Morningstar at Golden Ridge

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of cardiopulmonary resuscitation (CPR) training and first aid training, for one of three employees sampled. Findings include: 1. A review of E3’s personnel record revealed E3 was hired as the Assisted Living Coordinator. The review revealed documentation of CPR and first aid training dated as expired on July 18, 2025, and documentation of CPR and first aid training dated as issued on September 17, 2025. However, the review revealed no documentation of CPR and first aid training dated between July 18, 2025, and September 17, 2025. 2. In an interview, E1 stated E3 “sometimes” worked the floor as a caregiver. When the Compliance Officer asked if E3’s personnel record had documentation of CPR and first aid training dated between the aforementioned dates, E1 stated, “I’m sure there’s nothing there.” 3. In an interview, E3 reported E3 had completed CPR and first aid training for another job but did not have the certification in E3’s personnel record. Technical assistance was provided on this rule during the complaint and compliance inspection conducted on February 1, 2023.

Based on record review and interview, the health care institution failed to initiate cardiopulmonary resuscitation (CPR) in accordance with its certification training for CPR before the arrival of emergency medical services, to a resident who was nonresponsive or has a cessation of normal respiration, in accordance with that resident's advance directives, if known. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of R1’s medical record revealed a document titled “Resident Information”. This document, stated in the Advance Directive section, “CPR”. 2. A record review revealed a document titled “Incident Report” dated May 25, 2025. The incident report indicated that neither E2 nor E3 administered CPR when R1 was found on the floor, unresponsive, and without a pulse. The document reported that 911 was called. 3. In an interview, E1 acknowledged CPR was not initiated by the caregivers and stated that “when E3 called 911, E3 was instructed not to do CPR because of the condition of the resident”.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, for four of four sampled caregivers. The deficient practice posed a risk if a caregiver did not have the skills and knowledge necessary to meet a resident's needs and the Department was provided false or misleading information. Findings include: 1. A review of Department documentation revealed a Plan of Correction (POC) for this deficiency from the complaint and compliance inspection conducted on August 6, 2024. The POC indicated this deficiency was corrected on March 7, 2025. The POC stated: “Community now has a Policy and Procedure that designates how a caregiver’s skill and knowledge will be verified. All caregivers’ and assistant caregiver’s skills and knowledge have now been verified and documented according to the Policy and Procedure.” 2. A review of facility documentation revealed a policy and procedure (P&P) titled “New Hire Training and Competency Policy” dated March 1, 2025. The P&P stated: “A competency checklist will be used and completed upon hire and for retraining. All checklists will be reviewed and verified by the Business Officer Manager/Executive Director or designee to ensure compliance, and stored in their personnel file. The assessment/evaluation may include skills, tasks or competencies identified in the associate’s job description (i.e., bathing, handwashing, ambulation, transfer, etc.).” 3. A review of E3's, E4’s, and E6’s personnel records revealed E3, E4, and E6 were hired as caregivers before March 7, 2025 (the correction date on the POC). However, the review revealed no documentation demonstrating the manager ensured E3's, E4’s, and E6’s skills and knowledge were verified and documented before E3, E4, and E6 provided physical health services or before the correction date on the POC. 4. A review of E5's personnel record revealed E5 was hired as a caregiver after March 7, 2025 (the correction date on the POC). However, the review revealed no documentation demonstrating the manager ensured E5's skills and knowledge were verified and documented before E5 provided physical health services. 5. A review of facility documentation revealed a series of personnel schedules dated between November 2024 and May 2025. The schedules revealed E3, E4, E5, and E6 provided physical health services without E3’s, E4’s, E5’s, and E6’s skills and knowledge having first been verified and documented. 6. In an interview, E2 stated, “[E4’s] is incomplete.” When the Compliance Officer asked if E5 did not have documentation of E5’s skills and knowledge, E2 stated, “Yeah, I did not find one.” When the Compliance Officer asked about the same documentation for E3 and E6, E2 stated, “I don’t have one for any of them.” This is a repeat citation from the complaint and compliance inspection conducted on August 6, 2024.

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 three sampled residents. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1’s medical record revealed a service plan which indicated R1 received medication administration. The review revealed a medication order dated April 1, 2025, for the following medications: - “OLANZAPINE 5 MG TABLET…TAKE 1 TABLET BY MOUTH DAILY AT BEDTIME;” - “OLMESARTAN MEDOXOMIL 40 MG TAB…TAKE 1 TABLET BY MOUTH DAILY;” - “PAROXETINE HCL 40 MG TABLET…TAKE 1 TABLET BY MOUTH DAILY;” - “QUETIAPINE FUMARATE 25 MG TAB…TAKE 1 TABLET BY MOUTH AT BEDTIME;” - “STIMULANT LAXATIVE PLUS TABLET…TAKE 2 TABLETS BY MOUTH DAILY AT BEDTIME;” and - “TRAZODONE 50 MG TABLET…TAKE 1 TABLET BY MOUTH DAILY AT BEDTIME.” The review revealed a series of medication administration records (MAR) dated April 2025 and May 2025 which indicated the following: - R1 did not receive olanzapine on April 7-8 and 10, 2025, as the “Medication [was] not available;” - R1 did not receive olmesartan on May 4, 2025, as the “Medication [was] not available;” - R1 did not receive paroxetine on May 4, 2025, as the “Medication [was] not available;” - R1 did not receive quetiapine on April 6-8 and 10, 2025, and May 19, 2025, as the “Medication [was] not available;” - R1 did not receive Stimulant Laxative Plus on April 17, 28, and 30, 2025, and May 2-3 and 13, 2025, as the “Medication [was] not available;” and - R1 did not receive trazodone on April 30, 2025, and May 1-2 and 11-12, 2025, as the “Medication [was] not available.” 2. A review of R3’s medical record revealed a service plan which indicated R3 received medication administration. The review revealed a medication order dated April 15, 2025, for “dorzolamide 22.3 mg-timoloL 6.6 mg/mL eye drops INSTILL 1 DROP INTO AFFECTED EYE(S) TWICE DAILY” and “latanoprost 0.005 % eye drops INSTILL 1 DROP INTO BOTH EYES AT BEDTIME.” The review revealed MARs dated April 2025 and May 2025 which indicated R3 did not receive R3’s second dose of dorzolamide on April 26, 2025, and R3’s latanoprost on May 11, 2025, as both “Medication[s were] not available.” 3. In an interview, E1 acknowledged medications administered to R1 and R3 were not administered in compliance with medication orders, stating there were, “Holes in the MAR.” This is an uncorrected deficiency from the complaint inspections conducted on December 12, 2024; November 25, 2024; and September 13, 2024; and no acceptable plans of correction have been received by the Department.

Based on documentation review, observation and interview, the governing authority failed to designate, in writing, a manager who has either a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06. The deficient practice posed a risk as the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation on January 4, 2025, revealed that O1 notified the Department O1 would no longer serve as the Assisted Living Manager at "AL11067 MorningStar at Golden Ridge" effective January 8, 2024. 2. A review of Department documentation revealed E1 notified the Department on January 14, 2025 that E1 would serve as "interim executive director". However, a review of the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board) website revealed no managers certificate for E1. 3. The Compliance Officer observed that an assisted living facility manager certificate was not conspicuously posted in the facility during a complaint investigation conducted on February 06, 2025. 4. In a telephone interview, O1 reported O1 removed O1's license on January 8, 2024, and the facility has had no manager since. 5. In an interview, E3 and E4 reported the facility did not currently have a certified manager. E3 and E4 acknowledged the facility did not designate in writing a manager who either had a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06.

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 three of four sampled residents. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a current service plan which indicated R1 was to receive medication administration. The review revealed a medication order for "mesalamine PO 400 mg...2 caps twice daily" and "rivastigmine patch transdermal 9.5 mg...apply 1 patch daily"dated July 8, 2024. The review further revealed two medication administration records (MARs) dated September 2024 and October 2024. The MARS revealed the following: - R1 did not receive R1's second dose of mesalamine on September 11-12, 2024, due to the "Medication not [being] available;" - R1 did not receive R1's rivastigmine on October 25 and 28-30, 2024, due to the "Medication not [being] available;"and - R1 received ciclopirox 8% solution nearly every day between September 1, 2024, and November 21, 2024, without a medication order. 2. A review of R3's medical record revealed a current service plan which indicated R3 was to receive medication administration. The review revealed a medication order for "HYDROCORTISONE 1 % CREAM APPLY TOPICALLY TWICE DAILY" with a start date of January 12, 2023. The review further revealed a MAR dated November 2024 which indicated R3 did not receive R3's first dose of hydrocortisone cream on November 1 and 21, 2024. 3. A review of R4's medical record revealed a current service plan which indicated R4 was to receive medication administration. The review revealed medication orders for "levetiracetam (500mg/5mL) 10mL BID PO" dated March 4, 2024, and "Atenolol 25 mg Tab TAKE 1 TABLET BY MOUTH EVERY NIGHT AT BEDTIME" dated October 11, 2024. The review further revealed MARs dated September-November 2024. The MARS revealed the following: - R4 did not receive R4's first dose of levetiracetam on September 21, 2024, due to the "Medication not [being] available;" - R4 did not receive R4's second dose of levetiracetam on September 20-21, 2024, due to the "Medication not [being] available;" - R4 did not receive R4's atenolol on October 29 and 31, 2024, due to the "Medication not [being] available;"and - R4 did not receive R4's atenolol on November 17-18, 2024. 4. In an interview, E2 reported having an order to hold R4's atenolol on November 17-18, 2024. 5. A review of R4's medical record revealed an order to hold R4's atenolol on November 17-18, 2024, "due to pharmacy issue." However, the order was dated November 23, 2024, the day after the first day of the inspection and several days after the medication was not administered. 6. In an interview, E1 acknowledged medication administered to R1, R3, and R4 were not administered in compliance with the corresponding medication orders. This is an uncorrected citation

Based on observation and interview, the manager failed to ensure garbage and refuse were stored in covered containers. The deficient practice posed a risk to the health and safety of the residents as an uncovered garbage container can lead to the possibility of infection. Findings include: 1. During the environmental inspections of the facility conducted on November 22, 2024, and November 25, 2024, the Compliance Officer observed garbage in uncovered containers lined with plastic bags in R4's bedroom, in an upstairs conference room, and in an upstairs common bathroom. 2. In an interview, E1 reported the containers should have had covers. Technical assistance was provided on this rule during the complaint and compliance inspection conducted on August 5-6, 2024.