Mom and Dad Place Iiii

Based on observation and interview, the manager failed to ensure that medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. During a tour of the facility, the Compliance Officer observed unlocked medication in a kitchen refrigerator. The Compliance Officer observed a gray box and a red box, both of which contained unlocked padlocks in the refrigerator. A review of the contents of the gray box revealed a box of “Mounjaro (tirzepatide) injection” prefilled pens, five “Insulin Degludec Injection FlexTouch” prefilled pens, three bags of individually packaged “BISACODYL 10MG” suppositories, a bottle of “Insulin Lispro”, a bottle of “Morphine Sulfate Oral Solution”, and a bottle of “Lorazepam Intensol Oral Concentrate”. A review of the contents of the red box revealed a box of “Lantus SoloStar” prefilled pens, and a box of “Insulin Lispro KwikPen Injection” prefilled pens. 2. The Compliance Officer observed E2 apply the padlocks and secure the medications in the refrigerator. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review and interview, the governing authority failed to notify the Department according to Arizona Revised Statutes (A.R.S.) \'a7 36-425(I) when there was a change in the manager and identify the name and qualifications of the new manager. Findings include: 1. The Compliance Officer was last on-site on January 23, 2023, for a compliance survey. At that time E5 reported to the Compliance Officer E1 was the facility's new manager. The Compliance Officer asked E5 to reach out to E1 to ask if E1 had notified the department of being the new manager, and send a copy of the notification with the received documentation attached. There was no reply from E1. The Compliance Officer gave E5 technical assistance at that time to notify the department that E1 was the facility's new manager. 2. The Compliance Officer observed in department documentation the facility had E5 still listed as the manager of this facility as of March 10, 2022. No other entries were documented to show another manager had been added. The Compliance Officer asked E5 to call E1 to ask if E1 had notified the department of being the new manager. E5 reported E1 reported to E5 that E1 had notified the department. No evidence was provided to show E1 had notified the department at the time of the inspection. 3. In an interview, E5 reported E1 stated to E5 that E1 did notify the department when E1 became the new manager. E5 and E1 did not provide evidence of the email sent to the department with confirmation of the email.

Based on record review, documentation review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative, for one of three sampled residents. Findings include: 1. A review of R2's medical record revealed a service plan dated November 2, 2023, for directed care services. This service plan was not signed and dated by R2's representative. 2. In an interview, E5 acknowledged the service plan provided for R2 had not been signed and dated by R2's representative when the plan was developed or updated.

Based on observation, record review, and interview, the manager failed to ensure a resident was not subjected to a restraint. The deficient practice posed a health and safety risk to the resident. Findings include: 1. R9-10-101.199 defines "Restraint" as any physical or chemical method of restricting a patient's freedom of movement, physical activity, or access to the patient's own body. 2. During a tour of the facility the Compliance Officer observed R1 lying in a hospital bed up with two sets of bedrails in the upright position on each side of the bed. The Compliance Officer observed a moving tray table and a wood shelf pushed up alongside of the bed on R1's right side from E1's waist to the foot of the bed. The other side of the bed was pushed up against the wall. 3. In an interview, the Compliance Officer asked E2 why the bookshelf was next to R1's bed, and why R1 had bedrails. E2 reported to keep R1 from falling out of bed. 4. A review of R1's medical record revealed, R1 was receiving directed care services and was bedbound. The Compliance Officer asked R1 if R1 was able to move the bedrails up and down to get out of bed. There was no response from R1. E2 reported R1 doesn't communicate very well and R1 would not be able to move the bedrails up or down or get out of the bed. 5. During a tour of the facility the Compliance Officer observed R3 lying in a hospital bed up with two sets of bedrails in the upright position on each side of the bed. The hospital bed was positioned away from the walls. The Compliance Officer asked R3 if R3 could move the bedrails up and down and was able to get out of bed. R3 reported I might. However, R3 was unable to get out of bed and unable to lift the bedrails up and down. 6 . A review of E3's medical record revealed, R3 was receiving personal care services and was unable to get in and out of bed without assistance. 7. In an interview, E5 reported being unaware R1 and R3 could not have the bedrails, and reported being unaware a wood shelf was placed by R1's bedside.

Based on record review, documentation and interview, the manager failed to ensure the service plan for a resident receiving directed care services included the requirements in R9-10-815(C)(1-5), for one of two directed care residents sampled. Findings include: 1. A review of R1's medical record revealed documentation of a service plan indicating R1 was receiving directed care services. However, the service plans did not contain the following: - Cognitive stimulation and activities to maximize functioning; and - Strategies to ensure a resident's personal safety. 2. In an interview, E5 acknowledged R1's service plan did not contain all of the requirements for directed care residents.