Paradise Living Centers Camelback LLC

Based on record review and interview, the manager failed to ensure that a personnel record for each employee included initial training and continued competency training in fall prevention and fall recovery for one of three employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E3’s personnel record revealed no documentation of Initial fall prevention and recovery training based on E3's hire date (September 2025). This document is required. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeat citation from the compliance inspection conducted on July 5, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure that the manager and caregivers provided evidence of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, and as specified in R9-10-113, for eleven of eleven personnel reviewed. The deficient practice posed a potential TB exposure risk to residents. The deficient practice also posed a risk as the Department was provided false or misleading information. Findings include: 1. R9-10-113.A states, "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. A review of E3’s personnel record revealed no documentation of evidence of freedom from TB, including screening for signs and symptoms. Based on E3's approximate date of hire (September 2025), this documentation was required. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's evacuation drill documentation revealed that the last evacuation drill was conducted on November 1, 2024. 2. In an interview, E1 acknowledged that an evacuation drill for employees and residents was not conducted at least once every six months.

Based on observation and interview, the manager failed to ensure 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. Findings include: 1. The compliance officer observed Lysol all-purpose cleaner, Spray Away glass cleaner, and Cascade Platinum accessible underneath the facility’s kitchen sink. 2. In an interview, E1 acknowledged that poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on record review and interview, 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 \'a7 36-420.04(A)(1)-(9), for one of one applicable resident reviewed. Findings include: 1. Review of Department documentation revealed an intake which reported that R2 had been transported from the facility to the hospital by Emergency Medical Services (EMS) on August 27, 2024. 2. In an interview, E1 reported that R2 had been transported to the hospital by EMS on August 27, 2024. 3. When the Compliance Officer requested documentation of compliance with this statute, E1 was not able to provide a copy of the documentation provided to the emergency responder.

Based on record review and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, for two of four caregivers sampled. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs. Findings include: 1. Review of E2's personnel record revealed that E2 worked as a caregiver. 2. Review of E2's personnel record revealed no documentation of E2's skills and knowledge. 3. Review of E3's personnel record revealed that E3 worked as an assistant caregiver. 4. Review of E3's personnel record revealed no documentation of E3's skills and knowledge. 5. In an interview, E1 acknowledged documentation was not available that showed E2's and E3's skills and knowledge were verified before the caregiver or assistant caregiver provided physical health services.

Based on documentation review and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. Review of the posted personnel schedules dated August and September 2024 revealed "Agency AM" was documented as working the following dates and times: -August 25 7a-7p; -August 31 7a-7p; -September 1 7a-7p; and -September 7 7a-7p. 2. Review of the posted personnel schedules dated August and September 2024 revealed "Agency PM" was documented as working the following dates and times: -August 25 7p-7a; -August 26 7p-7a; -August 27 7p-7a; -August 30 7p-7a; -August 31 7p-7a; -September 1 7p-7a; -September 2 7p-7a; -September 3 7p-7a; -September 7 7p-7a; and -September 8 7p-7a. 3. In an interview, E1 had to call the staffing agency to provide the names of the persons who worked each shift to the Compliance Officer, as E1 did not have documentation of which agency staff worked each shift. E1 acknowledged documentation was not maintained of the caregivers working each day.

Based on record review and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training before providing assisted living services, for one of four caregivers reviewed. The deficient practice posed a risk if a caregiver was unable to meet a resident's needs during an emergency. Findings include: 1. Review of E2's personnel record revealed E2 worked as a caregiver. The personnel record revealed a first aid and CPR card with an expiration date of August 19, 2024. There was no other current documentation of first aid and CPR training in E2's record. 2. In an interview, E2 reported not having acquired a new first aid and CPR card. 3. In an interview, E1 acknowledged E2's first aid and CPR training had expired.

Based on record review, documentation review, and interview, the manager failed to ensure a trained caregiver was present on the assisted living facility's premises when the manager was not present. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. Review of E3's personnel record revealed that E3 was hired as an assistant caregiver, and did not have a caregiver certification. 2. Review of the posted personnel schedules dated August and September 2024 revealed that E3 was the only staff member documented as working with "Agency pm" on the following dates and times: -August 25 7pm-7am; -August 26 7pm-7am; -August 27 7pm-7am; -August 30 7pm-7am; -August 31 7pm-7am; -September 1 7pm-7am; -September 2 7pm-7am; -September 3 7pm-7am; -September 7 7pm-7am;and -September 8 7pm-7am. 3. In an interview, E1 reported being on site during the 7pm-7am shit with E3 only on September 6. 4. In an interview, E1 reported that E5 worked with E3 during the 7pm-7am shift on September 1 and September 3. 5. A personnel record for E5 was not available for review, and no documentation that E5 had completed 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) was provided. 6. In an interview, E1 reported that E6 worked with E3 during the 7pm-7am shift on September 2 and September 7. 7. A personnel record for E6 was not available for review, and no documentation that E6 had completed a caregiver training program approved by the Department or the NCIA Board was provided. 8. In an interview, E1 reported that E7 worked with E3 during the 7pm-7am shift on August 30. 9. A personnel record for E7 was not available for review, and no documentation that E7 had completed a caregiver training program approved by the Department or the NCIA Board was provided. 10. In an interview, E1 acknowledged that there was no evidence that a trained caregiver was present during the following shifts: -August 25 7pm-7am; -August 26 7pm-7am; -August 27 7pm-7am; -August 30 7pm-7am; -August 31 7pm-7am; -September 1 7pm-7am; -September 2 7pm-7am; -September 3 7pm-7am; -September 7 7pm-7am; and -September 8 7pm-7am.

Based on observation, record review, and interview, the manager failed to ensure a personnel record was available for three of seven employees reviewed. The deficient practice posed a risk as required information could not be verified for E5, E6, and E7. Findings include: 1. In an interview, E1 reported that E5 worked during the 7pm-7am shift on September 1 and September 3. 2. In an interview, E1 reported that E6 worked during the 7pm-7am shift on September 2 and September 7. 3. In an interview, E1 reported that E7 worked during the 7pm-7am shift on August 30. 4. Review of the personnel records revealed no record for E5, E6, and E7. 5. In an interview, E1 reported that E5, E6, and E7 were hired through a staffing agency, and that personnel records had not been provided. E1 acknowledged a personnel record was not available for E5, E6, and E7.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for one of three residents reviewed who received directed care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. Review of R3's medical record revealed a current written service plan for directed care services dated March 25, 2024. However, a service plan after March 25, 2024 was not available for review. 2. In an interview, E1 acknowledged R3 received directed care services and a service plan updated at least once every three months was not available for review.

Based on record review and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver documented the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of one resident reviewed who had an incident resulting in the resident needing medical services. The deficient practice posed a health and safety risk. Findings include: 1. Review of Department documentation revealed an intake which reported that R2 had been transported from the facility to the hospital by Emergency Medical Services (EMS) on August 27, 2024. 2. In an interview, E1 reported that R2 had been transported to the hospital by EMS on August 27, 2024. 3. Review of R2's medical record revealed no documentation for the incident. 4. In an interview, E1 acknowledged R2's medical record did not include documentation showing the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future.

Based on observation, interview, documentation review, and record review, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery which included initial training, for one of four personnel members sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs during an emergency. Findings include: 1. During a tour of the facility, the Compliance Officer observed E5 working at the facility. 2. In an interview, E3 reported E5 was an assistant caregiver. 3. A documentation review revealed a personnel schedule dated between February 1, 2023, and July 5, 2023. The schedule revealed E5 worked on the following dates: - February 1-3, 5-10, 12-17, 19-24, and 26-28, 2023; - March 1-3, 5-10, 12-17, 19-24, and 26-31, 2023; - April 2-7, 9-14, 16-21, 23-28, and 30, 2023; - May 1, 4-8, 11-15, 18-22, and 25-29, 2023; - June 1-5, 8-12, 15-19, 22-26, and 28-30, 2023; and - July 1-5, 2023. 4. A review of E5's personnel record revealed E5 was hired as an assistant caregiver in mid 2022. The review revealed documentation demonstrating E5 received fall prevention and fall recovery training on April 11, 2023. However, the review revealed E5 did not receive fall prevention and fall recovery initially upon hire.

Based on observation and interview, the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver. The deficient practice posed a risk if an assistant caregiver was not qualified to provide the required services alone. Findings include: A.R.S. \'a7 36-401(A)(46) defines supervision as "direct overseeing and inspection of the act of accomplishing a function or activity." 1. During a tour of the facility conducted at approximately 8:30 AM, the Compliance Officer observed E5 and E6 working at the facility. The Compliance Officer observed no other personnel inside or outside of the home, including in the shared bathroom in the hall, until E3 arrived at approximately 9:15 AM. 2. In an interview, E3 reported E5 and E6 were assistant caregivers. E3 reported E4 and another caregiver were at the facility when the Compliance Officer arrived, but that E4 was outside on the phone and the other caregiver was in the bathroom. 3. The Compliance Officer observed E5 feeding R1 in R1's bedroom. The Compliance Officer observed no personnel member in the room directly overseeing E5 or inspecting the act of E5 feeding R1. 4. In an interview, E3 reported a certified caregiver was always present at the facility. However, E3 acknowledged the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver.

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 two residents sampled. The deficient practice posed a risk of an adverse health condition due to a medication not being administered as ordered. Findings include: 1. A review of R1's medical record revealed a service plan dated April 5, 2023. The service plan revealed R1 received medication administration. The review revealed a medication order for the following medications: - "Bupropion HCL 100 MG TABS 1 tablet (100) mg orally 2 times a day" with an "Orig Date" of April 26, 2023; and - "Debrox 6.5 % SOLN Administer 3 drops in both ers [ sic ] for 3 days (beginning 6/20/2023)." The review further revealed a medication administration record for June 2023. The medication administration record revealed the following: - R1 was not administered R1's bupropion in the evening on June 14, 2023, due to "AWAITING ARRIVAL FROM PHARMACY;" - R1 was not administered R1's bupropion in the morning on June 15, 2023, due to "AWAITING ARRIVAL FROM PHARMACY;" and - R1 received R1's Debrox on June 20-23, 2023, even though the order stated it was only to be administered "for 3 days." 2. In an interview, E3 stated, "If it's [R1's Debrox] signed off it was given on the 23rd." Regarding R1's bupropion, E3 confirmed the facility did not administer it due to not having it at the facility. 3. A review of R2's medical record revealed a service plan dated June 19, 2023. The service plan revealed R2 received medication administration. The review revealed a medication order for "Omeprazole 2 Capsule[s] DR ORAL 1 times a day (20 MG Capsule DR)" dated June 16, 2023. The review further revealed a medication administration record for June 2023. The medication administration record revealed R2 was not administered R2's omeprazole on June 17, 2023, due to R1 being "ASLEEP" at 7:30 AM. However, the medication administration record revealed R2 received three other medications at 8:00 AM on the same day, only half an hour later.