Jmj Adult Care Home LLC

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record included documentation of compliance with the requirements in Arizona Revised Statutes (A.R.S.) \'a7 36-411(A), for one of five personnel members sampled. The deficient practice posed a risk if the individual was a danger to a vulnerable population. Finding include: 1. A.R.S. \'a7 36-411(A) states: "A. Except as provided in subsection F of this section, 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, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct 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 or contracted work." 2. A review of E3's personnel record revealed a fingerprint clearance card with an expiration date of February 12, 2024. 3. A review of the Arizona Department of Public Safety's website revealed E3's fingerprint clearance card was no longer valid. 4. In an interview, E2 confirmed there was no other documentation available for review to reflect E3 had a valid fingerprint clearance card at the time of the inspection.

Based on record review and interview, the manager failed to ensure a residency agreement included whether the manager or a caregiver was awake during nighttime hours, for one of three sampled residents. Findings include: 1. A review of R3's residency agreements revealed the agreement did not include whether the manager or a caregiver was awake during nighttime hours. 2. In an interview, E2 acknowledged the residency agreement for R3 did not include whether the manager or a caregiver was awake during nighttime hours at the assisting living home.

Based on documentation review and interview, the manager failed to ensure for a facility authorized to provide directed care services, there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort that controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if employees were unaware of the egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. A review of facility documentation revealed a policy titled "Wandering" which stated "5. Exit doors in the facility that are not wired for wander guard system may be equipped with delayed egress with an alarm that will sound if a resident exits through the door." 3. In an interview, E2 reported R1 left the facility from the front door, while E3 was taking out the trash. E1 and E2 acknowledged at the time of the incident, the exit did not have a working control or alert to notify an employee of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure the central heating system maintained the facility's temperature between 70 \'b0F and 84 \'b0F at all times. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed R4's and R5's shared bedroom. Using a Department-issued infared thermometer, the Compliance Officer observed the temperature to be between 89.9 \'b0F and 92.1 \'b0F in various areas of the room. E1 was observed adjusting the window blinds and adding an additional fan to cool R4's and R5's bedroom. After E1's intervention, R4's and R5's bedroom temperature read 83.8 \'b0F 2. In an interview, E1 acknowledged R4's and R5's room temperature was not maintained between 70 \'b0F and 84 \'b0F at all times.

Based on documentation review and interview, after the manager had a reasonable basis, according to Arizona Revised Statutes (A.R.S.) \'a7 46-454, to believe abuse, neglect, or exploitation had occurred on the premises, the manager failed to initiate an investigation and document the information required in Arizona Administrative Code (A.A.C.) R9-10-803(J)(5)(a-d), within five working days. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. A review of Department documentation revealed a document titled "Intake Information" dated May 22, 2024. The intake contained allegations of abuse and neglect regarding R1. 2. A review of facility documentation revealed there was no documentation to reflect an investigation was initiated by the facility regarding R1's allegations. 3. In an interview, E3 reported Adult Protective Services (APS) did call E1 regarding allegations of abuse and neglect made by R1, however E3 reported there was no investigation conducted by the facility regarding the allegations. This is a repeat/uncorrected deficiency from the complaint inspection conducted on April 12, 2024.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two sampled residents. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed no documentation indicating whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints, dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. 2. In an interview, E1 acknowledged R1's medical record did not contain the required documentation.

Based on record review, documentation review, and interview, the manager failed to ensure a written notice of termination of residency in subsection (G) included the date of notice, the reason for termination, the policy for refunding fees, charges, or deposits, the deposition of a resident's fees, charges, and deposits, and contact information for the State Long-Term Care Ombudsman. Findings include: 1. In a interview, E3 reported R1 was no longer a resident at the facility. E3 reported R1's family member was informed R1 had less than a week to move from the facility due to R1 being non-compliant with the facility's rules. 2. A review of R1's medical record revealed there was no documentation to reflect R1 or R1's representative received a required written notice of termination which included the date of notice, reason for termination the policy for refunding fees, charges, or deposits, the deposition of a resident's fees, charges, and deposits, and contact information for the State Long-Term Care Ombudsman. 3. A review of facility documentation revealed there was no documentation to reflect R1 or R1's representative received a written notice of termination of residency with all required compnents. 4. In an interview, E3 reported there was no documentation of R1's written notice of termination of residency available for review.

Based on documentation review and interview, when the manager had a reasonable basis to believe abuse, neglect, or exploitation occurred on the premises, the manager failed to initiate and document an investigation of the abuse, neglect, or exploitation within five working days. The deficient practice posed a risk if a resident was not adequately protected from abuse, neglect, or exploitation. Findings include: 1. A review of Department documentation revealed a report of an incident received on April 11, 2024. The report alleged a resident (later identified as R2) was pushed and hit by a caregiver employed at the facility. 2. A review of facility documentation revealed no documentation of an investigation initiated by the facility regarding the abuse allegation. 3. In an interview, E1 reported an investigation was initiated, however there was no documentation of the investigation. E1 reported speaking with R2 regarding the allegations, however R2 refused to discuss the allegations. E1 further reported Adult Protective Services (APS) conducted an investigation and closed the case.

Based on documentation review and interview, the manager failed to ensure for a facility authorized to provide directed care services, there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort that controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if employees were unaware of the egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. A review of facility documentation revealed a policy titled "Wandering" which stated "5. Exit doors in the facility that are not wired for wander guard system may be equipped with delayed egress with an alarm that will sound if a resident exits through the door." 3. In an interview, E1 reported R1 left the facility while the door alarms were shut off to prevent waking the residents while E1 was doing laundry. E1 and E2 acknowledged at the time of the incident, the exit did not have a working control or alert to notify an employee of the egress of a resident from the facility.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked. The deficient practice posed a risk as there was no record to ensure shifts and tasks were covered to ensure the health and safety of residents. Findings include: 1. When the Compliance Officer arrived at the facility, E1 was the only caregiver inside the facility. E2 arrived later during the inspection. 2. A review of facility documentation revealed there was no schedule for Novemer 2023, December 2023, January 2024, or February 2024. 3. In an interview, E1 acknowledged the facility did not have an employee schedule for Novemer 2023, December 2023, January 2024, or February 2024.

Based on record review and interview, the manager failed to ensure a written order verifying a verbal order was obtained from the medical practitioner within 14 calendar days after receiving the verbal order, for one of two sampled residents. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration or assistance in the self-administration of medication. Findings include: 1. A review of R1's medical record revealed a medication order dated December 26, 2023 for "Ropinirole 1 mg (milligram) tablet at night one hour before bed." Further review of R1's medical record revealed a medication administration record (MAR) dated January 2024. The MAR reflected R1 was administered "Ropinirole 2 mg" at 8:00 AM from January 1, 2024 through January 31, 2024. 2. In an interview, E1 reported R1's physician communicated a verbal order to the facility to change R1's dosage and time of administration for "Ropinirole." E1 acknowledged there was no documentation of R1's verbal order for "Ropinirole 2 mg."