Kare More Than That LLC

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, and as specified in R9-10-113, for one of two residents sampled. Findings include: 1. A review of R2’s medical record revealed that no TB screening was documented for R2. Based on R2’s date of occupancy, the documentation was required. 2. In an interview, the findings were reviewed with E1, and no additional information was provided. 3. Technical assistance was provided on this rule during the abbreviated inspection conducted on March 20, 2025

Based on record review, documentation review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery, to include initial training and continued competency training, for one of two employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E1’s personnel record revealed a hire date of January 16, 2025. Further review of E1’s record revealed no fall prevention and fall recovery training. Based on E1’s hire date, this documentation was required. 2. A review of the facility's staff schedule revealed E1 provided services to the residents. 3. A review of the facility’s policies and procedures revealed a policy titled “In-Service Education.” The policy stated the manager and caregivers were required to complete "at least 1 hour" of ongoing fall prevention and fall recovery training every 12 months from the starting date of employment. 4. In an interview, E1 acknowledged that E1 did not have the required fall prevention and fall recovery training. 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, documentation review, and interview, the health care institution failed to implement tuberculosis (TB) infection control activities, including annually providing training and education related to recognizing the signs and symptoms of TB to individuals employed by the health care institution, and annually assessing the health care institution's risk of exposure to infectious tuberculosis. The deficient practice posed a risk as the caregivers received no organized instruction or information related to TB surveillance, and posed a TB exposure risk to residents. Findings include: 1. A review of E1's personnel record revealed no documentation of training and education related to recognizing the signs and symptoms of TB. Based on E1's date of hire, this documentation was required. 2. A review of the facility’s documentation revealed no annual assessment of the facility's TB risk assessment. 3. In an interview, E1 acknowledged that an assessment of the health care institution's risk of exposure to infectious TB was not conducted, nor were the employees’ annual training. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for one of two personnel sampled. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411.C.3 states: "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." 2. A review of E2’s personnel records did not include documentation that E2 was not on the adult protective services registry pursuant to section 46-459. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for two of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a residents’ needs. Findings include: 1. A review of R1's medical record revealed a service plan dated September 4, 2025, that stated R1 received directed care services. 2. A review of R1's medical record revealed a "Consent to Continue Residency" form that indicated R1 required continuous medical services and continuous nursing services. However, the document was not dated or signed by a medical professional or a registered nurse. Based on R1’s acceptance date, this documentation was required. 3. A review of R2's medical record revealed a service plan dated June 6, 2025, that stated R2 received directed care services. 4. A review of R2's medical record revealed a "Consent to Continue Residency" form that indicated R2 did not require continuous medical services, continuous or intermittent nursing services, or restraints. The form was signed by R2's representative. However, the document was not dated or signed by a medical professional or a registered nurse. Based on R2’s acceptance date, this documentation was required. 5. In an interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure before or at the time of an individual’s acceptance by an assisted living facility there was a residency agreement with a documented date and signature of the manager, for two of two residents sampled. The deficient practice posed a risk if the manager was not informed of the terms of the residency. Findings include: 1. A review of R1’s medical record revealed a residency agreement for R1. However, the residency agreement was not dated or signed by the manager. Further review revealed R1 was a resident of the facility at the time of inspection. 2. A review of R2’s medical record revealed a residency agreement for R2. However, the residency agreement was not dated or signed by the manager. Further review revealed R2 was a resident of the facility at the time of inspection. 3. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that within five working days after a resident's acceptance by the assisted living facility, the documented agreement was signed by the resident or the resident's representative, for two of two residents sampled. The deficient practice posed a risk if the resident and the required individuals were not informed of the terms of residency. Findings include: 1. A review of R1’s medical record revealed an undated residency agreement for R1. However, the residency agreement was not signed by the resident or the resident’s representative within five working days after R1's acceptance by the assisted living facility. Based on R1's date of acceptance, this documentation was required. 2. A review of R2’s medical record revealed an undated residency agreement for R2. However, the residency agreement was not signed by the resident or the resident’s representative within five working days after R2's acceptance by the assisted living facility . Based on R2's date of acceptance, this documentation was required. 3. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident had a service plan that was established, documented, and implemented, which included a description of the resident’s medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments, for one of two residents sampled. Findings include: 1. A review of R1’s medical record revealed a service plan, dated September 4, 2025, which indicated R1 required directed care services. However, under the heading, “Diagnosis/Comorbid Conditions,” the service plan was left blank and did not contain a description of R1’s medical or health problems. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that a resident had a service plan that was established, documented, and implemented, and was reviewed and updated at least once every three months for a resident receiving directed care services, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan dated June 6, 2025, that indicated R2 received directed care services. However, no further documentation of a current, updated service plan was available for Compliance Officer review. Based on the date of the last service plan, an updated service plan was required. 2. A review of the facility’s policies and procedures revealed a policy titled, “Service Plan” which stated, “A. Except as required for a respite resident, a manager shall ensure that a resident has a written service plan that: G. Is reviewed and updated… No later than 14 calendar days after a significant change in the resident’s physical, cognitive, or functional condition, and... at least once every three months for a resident receiving directed care services.” 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, observation, documentation review, and interview, the manager failed to ensure that a resident’s medical record contained a medication order from a medical practitioner for each medication that was administered to the resident for one of two residents sampled. The deficient practice posed a risk as medication administered could not be verified against a medication order. Findings include: 1. A review of R2’s medical record revealed a service plan dated June 6, 2025. This service plan indicated R2 received medication administration. 2. A review of R2’s medication administration record (MAR) for February 2026 and March 2026 revealed the following medications were administered to R2: · Potassium Chloride 10 milligram (mg) was administered February 1, 2026, to March 11, 2026; · Trazodone 100 mg was administered February 1, 2026, to March 10, 2026; and · Diclofenac 1% topical gel was administered February 1, 2026, to March 11, 2026. 3. A review of R2’s medical record did not include an order for the following medications: · Potassium Chloride 10 mg; · Trazodone 100 mg; and · Diclofenac 1% topical gel. 4. A review of R2’s medical record revealed a Discontinued Medication order dated March 11, 2026. The discontinued order revealed Diclofenac 1% was to be discontinued on March 27, 2025. However, documentation of an additional medication order was not available for review. 5. The Compliance Officers observed Potassium Chloride 10mg and Trazodone 100mg were prefilled in R2’s medication organizer. Additionally, the Compliance Officers observed Diclofenac 1% in R2’s medication container. 6. A review of the facility’s policies and procedures revealed a policy titled, “Medications” which stated, “e. Medications will be administered in compliance with a medication order.” 7. In an interview, E1 reported E1 believed they had orders for all medications. No additional medication orders were provided during the inspection. 8. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure there was a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort that provides access to an outside area from which a resident may exit to a location at least 30 feet away from the facility that was secure and monitored or alerted employees of the egress. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed that the back egress door was not monitored or alerted of egress when the door was opened. The door contained an alert; however, the alert was turned off. 2. During the inspection, the Compliance Officers observed E1 turn on the back egress alarm, which began to sound. The Compliance Officers observed E1 turn off the egress alarm and not re-engage the alarm. 3. In an interview, E1 reported that the back egress alarm was functional, but they turned it off because the alarm wouldn’t stop sounding. E1 reported that they will consider replacing the back egress alarm. 4. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure medications stored by the facility were 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 the environmental inspection, the Compliance Officers observed a medication lockbox located inside the refrigerator in the kitchen. The lockbox had a combination lock on it. However, the combination lock had not been scrambled, and the Compliance Officers were able to gain access to the lockbox, which contained several vials of insulin injections. 2. In the exit interview, the findings were reviewed with E1, and no additional information was provided. 3. Technical assistance was provided on this rule during the abbreviated inspection conducted on March 20, 2025.

Based on documentation review and interview, the manager failed to ensure that 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 disaster drill documentation revealed documentation of a drill conducted on April 25, 2025. However, documentation of additional drills was not available for review. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided. 3. Technical assistance was provided on this rule during the abbreviated inspection conducted on March 20, 2025

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were in a locked area separate and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of the residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed the following items located in unlocked bathroom cabinets accessible to residents: · Two containers of germicidal disposable cloths; · One can of OdoBan air freshener; · One can Roach & Ant killer; · One bottle mold & mildew stain remover; · One bottle bathroom cleaner; · One bottle of glass cleaner; · One bottle of Comet cleaner; and · One bottle of Zep cleaner. 2. During the environmental tour, the Compliance Officers observed the following items located in an unlocked kitchen cabinet accessible to residents: · One bottle labeled “bleach water”; · One bottle labeled “Fabuloso cleaner”; · One can Roach & Ant killer; and · Several bottles of dish soap. 3. During the environmental tour, the Compliance Officers observed the following items located near an outdoor grill area and accessible to residents: · One bottle of charcoal lighter fluid; and · One bag of charcoal briquets. 4. A review of the facility’s policies and procedures revealed a policy titled, “Environmental Safety” which stated, “All poisonous or toxic materials will be stored in labeled containers, in locked areas … and are inaccessible to residents.” 5. In the exit interview, the findings were reviewed with E1, and no additional information was provided.