North Scottsdale Gardens Assisted Living Home

Based on documentation review and interview, the manager failed to ensure that policies and procedures were reviewed at least once every three years and updated as needed. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees. Findings include: 1. A review of the facility's policy and procedure revealed no documentation indicating that the policies and procedures were reviewed and updated as needed. 2. In an interview, E1 acknowledged that the policies and procedures were not reviewed at least once every three years.

Based on observation, record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided health services for two of three personnel sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs. Findings include: 1. During the facility tour, the Compliance Officer observed E2 assisting R2 with feeding and repositioning R2 in bed. E3 was observed assisting another resident who wanted to use the bathroom. 2. A review of E2's and E3's personnel records revealed no documentation verifying E2's and E3's skills and knowledge before providing health services. 3. In an interview, E1 acknowledged that verification of E2's and E3's skills and knowledge was not documented in E2's and E3's personnel records before E2 and E3 provided health services.

Based on interview and documentation review, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statute (A.R.S) \'a7 36-420.04(A)(1) through (9). Findings include: 1. In an interview, E1 reported two residents had accidents, emergencies, or injuries in March that resulted in the residents needing medical services. E1 reported R1 was sent to the hospital on March 11, 2024, and R2 was sent to the hospital on March 22, 2024. 2. A review of facility documentation revealed a standardized form for each resident. However, the form did not include the following: -A place to write the reason or reasons the emergency responder was requested on behalf of the resident; -The name, address and telephone number of the resident's current pharmacy; -The point-of-contact information for the assisted living home, including the telephone number, if available, cell phone number and email address; and -A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. 3. In an interview, E1 reported E1 told the hospital verbally about a resident's pharmacy of choice. E1 reported E1 sent a copy of the facility's business card with R1 and R2 which had the phone numbers and email address. However, E1 acknowledged the standardized form did not include the point-of-contact information for the home. E1 reported E1 did not know what the resident's health insurance portability and accountability act release was.

Based on interview and documentation review, the manager of an assisted living center failed to maintain a copy of the document provided to the emergency responder which included the items listed in Arizona Revised Statutes (A.R.S.) \'a7 36-420.04(A)(1) through (9), for two of two applicable residents sampled. Findings include: 1. In an interview, E1 reported two residents had accidents, emergencies, or injuries in March that resulted in the residents needing medical services. E1 reported R1 was sent to the hospital on March 11, 2024, and R2 was sent to the hospital on March 22, 2024. 2. A review of facility documentation revealed no copies of the documents provided to the emergency responders for R1 or R2 which included the items listed in A.R.S. \'a7 36-420.04(A)(1) through (9). 3. In an interview, when the Compliance Officer asked if E1 made a copy of the documents required by this rule, E1 stated, "No. I make a copy and give it to [emergency responders]."

Based on interview and documentation review, the manager failed to ensure a caregiver or an assistant caregiver immediately notified the resident's primary care provider when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, for one of two applicable residents sampled. The deficient practice posed a potential risk of re-injury if a resident did not receive adequate follow-up care. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(111) states "[i]mmediate" means "without delay." 2. In an interview, E1 reported R1 had an accident, emergency, or injury on March 11, 2024, that resulted in R1 needing medical services. However, E1 stated E1 did not notify R1's primary care provider until "a couple days later." 3. A review of facility documentation revealed no incident reports for the aforementioned accident, emergency, or injury.

Based on interview and documentation review, the manager failed to ensure when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, a caregiver or an assistant caregiver documented all items required by this rule, for two of two applicable residents sampled. The deficient practice posed a potential risk of re-injury. Findings include: 1. In an interview, E1 reported two residents had accidents, emergencies, or injuries in March that resulted in the residents needing medical services. E1 reported R1 was sent to the hospital on March 11, 2024, and R2 was sent to the hospital on March 22, 2024. 2. A review of facility documentation revealed no incident reports for the two aforementioned accidents, emergencies, or injuries. 3. In an interview, E1 reported the facility did not have the incident reports. E1 reported incident reports were completed at the end of the month.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411(A), for one of four personnel members sampled. The deficient practice posed a risk if a personnel member was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411(A) states: "A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work or contracted work." 2. A review of facility documentation revealed a policy and procedure titled "Fingerprint clearance card Verification A.R.S. 36-411(A) and (C)" dated October 2, 2019. The policy and procedure stated: "2. Manager will verify that all caregivers, assistant caregivers and manager's [sic] hold a valid Level 1 clearance card prior to providing care to residents...5. Clearance must be maintained and valid at all times during the caregiver, assistant caregiver or manager's employment." 3. A review of E2's personnel record revealed E2's physical fingerprint clearance card. However, the card expired on September 25, 2023. The review revealed no current fingerprint clearance card. 4. A review of the Arizona Department of Public Safety fingerprint clearance card verification website revealed E2's fingerprint clearance card expired on September 25, 2023. 5. In an interview, E1 stated, "I think we just forgot about it." After speaking with E2, E1 stated, "[E2] says [E2] has not applied." E1 stated, "[E2] comes [to the facility] almost every other day."

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver provided documentation of completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board), for one of three caregivers sampled. The deficient practice posed a risk if an employee was unqualified to provide caregiving services. Findings include: 1. A review of E3's personnel record revealed E3 was hired as a caregiver. The review revealed a caregiver certificate from Allbest Too, Inc (ALTP 0122) dated August 15, 2006. 2. A review of the medical records of R1 and R2 revealed E3 provided assisted living services to R1 and R2 on a regular basis since at least May 2023. 3. A review of the NCIA Board website revealed Allbest Too, Inc (ALTP 0122) was active from January 10, 2007, through September 30, 2012. The review revealed the school was not active on the date the certificate was issued. 4. A review of the caregiver certificate verification website (az.tmuniverse.com) revealed no valid caregiver certificate after August 2013 under E3's name. 5. In an interview, E1 reported E1 had contacted the NCIA Board upon E3's hire. E1 reported the NCIA Board had told E1 that Allbest Too, Inc was active on the date E3's certificate was issued. 6. In a series of messages, a representative from the NCIA Board confirmed Allbest Too, Inc (ALTP 0122) was not active on the date the certificate was issued.

Based on documentation review, observation, and interview, the manager failed to ensure 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 controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the environmental inspection of the facility, the Compliance Officer observed six doors leading from bedrooms and common areas to the outside did not have controls installed. The Compliance Officer observed each of the six doors had alerts installed. However, all six of the alerts were turned off. Upon opening each of the six doors, the Compliance Officer heard no alert. 3. In an interview, E1 acknowledged the six alerts had been turned off or were never turned on to begin with. This is a repeat citation from the compliance inspection conducted on December 29, 2022.

Based on documentation review, record review, observation, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of two 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. A review of facility documentation revealed a policy and procedure titled "Medication Administration" dated October 2, 2019. The policy and procedure stated, "Each resident's medications are ordered in writing and signed by the resident's physician, packaged and labeled by a licensed pharmacist, managed by the Manager and care staff administered." 2. 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 dated December 5, 2023 for "Acetaminophen Tab 650 mg (milligrams): take 1 tab q8hrs," "Quetiapine Tab 50 mg: take 1 tab q8hrs," and "Trazadone [sic] Tab 50 mg: take 1 tab qPM". The review further revealed a series of medication administration records (MAR) dated between December 2023 and February 2024. The MARs indicated the following: -R1 was administered "Acetaminophen" twice daily between December 1, 2023, and February 8, 2024, at 8:00 AM and 5:00 PM instead of every eight hours as ordered; -R1 was administered "Quetiapine" twice daily between December 1, 2023, and February 8, 2024, at 8:00 AM and 5:00 PM instead of every eight hours as ordered; and -R1 was administered "Trazodone" daily in February 2024 at 8:00 AM instead of every night as ordered. 3. The Compliance Officer observed the instructions on R1's pharmacy-provided multi-dose packs for the aforementioned medications matched those on the order. 4. In an interview, E1 acknowledged R1 was not administered the aforementioned medications according to the instructions on the order dated December 5, 2023.

Based on observation, documentation review, and interview, the manager failed to ensure meals and snacks provided by the assisted living facility were served according to posted menus. The deficient practice posed a risk if the source of a potential food borne illness could not be identified. Findings include: 1. During the environmental inspection of the facility, shortly after 12:00 PM, the Compliance Officer observed E5 preparing lunch. The Compliance Officer also observed a current posted food menu. 2. A review of the current posted food menu revealed lunch on the day of the inspection was to be a "Tuna sandwich [and] french fries." 3. In an interview, E5 reported E5 was preparing egg salad sandwiches and chips for lunch. E5 reported E5 did not have the chance to add the meal substitution in the morning.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and inaccessible to residents. The deficient practice posed a risk to residents with access to the poisonous or toxic materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a cabinet in the kitchen. The cabinet did not have locks installed. Upon opening the cabinet, the Compliance Officer observed air freshener and a concentrated germicide, both of which included warning labels. 2. In an interview, the Compliance Officer asked if the facility had a locked area to store poisonous or toxic materials, to which E1 stated, "Yes." E1 reported poisonous or toxic materials were to be stored near the laundry room. This is a repeat citation from the compliance inspection conducted on December 29, 2022.