Life Assisted Living, LLC

Based on record review and interview, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. § 36-420.04.A.1-9 for two out of two residents sampled. The deficient practice posed a risk if the facility was not prepared in case of an emergency. Findings include: 1. A review of R1's medical record revealed that the standardized form to be used if an emergency responder was contacted did not include the address of the resident's current pharmacy, basic information about the resident's physical and mental conditions and basic medical history, and a copy of the resident's advance directives. R1's medical record also revealed a service plan dated for October 20, 2025 that indicated R1's code status was Do Not Resuscitate. 2. A review of R2's medical record revealed that the standardized form to be used if an emergency responder was contacted was not available. 3. In an interview, E4 reported that hospice was in charge of R2's emergency needs. 4. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on documentation review and interview, the health care institution failed to ensure that the health care institution established, documented, and implemented tuberculosis (TB) infection control activities that included annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of the facility's documentation records revealed that no facility risk assessment for infectious tuberculosis was documented and available during the inspection. 2. In an exit interview, the findings were reviewed with E4 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 one of two 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 record revealed a service plan dated and signed on January 5, 2026 that stated R2 received personal care services. 2. A review of R2's medical record revealed no documentation that stated whether R2 required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a Physician, Registered nurse practitioner, Registered nurse, or Physician assistant. 3. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on interview and record review, the manager failed to ensure that a written notice of termination of residency 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 an interview, E4 reported R1’s residency at the facility was terminated and that R1 was no longer a resident. 2. A review of R1's medical record revealed no documentation of a written notice of termination that included the policy for refunding fees, charges, or deposits, the deposition of a resident’s fees, charges, and deposits, and the contact information for the State Long-Term Care Ombudsman. 3. In an exit interview, the findings were reviewed with E4 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 signed and dated by the resident or the resident’s representative for one out of two residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R2's medical record revealed a service plan dated January 5, 2026, however, this service plan did not include a signature and date by the resident or resident’s representative. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in the resident’s medical record for two out of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1’s medical record revealed a service plan, which included the following: Showering, once daily; Brushing teeth, once daily; Fingernails checked and cleaned once daily; and Skin maintenance (service plan did not include frequency.) 2. A review of R1’s activities of daily living sheet revealed no documentation of the following: No documentation of showers on January 1, 2, 4, 6, 7, 8, 10, 11, and 13, 2026. Showers were documented as given every other day or every 2-3 days or more from October 1, 2025 - January 14, 2026. No documentation of oral care from October 17, 2025 - January 14, 2026. No documentation of fingernail care except on November 27, 2025. No documentation of skin maintenance except for once on November 2, 2025. 3. A review of R2’s medical record revealed a service plan, which included the following: Showers, two times a week; Hair combed once daily; Oral care once daily; Check body once daily for bruises and discoloration due to diabetes; Skin checked once daily; and Incontinence care, change am and pm. 4. A review of R2’s activities of daily living sheet revealed no documentation of the following: Showers documented as completed once a week instead of twice a week in the month of January 2026. No documentation of hair combing on January 1, 2, 4, 6, 7, 8, 10, 11, 15, 17, 21, 22, 24, 28, 29, and 31, of 2026. No documentation of oral care January 1-11, and 15-31, 2026. No documentation of body checks. No documentation of skin maintenance checks on January 1, 4, 6, 8, 10, 11, 15, 17, 30, and 31, 2026. No documentation of incontinence care. 5. In an interview, E2 reported that E2 was the main caregiver responsible for providing these services. In an interview with E2, E2 reported they were unable to provide these services to R1 due to R1's refusal, however, there was no evidence or documentation of refusals. 6. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident’s medical record contained documentation of medication administered to the resident that included the dosage, for oneof two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication and a medication could not be verified as administered against a medication order. Findings include: 1. A review of R1’s medical record revealed R1’s current service plan dated October 20, 2025. The service plan revealed R1 required medication administration. 2. A review of R1's medical record revealed a signed medication order from a medical practitioner dated October 13, 2025. This medication order revealed a sliding scale for an insulin medication: "HumaLOG Solution 100 unit/mL, inject per scale Lispro three times a day". The sliding scale was documented as follows: Rx: "HumaLOG Solution 100 UNIT/ML (Insulin Lispro (Human)) Inject as per sliding scale: if 71 - 150 = 0; 151 - 200 = 1 unit; 201 - 250 = 2 units; 251 - 300 = 3 units; 301 - 350 = 4 units; 351 - 400 = 6 units, subcutaneously before meals and at bedtime for diabetes" 3. A review of R1's medical record revealed a blood sugar monitoring record for January 2026, used for recording R1's blood sugar to determine the measurement of insulin to be administered to R1, however, this blood sugar record was missing documentation of insulin units administered to R1. The January 2026 medication administration record also did not contain the units of insulin given for R1. The Compliance Officer could not determine whether R1 was administered the appropriate amount of insulin based on R1's blood sugar levels during the month of January 2026. 4. In an exit interview, the findings were reviewed with E4, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were stored in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer (CO) observed the following: a bottle of Oxi Clean Laundry Stain Remover Spray in an unlocked cabinet underneath the kitchen sink; and a bottle of high-strength wall repair putty in the bathroom of R2. Both items were stored by the facility. 2. The CO observed residents present at the facility who were ambulatory. 3. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on record review and interview, the manager failed to ensure medication was administered to a resident in compliance with a medication order and accurately documented in the medical record, for one of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication and a medication could not be verified as administered against a medication order. Findings include: 1. A review of R2’s medical record revealed R2’s current service plan dated January 5, 2026. The service plan revealed R2 required medication administration. 2. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Azithromycin 250 mg 1 tab by mouth three times a week on Mondays, Wednesdays and Fridays". Despite this, R2 was administered Azithromycin everyday on February 1, 2, 3, and 4, 2026, according to R2's February 2026 MAR. 3. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Carvidopa-Levodopa 25-100mg, two tabs by mouth, three times a day". Despite this, Carvidopa-Levodopa was not documented as administered on February 3 at 2pm and 8pm according to R2's February 2026 MAR. 4. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Hydrochlorothiazide 25 mg, 1 tab by mouth every day". Despite this, there was no documentation of the administration of Hydrochlorothiazide for the entire month of January and February 2026. 5. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Prednisone 10mg, 1 tab by mouth three times weekly on Monday, Wednesday and Friday". Despite this, R2 was administered Prednisone every day during the month of January 2026 according to R2's January 2026 MAR. 6. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Spiriva inhaler 2.5mcg by mouth three times weekly" and "Symbicort 120 inhalations, inhale 2 puffs by mouth twice daily". Despite this, there was no documentation that R2 was administered Spiriva nor Symbicort during the month of January 2026. 7. A review of R2's medical record revealed a documented medication order from a doctor dated January 28, 2026. According to this order, R2 was prescribed "Oxycodone, 1 tablet by mouth three times daily at 8am, 2pm and 6pm". Despite this, R2 was not administered Oxycodone at 8am on February 3 according to R2's February MAR. 8. In an exit interview, the findings were reviewed with E4, and no additional information was provided. E2 reported the medications were administered to R2 per the medication orders.

Based on observation and interview, the manager failed to ensure that food was free from spoilage, filth, or other contamination and was safe for human consumption. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer (CO) observed the presence of the following items: An opened bag of snack mix with an expiration date of December 20, 2025 sitting in the kitchen pantry; A burrito with a green fuzzy substance growing on it, sitting in the refrigerator drawer; and An opened half-gallon of milk with an expiration date of January 31, 2026. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41° F or below. The deficient practice posed a risk for potential food-borne illnesses. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer (CO) observed the following items stored in the facility's kitchen pantry: an opened bottle of ketchup that was labeled, "refrigerate after opening"; and an opened bottle of Ocean Spray cranberry juice that was labeled, "refrigerate after opening". 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that frozen foods were stored at a temperature of 0° F or below. The deficient practice posed a risk for potential food-borne illnesses. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer (CO) observed the following items in a refrigerator drawer in the facility: a bag of italian style meat balls that was labeled, “keep frozen”; a bag of fully cooked sausage links that was labeled, “keep frozen”; an opened bag of chicken and vegetable potsticker dumplings that was labeled, “keep frozen”; an opened bag of chicken burgers that was labeled, “keep frozen”; and an opened box of Stouffer’s meatloaf tv dinner that was labeled, “keep frozen” 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure the disaster plan was reviewed at least once every 12 months. Findings include: 1. A review of the facility’s documentation/policies and procedures revealed a disaster plan for the facility, however, there was no documentation of the disaster plan review. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

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. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's documentation records revealed the latest disaster drill was conducted on October 17, 2025. There was no documentation of a disaster drill after October 17, 2025. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that the premises and equipment used at the assisted living facility were cleaned. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer (CO) observed a drawer in the refrigerator that had sticky surfaces on the inside and dark, yellow, stuck-on substances that coated the inside of the drawer. Food meant for serving to residents was stored in this drawer. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.