Paradise Home in Phoenix

Based on documentation review and interview, the assisted living center failed to provide the required documentation to an emergency responder when an emergency responder had been contacted. Findings include: 1. A review of facility documentation revealed a "Incident report form" dated August 24, 2024. The documentation included all information required except the reason the emergency responder was requested on behalf of the resident, pharmacy information, basic medical history, and point of contact for the facility. 2. In an interview, E3 acknowledged documentation to an emergency responder when an emergency responder had been contacted had not included the reason the emergency responder was requested on behalf of the resident, pharmacy information, basic medical history, and point of contact for the facility.

Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under Arizona Revised Statutes (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 if the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation revealed the previous manager for the facility resigned from the facility effective February 1, 2024. 2. During the environmental inspection of the facility, the Compliance Officer observed a managers license posted on the wall for E1. 3. In an interview, E3 reported E1 had been the facility manager since July 5, 2024. They had another manager from a period of March 1, 2024 to June 1 2024, and had gaps with no manager from February 1, 2024 to March 1, 2024 and from June 1, 2024 to July 5, 2024. E3 was not aware the Department had not been notified of these changes. 4. In an interview, E3 acknowledged the governing authority failed to designate, in writing, a manager who had 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.

Based on documentation review, observation, record review and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before providing physical health services and according to policies and procedures, for two of three caregivers sampled. The deficient practice posed a risk if an employee did not possess required skills and knowledge to ensure the health and safety of residents. Findings include: 1. A review of facility documentation revealed a policy titled "Employees and Orientation and On-going Training Policy and Procedures." The policy stated "New staff will be given an orientation form/skills/knowledge verification form and it will be completed...before providing services to residents." 2. A review of E3's personnel record revealed a skills and knowledge verification form. However, the document had not included the employee name, completion date, or initials of the employee completing the skills and knowledge verifications. 4. A review of E4's personnel record revealed no documentation to indicate E4's skills and knowledge were verified before E4 provided services and according to policies and procedures. 5. In an interview, E3 acknowledged E3's and E4's skills and knowledge were not verified and documented before E3 and E4 provided physical health services, and according to policies and procedures.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, was only assigned to provide the assisted living services the caregiver or assistant caregiver had the documented skills and knowledge to perform, and documented the services provided in the resident's medical record, for one of five sampled residents. The deficient practice posed a risk if a resident did not receive required services from a qualified employee to meet their needs, and services could not be verified as provided against a service plan. Findings include: 1. A review of R5's medical record revealed Activities of Daily Living (ADL) sheets while R5 was residing in the home was not available for review at the time of inspection. 2. In an interview, E3 acknowledged R5's ADL sheets was not avalailable for review at the time of inspection.

Based on documentation review, observation and interview, the manager failed to ensure a resident was not subjected to restraint. The deficient practice posed a potential for physical injury and psychological distress. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(201) states: "Restraint" means "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 an environmental inspection of the facility, the Compliance Officer observed R6 had a rail on each side of their bed and was currently holding onto the one on his right side. 3. During an environmental inspection of the facility, the Compliance officer observed R2 had a rail on the side of their bed opposite of the wall. 4. In an interview, E3 reported both residents were bedbound and the rails were to help keep the residents from falling out of bed and were requested by hospice. E3 reported if R6 did not have the rails R6 would become very upset. 5. In an interview, E3 acknowledged R2 and R6 were subjected to restraints.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of freedom from infectious tuberculosis (TB), for five of five residents sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-113(B)(2)(a-b) states: "B. A health care institution's chief administrative officer shall: 2. As part of the annual assessment of the health care institution's risk of exposure to infectious tuberculosis according to subsection (A)(2)(d), ensure that documentation is obtained for each individual required to be screened for infectious tuberculosis that: a. Indicates the individual's freedom from symptoms of infectious tuberculosis; and b. Is signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101." 2. A review of R1's, R2's, R3's, R4's and R5's medical records revealed documentation of freedom from TB. However, documentation of TB screening was not available for review at the time of inspection. 3. In an interview, E3 acknowledged failure to ensure a resident's medical record contained documentation of freedom from infectious tuberculosis.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order and documented in the resident's medical record, for one of five residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration. Findings include: 1. In an interview, E3 reported all residents received medication administration services. 2. A review of R3's medical record revealed a signed medication order list for the following medications: -Capecitabine 500 MG take three tablets by mouth every 12 hours; and -Glargine-YFGN insulin pen inject 4 units every night at bedtime. However, these medications were not documented as administered at the following dates: -Capecitabine from August 20, 2024 to August 24, 2024; and -Glargine-YFGN from August 20, 2024 to August 24, 2024. 3. In an interview, E3 reported not administering medication because E3 was waiting on salibas to deliver. E3 had attempted alternative routes to obtain medication but was unable to obtain them. 4. In an interview, E3 acknowledged medication was not provided in compliance with an order.

Based on documentation review and interview, the manager failed to ensure the disaster plan required in subsection (A)(1) was reviewed at least once every 12 months. The deficient practice posed a risk if facility staff were unable to implement the disaster plan. Findings include: 1. A review of facility documentation revealed documentation of a disaster plan review conducted every 12 months was not available for review at the time of inspection. 2. In an interview, E3 acknowledged the manager failed to ensure the disaster plan required in subsection (A)(1) was reviewed at least once every 12 months.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of facility documentation revealed a disaster drill conducted on March 1, 2023. However, documentation of a disaster drill conducted after March 1, 2023 was not available for review at time of inspection. 2. In an interview, E3 acknowledged disasters drills were not conducted every three months on each shift and documented.

Based on observation and interview, the manager failed to ensure the premises was free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. During an environmental inspection of the facility the Compliance Officer observed broken window in R2's and R4's bedroom. The inside pane of the window was broken, with edges hidden behind a curtain. The outside window glass was still intact. 2. During an environmental inspection of the facility the Compliance Officer observed the backyard gate latch kept closed with a twisted piece of metal. The Compliance Officer could not easily remove the piece of metal to open the gate. 3. In an interview, E3 acknowledged the premises was not free from a condition or situation that may cause a resident or other individual to suffer physical injury. This is a repeat deficiency from the inspection conducted on April 27, 2023.

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. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed an cabinet underneath the sink. The locks on the cabinet had been disengaged and contained the following items: -A can of "Method antibac all purpose cleaner"; -A bottle of Febreeze "Unstopables" fabric spray; and -A bottle of Kroger Glass Cleaner with an unidentified clear liquid in the container. 2. In an interview, E3 acknowledged the sink where toxic materials were kept was not locked and inaccessible to residents. This is a repeat deficiency from the inspection conducted on April 27, 2023.

Based on observation and interview, the manager failed to ensure equipment used at the assisted living facility was maintained in working order. Findings include: 1. During an environmental inspection of the facility the Compliance Officer the garage lights were not functioning, and the garage was dark. The Compliance Officer asked E4 to turn on the lights. However, E4 opened the garage door to allow sunlight into the garage. The Compliance Officer observed a light source with bulbs on the ceiling of the garage. 2. In an interview, E4 reported needing to open the garage to let light into the garage, and the lights were not functional. 3. In an interview, E3 acknowledged the lights in the garage were not in working order. This is a repeat deficiency from the inspection conducted on April 27, 2023.

Based on interview and documentation review, the licensee failed to notify the department within thirty days after any change regarding a controlling person, and the licensee failed to provide the information and affirmation required pursuant to subsection A, paragraph 1, subdivision (d) of A.R.S. \'a7 36-422. Findings include: A.R.S. \'a7 36-422(H) states, "An applicant or licensee must notify the department within thirty days after any change regarding a controlling person and provide the information and affirmation required pursuant to subsection A, paragraph 1, subdivision (d) of this section." 1. The Compliance Officer conducted an inspection on April 17, 2023. 2. In an interview, E1 reported they were a part owner of the facility. In addition, E1 reported E5 was a part owner of the facility. 3. A search of E1's name on the Arizona Corporation Commission website revealed E1 was appointed the statutory agent on February 2, 2023. A review of the "Articles of Amendment" dated January 23, 2023, revealed E5 was removed from the LLC and E1 was added to the LLC. However, based on this discovery, E1 failed to notify the Department of the aforementioned changes to the LLC. The time frame ranged from February 2, 2023 to April 17, 2023 (when E1 was appointed the statutory agent to the day of the inspection). According to the aforementioned dates, the Department should have been notified of both changes to the LLC by March 4, 2023. 4. A review of Department records revealed no documentation of E1 notifying the department within thirty days after any change regarding a controlling person and no documentation was provided with the information and affirmation required pursuant to subsection A, paragraph 1, subdivision (d) of A.R.S. \'a7 36-422.

Based on observation, record review, documentation review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411(A) and (C); for one of three personnel records sampled. Findings include: A.R.S. \'a7 36-411(A) states, "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." A.R.S. \'a7 36-411(C), states, "Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency." 1. During a tour of the dining room, the Compliance Officer observed the posted staffing schedule for April 2023. The schedule indicated E2 worked alone on April 1-April 16, 2023 from 7:00PM-7:00AM. 2. A review of E2's personnel record revealed E2 was hired on March 1, 2023. E2's personnel record revealed no documentation of E2's fingerprint clearance card or an application for fingerprint clearance card within twenty working days of employment. In addition, E2's personnel record revealed a document titled "EMPLOYMENT HISTORY & REFERENCE CHECKS." E2 listed two previous employers. Each former employer reference had a section titled, "1st Attempt to Contact . . . 2nd Attempt to Contact . . . 3rd Attempt to Contact." However, these sections were blank and revealed no documentation of good faith efforts to contact E2's previous employers. 3. An online search on the Department of Public Safety's (DPS) website for E2's fingerprint clearance card and fingerprint clearance card application revealed no results. The DPS search results stated, "Your search has returned no results." 4. A review of facility policies and procedures (P&P) revealed a P&P titled, "Fingerprinting Employees Policy and Procedures." The P&P stated, "It is the policy of Paradise Home in Phoenix to require all employees to have a

Based on documentation review, observation, and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. This deficient practice posed a risk as the Department could not verify if sufficient staff were available to meet the resident's needs. Findings include: 1. A review of Department documentation revealed AL12287's license was effective on November 29, 2022. 2. In an interview, the Compliance Officer asked E1 for staffing schedules dating back to November 29, 2022. However, the staffing schedule for November-December 2022 was not provided for review. 3. A review of facility policies and procedures (P&P) revealed a P&P titled, "Employee Staffing and Recordkeeping Policy and Procedures." The P&P stated, "The employee work schedules will be kept for 12 months . . . The manager will periodically check the employee work schedule to ensure it reflects all personnel changes, i.e. vacations, sick days ... on or attached to the current work schedule or by other methods deemed appropriate." 4. In another interview, E1 reported E5 was no longer the manager and E5 took the November-December 2022 schedules when they left. E1 stated, "I didn't get the old ones [schedules] before I started here. I need to get that from [E5]."

Based on observation, record review, documentation review, and interview, the manager failed to ensure if the manager or caregiver is not awake during nighttime hours, the manager or caregiver can hear and respond to a resident needing assistance. Findings include: 1. A review of R1's and R2's medical records revealed R1 and R2 received personal care services. 2. During a tour of the caregiver's room, the Compliance Officer tested the facility's call button alert system to verify if it was audible from the caregiver's room. The alert system speaker was located on the kitchen counter. The caregiver's room was located past an adjoining door between the kitchen and laundry room. In addition, there was a second door leading into the caregiver's bedroom. The Compliance Officer conducted the first test on the alert system while the adjoining door between the kitchen and laundry room and the caregiver's bedroom door were opened. The Compliance Officer asked E1 and E7 to press a resident's call button. The first test revealed the alert system was barely audible. Moreover, the Compliance Officer asked E1 and E7 to press a resident's call button a second time. The second test revealed the alert was barely audible from the caregiver's bedroom. 3. A review of Department documentation revealed an incident occurred where the caregiver was unable to hear a resident "crying out for help." In addition, during this incident, Emergency Medical Services (EMS) attempted to ring the doorbell several times with no answer. When EMS entered AL12287, they yelled out "fire department" several times and the caregiver did not answer. 4. A review of facility policies and procedures (P&P) revealed a P&P titled, "Nighttime Resident Checks Policy and Procedures." The P&P stated, "It is the policy of Paradise Home in Phoenix that the manager or caregivers are allowed to sleep at night. The facility's policy is to be able to hear and respond to a resident needing assistance . . . The residents will have a security system and a wireless bell system to alert staff of resident needs and will be set up in every resident room. The alert system will provide an auditory sound loud enough to allow the manager or caregiver to hear and respond to a resident in need of assistance." 5. While conducting the second test, E7 stated, "You got to turn off the machine [referring to the washing machine and dryer], remember, everything is silent for the night." In an interview, E1 acknowledged the facility's alert system was not loud enough to hear from the caregiver's room. In an exit interview, E6 acknowledged, the alert system was not loud enough to hear from the caregiver's room.

Based on record review, documentation review, and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of the individual's education and experience applicable to the individual's job duties; for two of three personnel records sampled. Findings include: 1. A review of E2's personnel record revealed no documentation of E2's education and experience applicable to E2's job duties as a caregiver. E2's personnel record revealed a document titled, "JOB DESCRIPTION - CAREGIVER." The document indicated and stated, "Experience . . . Caregivers will have at least 1 month of experience providing health related care prior to working unsupervised at this facility. Education . . . Employees 18 years and older will have a high school diploma or equivalent." As required by the job description, E2's record did not contain E2's high school diploma. 2. A review of E3's personnel record revealed a document titled, "JOB DESCRIPTION - VOLUNTEER." The document indicated and stated, "Education . . . Must have a High School Diploma, GED or none if currently attending school, on temporary break from school." However, E3's personnel record revealed no documentation of E3's education as required by the job description. 3. A review of facility policies and procedures revealed the aforementioned job descriptions for caregivers and volunteers. 4. In an exit interview, E6 acknowledged E2's and E3's personnel records did not contain documentation of the individual's education and experience applicable to E2's and E3's job duties.

Based on observation, record review, documentation review, and interview, the manager failed to ensure a resident's medical record was protected from unauthorized use. Findings include: 1. During a tour of the dining room, the Compliance Officer observed binders on top of a filing cabinet. 2. During a review of resident medical records, E1 retrieved the aforementioned binders on top of the filing cabinet, and provided them to the Compliance Officer. E1 reported the binders contained residents' medical records. 3. A review of facility policies and procedures (P&P) revealed a P&P titled, "Medical Records Policy and Procedures." The P&P stated, "Resident medical records will be created upon acceptance into Paradise Home in Phoenix . . . The records are maintained in a locked room . . . All resident records are considered confidential and will be treated as such by the staff." 4. In an interview, E1 reported they normally stored resident records on top of the aforementioned filing cabinet. During an exit interview, E6 acknowledged all of the residents' medical records were not protected from unauthorized use.

Based on record review and interview, the manager failed to ensure a resident's medical record contained the names, addresses, and telephone numbers of the resident's primary care provider (PCP); for two of two resident records sampled. Findings include: 1. A review of R1's medical record revealed a document titled, "PARADISE HOME IN PHOENIX RESIDENT FACE SHEET." The document contained three sections titled, "PRIMARY CARE PROVIDER . . . ADDRESS . . . PHONE . . . PHYSICIAN . . . ADDRESS . . . PHONE . . . PHYSICIAN . . . ADDRESS . . . PHONE." However, all three sections were blank and revealed no documentation of the PCPs names, addresses, and telephone numbers. 2. A review of R2's medical record revealed a document titled, "PARADISE HOME IN PHOENIX RESIDENT FACE SHEET." The document contained three sections titled, "PRIMARY CARE PROVIDER . . . ADDRESS . . . PHONE . . . PHYSICIAN . . . ADDRESS . . . PHONE . . . PHYSICIAN . . . ADDRESS . . . PHONE." However, all three sections were blank and revealed no documentation of the PCPs names, addresses, and telephone numbers. 3. In an interview, E1 acknowledged R1's and R2's medical records did not contain the names, addresses, and telephone numbers of R1's and R2's PCPs.

Based on documentation review and interview, the manager failed to ensure policies and procedures (P&P) for medication administration were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. Findings include: 1. The Compliance Officer requested to review the facility's current P&Ps. 2. In an interview, E1 reported the P&Ps were digital. E1 emailed the digital P&Ps to the Compliance Officer. 3. A review of the second page of the digital P&P's revealed a signature line titled, "Medication Administration and Assistance with Self-Administration of Medications Policies and Procedures have been reviewed and are approved . . . Signature of medical practitioner, registered nurse, or pharmacist." However, the signature line was blank. 4. In a telephonic interview regarding the physical copy of the P&Ps, E1 stated, "The physical copies are signed, but [E5] has them." However, the physical copy of the P&Ps was not provided for review during the inspection.

Based on documentation review and interview, the manager failed to ensure policies and procedures (P&P) for the assistance in the self-administration of medication were reviewed and approved by a medical practitioner or nurse. Findings include: 1. The Compliance Officer requested to review the facility's current P&Ps. 2. In an interview, E1 reported the P&Ps were digital. E1 emailed the digital P&Ps to the Compliance Officer. 3. A review of the second page of the digital P&P's revealed a signature line titled, "Medication Administration and Assistance with Self-Administration of Medications Policies and Procedures have been reviewed and are approved . . . Signature of medical practitioner, registered nurse, or pharmacist." However, the signature line was blank. 4. In a telephonic interview regarding the physical copy of the P&Ps, E1 stated, "The physical copies are signed, but [E5] has them." However, the physical copy of the P&Ps was not provided for review during the inspection.

Based on record review, observation, documentation review, and interview, the manager failed to ensure the assistance in the self-administration of medication provided to a resident was provided to a resident in compliance with an order; for one of two resident records sampled. Findings include: 1. A review of R1's medical record revealed a current service plan. The service plan revealed R1 received the assistance in the self-administration of medication. In addition, R1's medical record revealed medication orders dated two days before R1's date of admission into the facility. 2. A review of R1's medical record revealed a current prescription for Aspirin. The prescription stated, "Aspirin Oral Capsule 81 MG (Aspirin) Give 1 capsule by mouth on time a day for DVT Propy." However, the prescription was not signed by the prescribing medical practitioner. In addition, R1's March-April medication administration record (MAR) indicated R1 received the assistance in the self-administration of medication for Aspirin. The Compliance Officer observed R1's medication bin did not contain Aspirin. However, the Compliance Officer observed a bin containing all of the facility's over the counter medications. The bin contained a bottle of Bayer Aspirin 81 MG enteric coated tablets. Further review of R1's medical record revealed the current and signed prescription for Midodrine. The prescription stated, "Midodrine HCI Tablet 5 MG Give 1 tablet by mouth three times a day for Low BP Hold for SBP greater than 120." However, a review of R1's March MAR revealed no documentation of R1 receiving their Midodrine. In addition, further review of R1's April MAR revealed R1's Midodrine was added and a handwritten note stated, "MIDODRINE 5MG 1 TAB 3X A DAY . . . FOLLOW UP DELIVERY." However, R1's April MAR revealed R1 did not receive their Midodrine as ordered. Both MARs revealed R1 did not receive their Midodrine for 18 days. Furthermore, the Compliance Officer observed R1's medication bin. R1's medication bin revealed Midodrine was not available. 3. A review of facility policies and procedures (P&P) revealed a P&P titled, "Facility Acceptance and Resident Rights." The P&P stated, "The admission process will be completed by the Manager or designee (as appropriate). This process will include . . . Obtaining medical and physicians' forms which include . . . Signed orders for all medications." Moreover, another P&P titled. "Medication and Medication Services Policies and Procedures" stated, "To prevent a medication error, caregivers will verify the medication is taken as ordered by the resident's medical practitioner by confirming that . . . the resident is taking the medication at the time stated on the medication container label and the medication administration record (MAR) is correct; and if a medication organizer is used and if questions arises [refer to] . . . the medical practitioner's order." 4. In an interview, E1 reported they were unaware they needed signed orders for R

Based on observation, documentation review, and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit. Findings include: 1. During a tour of the kitchen, the Compliance Officer observed a refrigerator without a lock. The second shelf on the refrigerator door did not have a lock or lock box. The Compliance Officer observed the following medication on the shelf: - One bottle of Nystatin; - Two bottles of Haloperidol Con 2MG/ML; - One box of Morphine Sulfate Oral Solution C II 100 mg per5 mL; - One box of Lorazepam Intensol Oral Concentrate USP C IV 2 mg per mL; - Two boxes of NovoLog 100 units/mL; - Two boxes of Humalog KwikPens 5 x 3 mL, U-100; - One box of Lispro INS 100 units/mL pens; - One box and one pen of Tresiba FlexTouch 200 units/mL pens; - Four boxes of Basaglar KwikPen, 5 x 3 mL per box, U-100; - Four boxes of Trulicity 1.5mg/0.5 mL, 4 pens per box; and - One box of Latanoprost Ophthalmic Solution 0.005% 125 mcg/2.5 mL. In addition, during a tour of the kitchen, the Compliance Officer observed four overhead glass cabinets. The left and middle section of the glass cabinets did not have a lock. The cabinets contained residents' medications, bubble packs, and pill organizers. Moreover, the Compliance Officer observed four wooden cabinets below the glass cabinets. The middle wooden cabinet did not have a lock and contained a bin. The bin contained the following medications: - One box of Kroger Anti-Diarrheal Loperamide Hydrochloride Tablets, 2 mg; - One bottle of Walgreens Ibuprofen Tablets USP, 200 mg 500 Tablets; - One bottle of Bayer Aspirin Pain Reliever, 81 mg 120 Enteric Coated Tablets; - One bottle Kirkland Signature Allergy Medicine Diphenhydramine HCI 25 mg, 600 Minitabs; - One bottle of Kroger Allergy Capsules Diphenhydramine HCI 25 mg, 100 Capsules; - One bottle of Walgreens Milk of Magnesia Magnesium Hydroxide/Saline Laxative 12 FL OZ; - One bottle of Aleve naproxen sodium tablets, 220 mg 50 Tablets; - One box of Equate Earwax Removal Aid Carbamide Peroxide 6.5% 0.5 FL OZ; - One bottle of Tylenol Acetaminophen 325 mg, 100 Tablets; - One box of Walgreens Ibuprofen Capsules, 200 mg, 20 Softgels Capsules; - One bottle of Kirkland Signature Ultra Strength Antacid Calcium Carbonate 1000 mg, 265 Tablets; - Two boxes of Advil Ibuprofen Tablets, 200 mg 6 Coated Tablets per box; and - Three boxes of Aleve naproxen sodium tablets, 220 mg 6 Caplets per box. 2. During a tour of the garage, the Compliance Officer observed the exit door leading into the garage was unlocked. The Compliance Officer was able to gain access to the garage. The garage lights were not functioning, and the garage was dark. The Compliance Officer asked E7 to turn on the lights. E7 reported they were not working, and E7 opened the garage door. After entering the garage, the Compliance Officer observed a tote containing a bag of mixed medications and a reclosable plastic bag. The reclosable plast

Based on observation, documentation review, and interview the manager failed to ensure medication was stored according to the instructions on the medication container. Findings include: 1. During a tour of the kitchen, the Compliance Officer observed a refrigerator without a lock. The Compliance Officer checked the refrigerator temperature with the Department issued thermometer gun. The thermometer gun indicated the temperature at the warmest part of the refrigerator was 51.4 \'b0 F. In addition, the Compliance Officer observed a thermometer in the butter compartment. The thermometer indicated the temperature was 51\'b0 F. The Compliance Officer observed food stored with medications inside the refrigerator. The second shelf on the refrigerator door did not have a lock or lock box and was the warmest part of the refrigerator. The Compliance Officer observed the following medications requiring refrigeration on the shelf: - One box of Morphine Sulfate Oral Solution C II 100 mg per5 mL. The label stated, "Store at . . . (68\'b0 to 77\'b0 F)". This medication was not stored in the required warmer temperatures. - One box of Lorazepam Intensol Oral Concentrate USP C IV 2 mg per mL. The label stated, "Refrigerate at . . . (36\'b0 to 46\'b0 F)."; - Two boxes of NovoLog 100 units/mL. The label stated, "Store refrigerated at . . . (36\'b0 to 46\'b0 F)"; - Two boxes of Humalog KwikPens 5 x 3 mL, U-100. The label stated, "REFRIGERATE." A Google search for the storage instructions indicated the Humalog should be stored at 36\'b0 to 46\'b0 F; - One box and one pen of Tresiba FlexTouch 200 units/mL pens. The label stated "Store at 36\'b0 to 46\'b0 F"; and - Four boxes of Basaglar KwikPen, 5 x 3 mL per box, U-100. The label stated, "REFRIGERATE." A Google search for the storage instructions indicated the Basaglar should be stored at 36\'b0 to 46\'b0 F. The aforementioned medications were stored at the incorrect temperature ranges. 2. A review of facility policies and procedures (P&P) revealed a P&P titled, "Medication and Medication Services Policies and Procedures." The P&P stated, "The policy for storing medications is that the facility will store medications for residents in a locked area . . . The procedure for storing medication is that medication is stored in a locked cabinet or self-contained unit used only for medication storage and is stored in accordance with the instructions on the medication container. Medications requiring refrigeration will be kept in a locked container in the refrigerator. There will not be other items stored with medications . . . The procedures for storing controlled substances are that controlled substances are kept with locked with the resident's other medications." 3. In an exit interview, E6 acknowledged the refrigerator temperature was not in the required ranges and medication was not stored according to the instructions on the medication containers.

Based on observation, documentation review, and interview, the manager failed to ensure food requiring refrigeration was maintained at 41\'b0 F. or below. Findings include: 1. During a tour of the kitchen, the Compliance Officer observed a refrigerator containing perishable food such as milk, cheese, and cream cheese and unlocked medications which required refrigeration. The Compliance Officer checked the refrigerator temperature with the Department issued thermometer gun. The thermometer gun indicated the temperature at the warmest part of the refrigerator was 51.4 \'b0 F. In addition, the Compliance Officer observed the facility's thermometer in the butter compartment. The facility's thermometer indicated the temperature was 51\'b0 F. 2. A review of facility policies and procedures (P&P) revealed a P&P titled, "Food Services Policy and Procedures." The P&P stated, "Foods requiring refrigeration are maintained at 41\'b0 F or below." 3. In an exit interview, E6 acknowledged food requiring refrigeration was not maintained at 41\'b0 F. or below.

Based on observation, documentation review, and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were free from condition or situation which may cause a resident or other individuals to suffer physical injury. This deficient practice posed a risk to the health and safety of the residents. Findings include: 1. The Compliance Officer observed ambulatory residents at the facility. 2. During a tour of the backyard, the Compliance officer observed six potholes which created a fall hazard. 3. During a tour of the common bathroom, the Compliance Officer observed the light fixture above the sink. The light fixture had three light bulb sockets. The middle socket was exposed and did not have a light bulb in it creating a potential shock hazard. 4. During a tour of the dining room, the Compliance Officer observed the upholstered section of a chair was partially detached and attached to the chair frame by one screw. This condition rendered the chair unsafe for a resident to sit in. 5. A review of facility policies and procedures (P&P) revealed a P&P titled, "Equipment Inspection and Maintenance Policy and Procedures" The P&P stated, "It is the policy of Paradise Home in Phoenix to keep the facility and equipment in good repair." Another P&P titled, "Medication and Medication Services Policies and Procedures" stated, "The policy for storing medications is that the facility will store medications for residents in a locked area . . . Medications requiring refrigeration will be kept in a locked container in the refrigerator." In addition, another P&P titled "Wandering Resident Checks Policy and Procedures" stated, "The facility will have a system to secure all . . . areas containing hazardous or toxic materials." Lastly, a P&P titled "Food Services Policy and Procedures" stated "Foods requiring refrigeration are maintained at 41\'b0 F or below." 6. In an interview, E6 acknowledged the premises and equipment used at the assisted living facility were not free from conditions or situations which may cause residents or other individuals to suffer physical injury.

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic material stored by the assisted living facility were maintained in a locked area separate from food preparation areas and were inaccessible to residents. Findings include: 1. During a tour of the kitchen, the Compliance Officer observed a cabinet below the kitchen sink. The cabinet door had two magnetic child locks. Both locks were in the opened position and the Compliance Officer was able to gain access to the cabinet. The cabinet contained three mugs and a knife block stored with the following poisonous or toxic materials: - One 32 FL OZ spray bottle of "Kroger Glass Cleaner STREAK-FREE SHINE Ammonia Cleaning Power." The label stated, "CAUTIONS: Eye Irritant. Do not get in eyes. Do not ingest. To prevent possible skin, irritation, wear gloves . . . KEEP OUT OF REACH OF CHILDREN AND PETS."; - One NET WT 15 OZ spray can of "Hot Shot Flying Insect Killer." The label stated, "[Front] KEEP OUT OF REACH OF CHILDREN CAUTION . . . [Back] PRECAUTIONARY STATEMENTS Hazards to Humans and Domestic Animals."; - One 40 FL OZ bottle of "Glassex The King Of Glass Glass Cleaner." The label stated, "DANGER."; and - One 28 FL OZ spray bottle of "Method ANTIBAC All-Purpose Cleaner Citron." The label stated, "KEEP OUT OF REACH OF CHILDREN." 2. During a tour of the garage, the Compliance Officer observed the exit door leading into the garage was unlocked. The Compliance Officer was able to gain access to the garage. After entering the garage, the Compliance Officer observed one 22 OZ spray can of "Resolve High Traffic Area Carpet Foam." The label stated, "KEEP OUT OF THE REACH OF CHILDREN AND PETS. CAUTION: MAY CAUSE EYE IRRITATION." 3. During a tour of the kitchen, the Compliance Officer observed the door leading into the laundry room was unlocked and left opened. The Compliance Officer was able to gain access to the laundry room. The Compliance Officer observed a tall storage cabinet without a lock. The cabinet contained the following poisons or toxic materials: - One 24 FL OZ bottle of "Lysol Power Toilet Bowl Cleaner." The label stated, "DANGER: CORROSIVE. HARMFUL IF SWALLOWED."; - One 32 FL OZ bottle of "Great Value Glass Cleaner with Ammonia." The label stated, "KEEP OUT OF THE REACH OF CHILDREN. CAUTION: EYE IRRITANT"; and - One 80 FL OZ bottle of "Drano Max Gel." The label stated, "DANGER: KEEP OUT OF REACH OF CHILDREN AND PETS. CAN CAUSE BURNS ON CONTACT HARMFUL IF SWALLOWED." In addition, the Compliance Officer observed three overhead cabinets. The cabinet to the left had a lock. However, the lock was not in the locked position and the Compliance Officer was able to gain access to the cabinet. The cabinet contained the following poisons or toxic materials: - One 24 FL OZ bottle of "Lysol Power Toilet Bowl Cleaner." The label stated, "DANGER: CORROSIVE. HARMFUL IF SWALLOWED."; - One 121 FL OZ bottle of "Great Value Low-Splash Bleach." The label stated,

Based on observation, documentation review, and interview, the manager failed to ensure combustible or flammable liquids and hazardous materials stored by the assisted living facility were stored in a locked area inaccessible to residents. Findings include: 1. During a tour of the kitchen, the Compliance Officer observed a cabinet below the kitchen sink. The cabinet door had two magnetic child locks. Both locks were in the opened position and the Compliance Officer was able to gain access to the cabinet. The cabinet contained three mugs and a knife block stored with one NET WT 15 OZ spray can of "Sprayway Stainless Steel Cleaner & Polish." The label stated, "DANGER: HARMFUL OR FATAL IF SWALLOWED. EXTREMELY FLAMMABLE". In addition, the Compliance Officer observed one 19 OZ spray can of "Lysol Disinfectant Spray Crisp Linen Scent" on the kitchen counter. The label stated, "PRECAUTIONARY STATEMENTS Hazards to Humans and Domestic Animals . . . PHYSICAL HAZARDS: FLAMMABLE." 2. During a tour of the backyard, the Compliance Officer observed a built-in BBQ grill. To the right of the BBQ grill was one unlocked flammable bottle of "EXPERT GRILL LIGHTER FLUID." The label stated, "DANGER: COMBUSTIBLE. HARMFUL OR FATAL IS SWALLOWED." 3. A review of facility policies and procedures (P&P) revealed a P&P titled "Wandering Resident Checks Policy and Procedures." The P&P stated, "The facility will have a system to secure all . . . areas containing hazardous or toxic materials." 4. In an interview, E6 acknowledged the combustible or flammable liquids and hazardous materials stored by the assisted living facility were not stored in a locked area and were accessible to residents.

Based on observation, documentation review, and interview, the manager failed to ensure equipment used at the assisted living facility was maintained in working order. Findings include: 1. During a tour of the garage, the Compliance Officer observed the exit door leading into the garage was unlocked. The Compliance Officer was able to gain access to the garage. The garage lights were not functioning, and the garage was dark. The Compliance Officer asked E7 to turn on the lights. However, E7 opened the garage door to allow sunlight into the garage. 2. A review of facility policies and procedures (P&P) revealed a P&P titled, "Equipment Inspection and Maintenance Policy and Procedures" The P&P stated, "It is the policy of Paradise Home in Phoenix to keep the facility and equipment in good repair." 3. In an interview while touring the garage, E7 reported E7 had to open the garage door because the garage lights were not working. In an exit interview, E6 acknowledged equipment used at the assisted living facility was not maintained in working order.