King Assisted Living

Based on documentation review, interview, observation, and record review, the governing authority failed to maintain a health care institution within the licensed capacity of five residents. The deficient practice posed a risk if the Department was unable to assess and approve an increased occupancy and the Department was provided false or misleading information. Findings include: 1. A review of Department documentation revealed King Assisted Living was licensed effective December 9, 2014, with a capacity of five residents. 2. A documentation review revealed a fire permit from the City of Phoenix, dated September 27, 2021. The permit stated, "NUMBER OF BEDS: 5." 3. In an interview, E2 reported the facility had five residents. 4. During a tour of the facility, the Compliance Officer observed five residents, five bedrooms, and six beds. 5. A medical record review revealed documentation of assisted living services provided to six residents and not five as previously reported. 6. In an interview, the Compliance Officer again asked how many residents the facility had, to which E2 stated, "Five." The Compliance Officer requested R6's medical record. E2 reported R6 no longer lived at the facility. E2 reported E2 moved R6 to another facility the morning of the inspection after the Compliance Officer arrived. E2 reported the facility had six residents and E2 moved R6 because E2 did not want the Compliance Officer to find out the facility was over capacity. Turning to E3, E2 stated, "Okay [E2], we got caught." 7. A review of R6's medical record revealed a residency agreement with the facility, a service plan, documentation of assisted living services provided to R6, and other documentation. 8. A review of the medical records of R1, R2, R3, R4, R5, and R6 revealed the facility had six residents between May 2, 2023, and July 18, 2023, totaling 74 days.

Based on documentation review, interview, and record review, the manager failed to ensure policies and procedures were established to protect the health and safety of a resident that covered methods by which the assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide. The deficient practice posed a risk as the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A documentation review revealed no policy and procedure covering this rule. 2. In an interview, E2 and E3 reported not having a policy and procedure covering this rule. 3. A review of R7's medical record revealed an incident report. The incident report revealed R7 had been dropped off at a medical appointment and not picked up when the appointment was over. The incident report revealed R7 left the appointment on foot after calling E1 to pick up R7. The incident report revealed facility personnel did not know the general or specific whereabouts of R7.

Based on observation, interview, documentation review, and record review, the manager failed to ensure an assisted living facility had caregivers with the qualifications, experience, skills, and knowledge necessary to provide the assisted living services and ancillary services in the assisted living facility's scope of services, meet the needs of a resident, and ensure the health and safety of a resident, for one of four personnel members sampled. The deficient practice posed a risk to the health and safety of a resident. Findings include: 1. During a tour of the facility, the Compliance Officer observed a cabinet in the kitchen above and to the side of the sink. The Compliance Officer observed both cabinet doors had locks installed. However, the key was left in one of the locks. The Compliance Officer observed no personnel member within sight of the cabinet. The Compliance Officer observed E2 enter the kitchen, turn the aforementioned key, remove the keys, and place the keys on the counter below the cabinet. 2. In an interview, E2 reported the cabinet in question was the medication cabinet. 3. The Compliance Officer then observed E2 grab the keys on the counter and conceal them. The Compliance Officer observed E2 open the medication cabinet, leave the key in the lock, and leave the area several times during the inspection, even going outside twice, despite the Compliance Officer telling both E2 and E3 several times the cabinet needed to remain locked and the keys needed to be inaccessible to residents at all times. 4. In an interview, E3 reported not realizing E2 left the key to the medication cabinet in the lock several times, leaving the medication accessible to a resident each time. 5. A documentation review revealed a policy and procedure titled "Scope of Service" dated August 25, 2020. The policy and procedure stated: "King Assisted Living assist[s] residents with activities of daily living and basic care support in a homelike or apartment setting. Residents receive three meals a day, healthy snacks, recreational and social activities, housekeeping, linen service, apartment and room maintenance, transportation and much more." 6. A review of R7's medical record revealed an incident report. The incident report revealed E2 transported R7 to a medical appointment. 7. A review of E2's personnel record revealed a photocopy of the front and back of E2's fingerprint clearance card. However, the back of the card revealed E2 had driving restrictions which precluded E2 from driving any vehicle to transport a resident as part of the E2's employment. 8. In an interview, E2 reported knowing about the driving restrictions. E2 stated E2 transported R7 "a couple times."

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 that was dated within 90 calendar days before the individual was accepted by an assisted living facility that included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints that was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for one of seven residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2's medical records revealed a document titled "PRELIMINARY ADMISSION SUMMARY - R9-10-807.B.C." The document included whether the R2 required continuous medical services, continuous or intermittent nursing services, or restraints. However, the document was not dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. 2. In an interview, E2 and E3 acknowledged the aforementioned document was not dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. This is a repeat deficiency from the compliance inspection conducted on November 18, 2021.

Based on record review and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility that included terms of occupancy, including the date of occupancy or expected date of occupancy, for seven of seven residents sampled. The deficient practice posed a risk as required information could not be verified. Findings include: 1. A review of the medical record of R1, R2, R3, R4, R5, R6, and R7 revealed residency agreements for R1, R2, R3, R4, R5, R6, and R7. However, the residency agreements did not include the date of occupancy or expected date of occupancy. 2. In an interview, E2 and E3 acknowledged the residency agreements of R1, R2, R3, R4, R5, R6, and R7 did not include the date of occupancy or expected date of occupancy. Technical assistance was provided on this rule during the compliance inspection conducted on November 18, 2021.

Based on record review and interview, the manager failed to ensure a resident had a written service plan that included the frequency of assisted living services being provided to the resident, for six of seven residents sampled. The deficient practice posed a risk if a resident's service plan did not include the services to be provided. Findings include: 1. A review of the medical records of R1, R2, R3, R4, R5, and R6 revealed current service plans. However, the service plans revealed the following: - R1's and R4's service plans did not include the frequency of assistance with dressing, "teeth hair groom," shaving, and medication administration; - R2's, R3's, and R5's service plans did not include the frequency of assistance with dressing or medication administration; and - R6's service plan did not include the frequency medication administration. 2. In an interview, E2 and E3 acknowledged the service plans for each resident did not include the frequency of assisted living services being provided to the resident, including medication administration. Technical assistance was provided on this rule during the compliance inspection conducted on November 18, 2021.

Based on record review and interview, the manager failed to ensure a caregiver or employee coordinated the transport and the services provided to the resident, for one of one applicable resident sampled. The deficient practice poised a risk as the facility was not aware of the whereabouts of a resident. Findings include: 1. A review of R7's medical record revealed an incident report dated April 22, 2023, written by E1. The incident report revealed E2 transported R7 to a medical appointment in the morning. The report stated the following: "[R7] called at 2:47pm on the phone. I didn't get to the phone to answer but I called in 5 min[utes] the other caregiver to see why is [R7] calling. [E2 informed] me that [R7] did not call [E2] to go to pick [R7] up from [appointment type]. [R7] normally finishes at ~ 2pm and the[n] always calls to be picked up. Today [R7] did not call until 2:47pm. At 2:54pm, [R7's family member] calls me [screaming] and cursing that nobody went to pick up [R7]. [R7's family member] that [R7] left the [appointment] center on foot and [R7] is walking back home. [E2] went to look for [R7] around the neighborhood but [R7] was nowhere to be found." 2. In an interview, E2 reported R7's appointments were a regular occurrence when R7 was living at the facility. E2 reported R7 usually went to R7's appointments on Tuesdays, Thursdays, and Saturdays at 9:30 AM and was ready to be picked up by 2:00 PM. E2 reported E2 failed to coordinate R7's transport back to the facility.

Based on record review and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as a resident's rights were violated. Findings include: 1. A review of R7's medical record revealed an incident report dated April 22, 2023, written by E1. The incident report revealed E2 transported R7 to a medical appointment in the morning. The report stated the following: "[R7] called at 2:47pm on the phone. I didn't get to the phone to answer but I called in 5 min[utes] the other caregiver to see why is [R7] calling. [E2 informed] me that [R7] did not call [E2] to go to pick [R7] up from [appointment type]. [R7] normally finishes at ~ 2pm and the[n] always calls to be picked up. Today [R7] did not call until 2:47pm. At 2:54pm, [R7's family member] calls me [screaming] and cursing that nobody went to pick up [R7]. [R7's family member] that [R7] left the [appointment] center on foot and [R7] is walking back home. [E2] went to look for [R7] around the neighborhood but [R7] was nowhere to be found." 2. In an interview, E2 reported R7's appointments were a regular occurrence when R7 was living at the facility. E2 reported R7 usually went to R7's appointments on Tuesdays, Thursdays, and Saturdays at 9:30 AM. E2 reported knowing R7 was usually picked up at 2:00 PM. E2 reported E2 did not pick up R7 at or around 2:00 PM. Instead, E2 reported waiting for a phone call from R7 to go pick up R7.

Based on record review, observation, and interview, the manager failed to ensure a resident's medical record contained documentation of medication administered to the resident that included the strength and dosage, for one of seven residents sampled. The deficient practice posed a risk as medication administration could not be verified against a medication order. Findings include: 1. A review of R1's medical record revealed a medication order dated January 17, 2023, for the following medications: - "Carbidopa 25/ Levodopa 100 Mg 1-\'bd [one and one half] tbl 3x day," - "Divalproex NA 125 Mg sprinkle cup/ day ... 4 capsules at Bedtime," and - "Furosemide 20 Mg \'bd tbl day." 2. The Compliance Officer observed R1's medication containers. The medication container for 8:00 AM contained the following: - Carbidopa 25/Levodopa 100 mg two tablets, even though the order was for one and one half tablets; and - Furosemide 40 mg one half tablet, even though the order was for 20 mg one half tablet. The medication container for 2:00 PM contained carbidopa 25/Levodopa 100 mg one tablet, even though the order was for one and one half tablets. The medication container for 2:00 PM contained the following: - Carbidopa 25/Levodopa 100 mg two tablets, even though the order was for one and one half tablets; and - Divalproex 125 mg two capsules, even though the order was for four capsules. 3. A review of R1's medical record revealed a medication administration record dated July 2023. The document revealed the following: - R1's carbidopa 25/levodopa 100 mg was labeled as "Carbidopa 25 - Levodopa 100 mg 1-\'bd [one and one half] tbl TID," even though R1 received two tablets in the morning, one tablet in the afternoon, and two tablets in the evening; - R1's divalproex 125 mg was labeled as "Divalproex NA 125 mg sprinkle 4 capsule QD Bed," even though R1 received two capsules every night before bedtime; and - R1's furosemide 20 mg was labeled as "Furosemide 40 mg," even though R1 received one 40 mg tablet, even though the order was for one half 20 mg tablet. Technical assistance was provided on this rule during the compliance inspection conducted on November 18, 2021.

Based on documentation review, observation, and interview, the manager failed to ensure 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 to the health and safety of the residents as residents could have exited the facility without the knowledge of the employees, potentially putting residents at the mercy of the elements. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services as of December 9, 2014. 2. During a tour of the facility, the Compliance Officer observed the front door. The door did not have a locking mechanism from the inside installed but did have an alert installed. However, upon opening the door, the Compliance Officer heard no alert. The Compliance Officer observed a sliding glass door leading from the living room to the back yard. The Compliance Officer observed the sliding glass door did not have a control or alert installed. The Compliance Officer observed a sliding glass door leading from the dining room to the back yard. The Compliance Officer observed this second sliding glass door did not have a control or alert installed either. 3. In an interview, when the Compliance Officer asked if the alert on the front door sounded, E2 stated, "No."

Based on observation, interview, and record review, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of seven residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. During a tour of the facility, the Compliance Officer observed R1 and a small medication container with a label that stated "[R1] 8 AM" in R1's bedroom. The Compliance Officer observed no personnel within sight of the container or R1. Inside the container, the Compliance Officer observed the following medications, among others: - Carbidopa 25/Levodopa 100 mg 2 tablets, - Furosemide 20 mg \'bd tablet, and - Pantoprazole 40 mg 1 tablet. 2. In an interview, E2 and E3 reported E2 and E3 placed each resident's medication in small containers the night before the morning administration then placed the containers back in the medication cabinet. E2 and E3 reported E2 and E3 placed the medications in front of each resident at the table during breakfast and supervised each resident as each resident took the medication. However, E2 and E3 acknowledged this process was not followed with R1 on the morning of the inspection. 3. A review of R1's medical record revealed a service plan dated April 21, 2023. The service plan revealed R1 was to receive medication administration. The review revealed a medication order dated January 17, 2023, for the following medications: - "Carbidopa 25/ Levodopa 100 Mg 1-\'bd [one and one half] tbl 3x day," - "Divalproex NA 125 Mg sprinkle cup/ day ... 4 capsules at Bedtime," - "Furosemide 20 Mg \'bd tbl day," and - "Quetiapine Fumurate [ sic ] (Seraquel) [ sic ] 25 Mg \'bd tbl bedtime." The document included an order to discontinue "Panteprazole [ sic ] NA 40 Mg 1 tbl 2xday 30 min before meals." 4. The Compliance Officer observed R1's medication containers. The medication container for 8 AM contained the following: - Carbidopa 25/Levodopa 100 mg two tablets, even though the order was for one and one half tablets; - Furosemide 40 mg one half tablet, even though the order was for 20 mg one half tablet; and - Pantoprazole 40 mg one tablet, even though there was no current order. The medication container for 2 PM contained carbidopa 25/Levodopa 100 mg one tablet, even though the order was for one and one half tablets. The medication container for 2 PM contained the following: - Carbidopa 25/Levodopa 100 mg two tablets, even though the order was for one and one half tablets; - Divalproex 125 mg two capsules, even though the order was for four capsules; - Quetiapine 25 mg one tablet, even though the order was for one half tablet. 5. A review of R1's medical record revealed a medication administration record dated July 2023. The document, compared with the orders and the medication containers, revealed the following: - For R1's carbidopa 25/levodopa 100 mg, from July 1, 2023, throug

Based on observation, interview, and record review, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for one of seven residents sampled. The deficient practice posed a risk to the health and safety of a resident as emergency personnel would not have correct health data to make decisions regarding a resident's treatment in an emergency and as the Department was provided false or misleading information. Findings include: 1. During a tour of the facility, the Compliance Officer observed E2 writing in the medication administration records of the residents. 2. In an interview, the Compliance Officer asked what E2 was doing. E2 reported E2 was signing off on medications administered the day before the inspection. E2 stated, "My caregiver didn't sign it." 3. The Compliance Officer observed R1 and a small medication container with a label that stated "[R1] 8 AM" in R1's bedroom. The Compliance Officer observed no personnel within sight of the container or R1. Inside the container, the Compliance Officer observed a variety of medications. 4. In an interview, E2 and E3 reported E2 and E3 placed each resident's medication in small containers the night before the morning administration then placed the containers back in the medication cabinet. E2 and E3 reported E2 and E3 placed the medications in front of each resident at the table during breakfast and supervised each resident as each resident took the medication. However, E2 and E3 acknowledged this process was not followed with R1 on the morning of the inspection. 5. A review of R1's medical record revealed a medication administration record dated July 2023. The document revealed E2 had signed off on R1's morning medication even though R1 had not taken R1's morning medication. 6. In an interview, E2 stated, "I signed it already and didn't know if [R1] took it."

Based on documentation review, observation, and interview, the manager failed to ensure medication stored by an assisted living facility 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 were not prescribed the expired and accessible medication. Findings include: 1. A documentation review revealed a policy and procedure titled "Medications: Storing" dated August 25, 2020. The policy and procedure stated: "All resident medications must be secured in a locked storage area. Only individuals authorized may have access to the facility's medication storage area.... Medications requiring refrigeration need to be kept in a lock[ed] container in the refrigerator or the refrigerator needs to be locked or the area where the medication refrigerator is located is locked." 2. During a tour of the facility, the Compliance Officer observed a refrigerator in the kitchen. The Compliance Officer observed the refrigerator had no locking mechanisms installed. Upon opening the refrigerator, the Compliance Officer observed a small metal box in the door of the refrigerator with the key in the box. Underneath the box, in the door, the Compliance Officer observed a box of semaglutide pens. Upon opening the small metal box with the key, the Compliance Officer observed a bottle of Lantus insulin, three semaglutide pens, and three syringes with an unknown substance inside. 3. In an interview, E2 reported forgetting to put the box of semaglutide pens back in the medication lock box. E2 reported forgetting to lock the small metal box as well. 4. The Compliance Officer observed E2 remove the three syringes from the medication lock box and place them on the kitchen counter. The Compliance Officer observed E2 and E3 leave the room, out of sight of the three syringes. 5. In an interview, after E2 returned to the kitchen, the Compliance Officer informed E2 that E2 had left the three syringes out. 6. The Compliance Officer observed E2 return the three syringes to the medication lock box. The Compliance Officer observed a cabinet in the kitchen above and to the side of the sink. The Compliance Officer observed both cabinet doors had locks installed. However, the key was left in one of the locks. The Compliance Officer observed no personnel member within sight of the cabinet. The Compliance Officer observed E2 enter the kitchen, turn the aforementioned key, remove the keys, and place the keys on the counter below the cabinet. 7. In an interview, E2 reported the cabinet in question was the medication cabinet. 8. The Compliance Officer then observed E2 grab the keys on the counter and conceal them. The Compliance Officer observed E2 open the medication cabinet, leave the key in the lock, and leave the area several times during the inspection, even going outside twice, despite the Compliance Officer telling both E2 and E3 several times the cabinet needed to remain locked and

Based on documentation review and interview, the manager failed to ensure a disaster plan was developed and documented that included how a resident's medical record would be available to individuals providing services to the resident during a disaster and a plan to ensure each resident's medication would be available to administer to the resident during a disaster. The deficient practice posed a risk as there was no adequate plan to ensure the health and safety of residents in an emergency. Findings include: 1. A documentation review revealed a policy and procedure titled "Disaster Plan" dated August 25, 2020. The disaster plan stated: "Resident records will be relocated along with each resident [and] Medication for each resident will be relocated with the resident." However, the disaster plan did not include a procedure stating how a resident's medical record would be available to individuals providing services to the resident during a disaster or a plan to ensure each resident's medication would be available to administer to the resident during a disaster. 2. In an interview, E2 and E3 acknowledged the disaster plan did not include all items required by this rule. Technical assistance was provided on this rule during the compliance inspection conducted on November 18, 2021.

Based on documentation review, observation, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A documentation review revealed a policy and procedure titled "Environmental and Physical Plant Safety" dated August 25, 2020. The policy and procedure stated, "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 medications and are inaccessible to residents." 2. During a tour of the facility, the Compliance Officer observed a cabinet under the sink in the kitchen. The Compliance Officer observed the cabinet did not have a locking mechanism installed. Inside the cabinet, the Compliance Officer observed bathroom cleaner, Clorox, Comet, dishwasher pods, fabric softener, and Raid. On a counter in the kitchen, the Compliance Officer observed a dispenser of disinfecting wipes. 3. In an interview, E2 reported the rest of the facility's poisonous and toxic materials were stored in a cabinet above the washer. 4. The Compliance Officer observed a cabinet above the washer. Upon opening the cabinet, the Compliance Officer observed a magnetic locking mechanism installed on the inside of the door. However, the magnetic locking mechanism was not functioning properly. Inside the cabinet, the Compliance Officer observed a variety of poisonous or toxic materials. The Compliance Officer observed two cabinets above the dryer. The Compliance Officer observed neither cabinet had locking mechanisms installed. Inside the first cabinet, the Compliance Officer observed air fresheners. Inside the second cabinet, the Compliance Officer observed a container of spackling. In a bathroom accessible from a hallway, the Compliance Officer observed a can of air freshener on the counter. In a second bathroom, the Compliance Officer observed another can of air freshener on the counter. In a resident's bedroom, the Compliance Officer observed a third can of air freshener. Technical assistance was provided on this rule during the compliance inspection conducted on November 18, 2021.