Orange Garden Assisted Living LLC

Based on record review and interview, the assisted living home failed to maintain written documentation of emergency responder (EMS) information that included the items listed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1-9) for two of two residents sampled. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident. Findings include: 1. A review of R1 and R2's medical records revealed a standardized form that did not include 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. 2. In an exit interview, findings were reviewed with E1, and no additional information was provided.

Based on record review, and interview, the chief administrative officer failed to implement tuberculosis (TB) infection control activities including annually providing training and education related to recognizing the signs and symptoms of TB, for two of two sampled employees. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of E1’s and E2’s personnel records revealed E1 and E2 did not have annual TB training in identifying the signs and symptoms for the years 2024 and 2025 in their file at the time of the inspection. Based on E1’s and E2’s hire date this documentation was required. E2 did have TB training for April 2023. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure there was 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, that provided access to an outside area that allowed a resident to be at least 30 feet away from the facility that is secured, and monitored 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 general or specific whereabouts of a resident. Findings Include: 1. The facility was licensed at the directed care level. 2. During an environmental inspection of the facility with E1, the Compliance Officers observed that the door in bedroom 1 leading to the backyard was unlocked and the alarm was inactive. The door was not monitored. 3. The Compliance Officers observed that the door in the kitchen leading to the backyard was unlocked, and the alarm was broken. The door was not monitored. 4. In an exit interview. The findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure there was a current toxicology reference guide that was available for use by personnel members. Findings include: 1. During the environmental inspection with E1, the Compliance Officers observed that no toxicology reference guide was provided to the department for review. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that medication was stored in a separate locked, self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During the environmental inspection of the facility with E1, the Compliance Officers observed a bottle of "MicroKlenz First Aid Antiseptic" and "Medicated Selsun Blue Dandruff Shampoo" stored in an unlocked cabinet in Bedroom 3’s bathroom. 2. The Compliance Officers observed a bottle of Nystatin 100,000 Units/mL on the desk below the medicine cabinet in the kitchen. 3. The Compliance Officers observed E1 take the bottle of Nystatin and attempt to place it in the locked medicine cabinet above the desk after being instructed to keep all items in their original locations during the time of the inspection. 4. In an exit interview, findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure 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 conducted with E1, the Compliance Officers observed containers of "Sweet Baby Ray's Barbecue Sauce," "Heinz Tomato Ketchup," and "Smucker's Strawberry Jam" stored in the dry cabinet and not refrigerated. 2. The Compliance Officers observed two containers of moldy strawberries on the kitchen counter. E1 immediately disposed of the containers in the trash. 3. In an interview, the findings were discussed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that the premises was free from conditions or situations that may cause a resident or other individual to suffer physical injury. The deficient practice posed a risk to physical health and safety of residents. Findings Include: 1. During an environmental inspection of the facility conducted with E1, the Compliance Officers observed that the following items were accessible to all ambulatory individuals in the walkway outside: Two wheelchairs Walker Commode chair Hospital bed Transfer equipment 2. In an exit interview, the findings were reviewed with E1, 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 maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications, and were inaccessible to residents. The deficient practice posed a risk to physical health and safety of residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officers observed that the following bottles of toxic materials were stored on top of the sink in Bedroom 1’s bathroom: "Kroger Laundry Stain Remover" "Linen Fresh Air Freshener" 2. The Compliance Officers observed that the following bottles of toxic materials were stored in an unlocked cabinet underneath the laundry cabinet in the hallway: "Xtra Detergent" "OdoBan Disinfectant Fabric and Air Freshener" "Lysol Advanced Power Clinging Gel" "Great Value Low-Splash Bleach" 3. The Compliance Officers observed that the following bottles of toxic materials were stored in an unlocked cabinet underneath the kitchen sink: "Member's Mark Liquid Dish Soap" "Clorox No-Splash Formula" "CLR Brilliant Bath Foaming Cleaner" 4. The Compliance Officers observed a bottle of "Comet Bleach" stored in a locked cabinet in Bedroom 3’s bathroom, with the magnetic key affixed to the side of the cabinet. 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review and interview, after the manager had a reasonable basis, according to Arizona Revised Statutes (A.R.S.) \'a7 46-454, to believe abuse, neglect, or exploitation had occurred on the premises, the manager failed to initiate an investigation and document the information required in Arizona Administrative Code (A.A.C.) R9-10-803(J)(5)(a-d), within five working days. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. A review of facility documentation revealed a document dated August 31, 2023. The document reflected Arizona Adult Protective Services (APS) completed an investigation regarding allegations of neglect regarding R4. 2. A review of Department documentation revealed a document titled "Intake Information" dated January 8, 2024. The intake contained allegations of neglect regarding R3. 3. In an interview, E1 reported APS visited the facility to investigate allegations of neglect regarding R3. E1 reported being unaware of all of the allegations associated with the report, and reported the case with APS was closed. 4. In an interview, E1 acknowledged internal investigations of the allegations of neglect of R3 and R4 were not initiated and information required in A.A.C. R9-10-803(J)(5)(a-d) was not documented within five working days.

Based on documentation review and interview, the manager failed to ensure policies and procedures were established, documented, and implemented to ensure the safety of a resident who may wander. The deficient practice posed a risk if facility staff were unaware of the whereabouts of a resident. Findings include: 1. A review of Department documentation revealed AL11714 was licensed to provide directed care services. 2. A review of facility policies and procedures revealed a policy on wandering. The policy reflected "Facility will do routine checks and document to verify location in facility." 3. A review of facility documentation revealed no documentation to reflect routine checks were conducted and documented. 4. In an interview, E1 reviewed and acknowledged the facility's wandering policy was not implemented.

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 of not meeting residents' dietary needs. Findings include: 1. During the environmental inspection of the facility conducted on May 8, 2024, at approximately 10:15 AM, the Compliance Officer observed residents being served hamburgers, french fries, and water for lunch. 2. A review of the facility's menu dated May 8, 2024 revealed "Chicken stir fry with vegtable and rice, fruit juice, soda, or ice tea, and ice cream" was scheduled to be served for lunch, and "Egg salad sandwich with lettuce, pickle salad, ice cream and fruit juice or milk or coffee" was scheduled to be served for dinner. 3. In an interview, E4 reported the residents would be served bologna sandwich, egg salad and water, orange juice, or coffee for dinner. 4. At approximately 4:45 PM, the Compliance Officer observed E4 preparing bologna sandwiches for dinner. 5. In an interview, E1 acknowledged meals were not served according to the posted menu.

Based on observation, documentation review, and interview, the governing authority failed to notify the Department according to 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. The deficient practice posed a risk as the Department was unable to ensure the facility maintained a qualified manager. Findings include: 1. A review of Department documentation revealed O1 was no longer the manager of AL11714 on April 1, 2023. 2. The Compliance Officer observed E1's license, issued by the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA), posted on the premises. 3. A review of E1's (hired in 2023) personnel record revealed E1 was hired as the licensed manager. However, documentation the Department was notified when there was a change in the manager was not available for review. 4. In an interview, E3 acknowledged the governing authority did not notify the Department according to A.R.S. \'a7 36-425(I) when there was a change in the manager.

Based on documentation review, record review, and interview, the manager failed to ensure the assisted living facility had caregivers with the qualifications, experience, skills, and knowledge necessary to meet the needs of a resident. The deficient practice posed a risk if there was not sufficient staff with the qualifications, experience, skills, and knowledge necessary to meet the needs of the residents. Findings include: 1. A review of R3's medical record, contained an incident report dated May 7, 2022. The document stated, "Resident found on floor...resident slide [R3's]self on floor...resident wants us to put back on floor...refused to go to the hospital..stated ok and no injury sustained...action taken: check resident every two to three hours". There was no documentation of resident checks in R3's record. 2. An incident report dated May 8, 2022 stated "resident found on floor...called 911 and resident pronounced death". 3. In an interview, E2 and E3 acknowledged there was no documentation of resident checks in R3's record. E2 reported R3 was checked on.

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 stating whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of three residents reviewed accepted by the assisted living facility on or after October 1, 2013. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R1's medical record revealed documentation stating R1 required continuous medical services with a note underneath the corresponding area that read "feeding liquid food and medication". 2. During an interview, E2 and E3 acknowledged R1's record contained documentation of continuous medical services required. E3 indicated the form was filled out incorrectly. This is a repeat deficiency from the last compliance inspection conducted on May 11, 2022.

Based on record review and interview, the manager failed to ensure an assistant caregiver was only assigned to provide the assisted living services the assistant caregiver had the documented skills and knowledge to perform, for one of four caregiver sampled. The deficient practice posed a risk if the caregivers were unable or to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed a service plan dated June 14, 2023. The service plan revealed R1 required g-tube feeding four times a day with flushing of g-tube with water before and after feeding. 2. In an interview, E3 reported E2 was trained on g-tube feeding from E3 on March 15, 2023, and provided the Compliance Officer with a form titled "Employee Certification that had the area checked for "Feeding tube care/feeding pump". However, E3 was not a licensed medical person. The there was no further documented evidence of tube feed training for review.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of three residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R1's medical record revealed a current written service plan for personal care services dated June 14, 2023. This service plan stated "Tube feeding...flush g-tube with 60cc of water before feeding and 30 cc after feeding". However, documentation was not available indicating this service was provided. 2. During an interview, E2 and E3 acknowledged R1's medical record did not include documentation of the above listed service and reported the service was provided as indicated in the service plan.

Based on observation and interview, the manager failed to ensure food stored by the facility was free from spoilage, and was safe for human consumption. Findings include: 1. During an environmental inspection, the Compliance Officer observed the refrigerator located on the patio had spoiled tomatoes with black spots, mold and indentation. 2. In an interview, E2 reported the food in the extra refrigerator is for resident consumption. E2 acknowledged the spoiled food.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in labeled containers 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. The Compliance Officer observed the following materials in an unlocked shed located in the backyard: - gallon container of Pinesol; - canister of Raid; - Clorox. 2. In an interview, E2 acknowledged the poisonous or toxic materials were not maintained in a locked area and were accessible to residents.