 2023 to August 8, 2023 was not available for review. 8. The Compliance Officer observed medications for R2 on the premises. 9. In an interview, E1 acknowledged R1's and R2's medical record did not include documentation of medication administered to R1 and R2. E1 reported the residents received their medications.

Based on record review and interview, the manager failed to ensure documentation of a determination stating the resident's needs can be met by the assisted living facility for a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, for one of two residents sampled who was unable to ambulate even with assistance. Findings include: 1. A review of R1's medical record revealed a service plan for January 2023, for personal care services. The service plan stated "non-ambulatory." 2. A review of R1's medical record revealed a document titled "Continued Residency." The form was signed and dated on January 1, 2023. However, subsequent documentation to demonstrate R1's primary care provider or other medical practitioner examined R1 at least once every six months throughout the duration of the resident's condition, reviewed the assisted living facility's scope of services, and signed and a dated a determination was not available for review. 3. In an interview, E1 confirmed R1 was unable to ambulate even with assistance. E1 acknowledged documentation to demonstrate R1's primary care provider or other medical practitioner examined R1 at least once every six months throughout the duration of the resident's condition, reviewed the assisted living facility's scope of services, and a signed and dated determination was not available for review.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. The Compliance Officer observed a bottle of Ferrous Sulfate sitting on the kitchen counter. 2. In an interview, E1 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit.

Based on observation and interview, the manager failed to ensure a food menu was prepared at least one week in advance. Findings include: 1. The compliance Officer observed a food menu was posted on a bulletin board located in the kitchen area. However, the food menu was dated July 1, 2023, through July 31, 2023. 2. In an interview, E1 reported a current food menu was not posted. E1 acknowledged a current food menu was not prepared at least one week in advance.