Palm House I Plc

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 two 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 R2's medical record revealed no documentation stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R2's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged R2 did not provide documentation signed by a medical practitioner or a registered nurse stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on observation and interview, the manager failed to ensure a current calendar of activities was posted. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed that the calendar of activities posted was dated June 2022. 2. In an interview, E1 acknowledged the calendar of activities was not current.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. Review of R1's medical record revealed R1 refused the flu and pneumonia vaccinations October 13, 2022. However, current documentation was not available that showed the flu and pneumonia vaccinations were offered or received. Based on R1's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's medical record did not include current documentation that showed the flu and pneumonia vaccinations were offered or received.

Based on record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, every six months, that stated the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of one resident reviewed who was confined to a bed or chair. 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 a current written service plan for directed care services dated August 22, 2023. This service plan stated "bed bound". 2. Review of R1's medical record revealed a written determination from R1's medical practitioner signed and dated March 21, 2023. However, documentation was not available that stated R1's needs could be met by the facility and R1's needs were within the facility's scope of services, at least once every six months. 3. In an interview, E1 reported R1 was unable to ambulate even with assistance since acceptance and acknowledged R1's medical practitioner did not provide a written determination at least once every six months.

Based on observation and interview, the manager failed to ensure a menu was conspicuously posted at least one day before the first meal on the food menu was served. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed that there was no posted menu. The Compliance Officer asked E1 about the menu and E1 grabbed a menu from the top of the kitchen refrigerator. This menu was not dated. 2. In an interview, E1 acknowledged a menu was not conspicuously posted at least one day before the first meal on the food menu was served.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and 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 with E1, the Compliance Officer observed Easy-Off, Comet, Roach & Ant Killer, and Simple Green unlocked in the cabinet under the kitchen sink. This cabinet had a locking device, however the device was not locked. 2. During an observation, the caregivers were not accessing the toxic materials at the time of arrival. 3. In an interview, E1 acknowledged toxic materials were stored unlocked.