Lamba Care Home

Based on record review and interview, the manager failed to ensure a personnel record for each employee included evidence of documentation outlined in R9-10-806(C)(1)(a-c) as required. Findings include: 1. A review of E2’s personnel record revealed documentation of the following items was unavailable for review: -documentation of E2’s skills and knowledge; -completed orientation; -Cardiopulmonary resuscitation (CPR) training; and -First aid training. 2. In an interview, E1 acknowledged E2’s personnel record did not contain documentation of E2’s documented skills and knowledge, completed orientation, CPR training, and first aid training. This is a repeat citation from the compliance inspection conducted June 19, 2023 (no CPR).

Based on record review and interview, the manager accepted an individual requiring continuous medical services and continuous nursing services, for one of one resident records reviewed. The deficient practice posed a risk as an assisted living facility cannot provide continuous medical or continuous nursing services. Findings include: 1. A review of R1's medical record revealed a document titled "DETERMINATION FOR ADMISSION". The document stated "… Please answer the following questions: Questions #1, 2, 4, & 5 must be checked NO for appropriate placement in ALF. 1. Does the person require continuous medical services?... 2. Does the person require continuous nursing services?” Questions one and two were marked to indicate R1 required continuous medical services and continuous nursing services. The document was signed by a medical practitioner. 2. In an interview, E1 reported R1 does not receive continuous medical services or nursing services. E1 reported the box indicating R1 required continuous medical services should not have been marked.

Based on record review and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of one resident records reviewed. The deficient practice posed a risk if medications were not administered as ordered. Findings include: 1. A review of R1's medical record revealed R1 received medication administration. 2. A review of R1's medical record revealed signed medication orders dated February 27, 2025. The orders included “Insulin Glargine Subcutaneous Solution 100 UNIT/ML”, “Inject 15 units subcutaneously at bedtime for DM 2. Hold for gluc less than 100”. 3. A review of R1’s medical record revealed a Medication Administration Record (MAR) which included the administration of 32 units of Insulin Glargine, each night at bedtime, from March 24, 2025, through March 31, 2025. No signed order for the change to 32 units was provided for review. 4. A review of R1's signed medication orders dated February 27, 2025 also revealed a signed order for, “Insulin Lispro Injection Solution 100 UNIT/ML”, “Inject as per sliding scale: if 201-250=2 units; 251-300=4 units; 301-350=6 units; 351-400=8 units; 401-450=10 units If BS>450 then notify provider, subcutaneously before meals for DM2”. 5. A review of the documentation of administration of the Insulin Lispro revealed on March 4, 2025, R1’s glucose was recorded as 365, and only 6 units were administered. 6. Further review revealed a hospital visit on April 1, 2025, with a change to the order for Insulin Lispro. The order stated, “insulin ss lispro low, Inject into the skin with meals. Correct blood sugar 3 times /day: Use the following scale: 390= 8 PLUS give 1 unit with meals to cover food even if blood sugar correction not needed.” 7. A review R1's MAR revealed on the following dates, one unit of Insulin Lispro was administered, though additional units were required based on the glucose reading recorded: April 1: glucose 235; April 1: glucose 237; April 2: glucose 230; April 10: glucose 258; April 10: glucose 211; April 12: glucose 220; April 13: glucose not recorded at 11:30am and 4pm; and April 14: glucose not recorded at 730am and 12:30pm. On April 3, 2025, R1’s glucose was recorded as 165 and was administered 2 units. 8. In an interview, E1 acknowledged medications for R1 were not administered in compliance with medication orders. This is a repeat citation from the on-site compliance inspection conducted on June 19, 2023, and is an uncorrected deficiency from the on-site compliance inspection and complaint investigation conducted on September 27, 2024.

Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was accurately documented in the resident's medical record, for one of one resident records reviewed. Findings include: 1. A review of R1's medical record revealed R1 received medication administration. 2. A review of R1's medical record revealed a signed medication order for "Atorvastatin Calcium Oral Tablet 40 MG… Give 1 tablet by mouth at bedtime…”. dated February 27, 2025. 3. A review of R1's medication administration record (MAR) revealed Atorvastatin was not included on the MAR. 4. A review of R1's medication revealed a bottle of Atorvastatin, which E1 reported was being given daily as ordered. 5. In an interview, E1 acknowledged a medication administered to R1 was not documented in R1's medical record.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. Findings include: 1. During a tour of the facility, the Compliance Officer observed a bottle of "ATROPINE 1% EYE DROPS”, unsecured, on a kitchen table. 2. E1 advised the medication was to be destroyed and secured the medication in a locked cabinet. 3. During an interview, E1 acknowledged the Compliance Officer found a medication stored in an unlocked area. This is a repeat deficiency from the compliance inspection conducted June 19, 2023.

Based on record review and interview, the manager failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. On September 27, 2024, the Compliance Officer requested the following documents during the on-site inspection: - Complete medical records, for three residents, including the Medication Administration Record (MAR) and documentation of services provided. 2. E1 reported the MAR and ADL logs were provided to R3's case manager and were unable to be located during the on-site inspection. 3. In an interview, E1 acknowledged the requested MAR and ADL logs were not provided within two hours of the Department's request.

Based on record review, and interview, the health care institution failed to administer a training program regarding fall prevention and fall recovery, for one of two personnel records reviewed. Findings include: 1. A review of E2's personnel record revealed training, in fall prevention and fall recovery, was not available for review. 2. In an interview, E1 acknowledged documented training in fall prevention and fall recovery had not been completed for E2.

Based on documentation review, and interview, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility's premises. Findings include: 1. During a facility tour, the Compliance Officer observed a document posted on the wall titled, "Designation of Management," which listed the name of one individual designated as acting manager, E3 2. In an interview, E1 confirmed E3 no longer worked at the facility. E1 acknowledged the the facility did not have a designated caregiver who would be present on the assisted living premises, when the manager was not present. E1 advised E1 does not leave the premises.

Based on documentation review, record review, interview, and observation, the manager failed to ensure the facility had a manager and caregivers with the skills and knowledge necessary to meet the needs of a resident and ensure the health and safety of a resident. Findings include: 1. A review of R2's medical record revealed an incident report dated April 9, 2024 at 2pm. The report detailed a fall involving R2. The document stated the fall was unwitnessed and R2 was assessed to not have injuries. The report stated, "E1 found R2 on the floor, and R2 had no injuries, no bleeding, then I decided to call the 911, and they came took V/S was normal and helped R2 back in bed." 2. In an interview E1 reported the reason for calling 911, when R2 was uninjured, was because E1 was unable to get R2 up alone because R2 was much larger than E1. E1 reported E1 was the only caregiver and has no back up at this time. 3. A review of the facility's policies and procedures revealed a policy titled, "STAFFING ATTENDANCE POLICY AND PROCEDURE". the policy stated," ... e) That one Caregiver, who is on sight, is able to provide Personal and Directed Care services ..." and " ... 4. At least one qualified Caregiver who is at least 21 yrs. Must be designated and onsite of this facility when the manager is absent from the premises ...". 4. Further review of R2's medical record revealed a Hoyer lift was delivered to the facility four days after the fall occurred. 5. In an interview, E1 acknowledged the facility did not have enough caregivers and stated it was difficult to find and keep caregiving staff. E1 neither acknowledged nor disputed that the facility did not have a manager and caregivers with the skills and knowledge necessary to meet the needs of a resident and ensure the health and safety of a resident.

Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after the resident's date of acceptance, for one of three resident records reviewed. The deficient practice posed a risk if the assisted living facility was unable to meet the needs of R2. Findings include: 1. A review of R2's medical record revealed no service plan was available for review. However, based on R2's date of acceptance, a completed service plan was required. 2. In an interview, E1 acknowledged a service plan for R2 was not completed. R2's medical record contained a service plan from a hospice agency.

Based on record review and interview, the manager failed to ensure a resident had a written service plan that was reviewed and updated no later than 14 calendar days after a significant change in the resident's physical, cognitive, or functional condition, for one of three resident records reviewed. Findings include: 1. A review of R1's medical record revealed a service plan for supervisory care services dated February 27, 2024. The service plan detailed R1 "self showers" 5 days per week; "eats 100% of meals"; and intermittent assistance with incontinence, "[R1] MAY NEED BREIFS AT TIMES - MOST OF THE TIME [R1] IS ABLE TO USE THE RESTROOM". 2. A review of R1's medical record revealed R1 was admitted to hospice services on July 5, 2024. The notes from the hospice report stated R1 was complete assistance with dressing grooming and showering; had a decreased intake of food; max assist with toileting; and increased confusion. In an interview, E1 reported R1 was no longer able to find R1's room. 3. A review of R1's medical record revealed no service plan update. 4. In an interview, E1 acknowledged R1's service plan was not updated within 14 calendar days after a significant change of condition.

Based on record review, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of three residents sampled. The deficient practice posed a risk if medications were not administered as ordered. Findings include: 1. A review of R2's medical record revealed R2 received medication administration. 2. A review of R2's medical record revealed the following orders signed on March 15, 2024: - "Apixaban Oral Tablet 2.5 MG", "Administer one tablet by mouth twice daily"; and - "Metoprolol Tartrate Oral Tablet 25 MG", "Administer one tablet by mouth twice daily". 3. A review of R2's Medication Administration Record (MAR) revealed documentation of administration of the following medications administered from March 15, 2024 through May 14, 2024: - Eliquis 2.5 MG, also known by the generic name Apixaban, was administered "Give half PO BID"; and - Metoprolol 50 MG was administered "Give 1 tab PO BID". 4. A review of R3's medical record revealed no evidence of a MAR. 5. In an interview E1 acknowledged medication administered to R2 was not in compliance with a signed order. This is a repeat citation from the on-site complaint inspection conducted on March 2, 2022 and the on-site compliance inspection conducted on June 19, 2023.

Based on record review and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411, for one of two employees sampled. A.R.S. \'a7 36-411 states: " ...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, nursing care institution or home health agency ..." Findings include: 1. A review of E2's application for employment revealed no documentation of contact with previous employers to obtain information or recommendations that may be relevant to E2's fitness to work in a residential care institution. 2. In an interview, E1 acknowledged E2's personnel record did not include did not include documentation of compliance with A.R.S. \'a7 36-411, which included reference checks with former employers.

Based on record review and interview, the manager failed to ensure a policy and procedure was implemented to protect the health and safety of a resident that covered cardiopulmonary resuscitation (CPR) training for applicable employees, which includes a demonstration of the employee's ability to perform CPR, for one of two personnel records sampled. Findings include: 1. A review of E1's personal record revealed current proof of CPR training issued on April 24, 2023, by "NationalCPRFoundation," an online-only CPR training program. 2. In an interview, E1 acknowledged E1's personnel record did not include current documentation of CPR training which also included a demonstration of the employee's ability to perform CPR.

Based on record review, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan for directed care level of services and medication administration dated April 20, 2023. 2. A review of R1's medical record revealed a signed order to discontinue desvenlafaxine100 mg on May 17, 2023. 3. A review of R1's Medication Administration Record (MAR) revealed desvenlafaxine 100 mg administered to R1 once per day from May 17, 2023 to June 18, 2023. 4. In an interview, E1 reported the medication was continued at another office visit, though was unable to provide documentation. E1 telephoned R1's doctor to get a copy of the prescription and was unable to obtain the documentation. 5. A review of R2's medical record revealed a service plan for directed care level of services and medication administration, dated March 22, 2023. 6. A review of R2's MAR revealed R2 was administered, "Benadryl 25 MGS TABLET TAKE 1 X 2 DAILY OVER THE COUNTER". The MAR revealed the medication was administered at 8 am and 8 pm from June 1, 2023 through June 18, 2023 and at 8 am on June 19, 2023. 7. A review of R2's medical record revealed no order for Benadryl. 8. In an interview E1 acknowledged R2 was administered Benadryl without a signed order. This is a repeat citation from the on-site complaint inspection conducted on March 2, 2022.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. Findings include: 1. During a tour of the facility, the Compliance Officer observed a bottle of "Senna 8.8 mg/5 ML syrup" unlocked on a kitchen counter. 2. E1 advised the medication was to be destroyed. The lid was difficult to unscrew and this Compliance Officer assisted in unscrewing the lid for E1 to dispose of the medication. 3. The Compliance Officer observed E1 dispose of the medication. 4. During an interview, E1 acknowledged the Compliance Officer found a medication stored in an unlocked area. This is a repeat citation from the on-site complaint inspection conducted on May 13, 2022.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were stored in a locked area and inaccessible to residents. Findings include: 1. During a tour of the facility, the Compliance Officer observed an unlocked cabinet, in a room off the kitchen. The area was accessible to residents. The cabinet had two doors, one which had a chain and padlock hanging from the knob. The other door was missing the knob to secure the cabinet. 2. The Compliance Officer observed a bottle of "LAUNDRY PRE-WASH STAIN REMOVER", a jug of bleach, and two bottles of "FOAMING BATHROOM CLEANER". 3. In an interview, E1 acknowledged poisonous or toxic materials stored by the facility were not stored in a locked area. E1 was able to utilize another cabinet door knob to secure the doors prior to the exit of the inspection.