Paradise Living Centers Camelback LLC

Based on record review, documentation review, 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. The deficient practice posed a risk as the Department was unable to verify services were provided to residents as documented. Findings include: 1. A review of the medical records of R1 and R2 revealed printed medication administration records (MAR) dated November 2023. The MARs revealed the following: -E5 administered "Levothyroxine" to R1 at 6:00 AM on November 1-2 and 5-8, 2023; -E5 administered "Levothyroxine" to R2 at 5:00 AM on November 1-3 and 5-7, 2023; and -E5 administered "Brimonidine" to R2 at 8:00 PM on November 1-3 and 5-7, 2023. 2. A review of facility documentation revealed a series of personnel schedules dated between November 1, 2022, and November 9, 2023. The schedules revealed the following: -No schedule dated January 2023; -E5 did not work at 5:00 AM on November 6, 2023, contradicting the MAR; and -E5 did not work at 8:00 PM on November 3 and 5, 2023, contradicting the MAR. 3. In an interview, E2 reported the facility had the aforementioned printed/paper copy of all MARs in case the computer system was not working properly as well as a digital copy that could be printed from the computer system itself. E2 reported E2 would have another personnel member print off the MARs for R1 and R2 from the computer system and provide them to the Compliance Officer. E2 reported the personnel schedule was not entirely accurate, reporting individuals have called off work on certain shifts and others have taken over without it being documented. 4. A review of R1's and R2's medical records revealed the newly printed copy of R1's and R2's MARs for November 2023 from the computer system. The newly printed MARs revealed the following: -E3 administered "Levothyroxine" to R1 at 6:00 AM on November 1-2 and 6-8, 2023, contradicting the paper copy of the MAR; -E7 administered "Levothyroxine" to R1 at 6:00 AM on November 5, 2023, contradicting the paper copy of the MAR; -E3 administered "Levothyroxine" to R2 at 5:00 AM on November 1-3, 2023, contradicting the paper copy of the MAR; -E7 administered "Levothyroxine" to R2 at 5:00 AM on November 5, 2023, contradicting the paper copy of the MAR; -E3 administered "Brimonidine" to R2 at 8:00 PM on November 1-3 and 6-7, 2023, contradicting the paper copy of the MAR; -E7 administered "Brimonidine" to R2 at 8:00 PM on November 5, 2023, contradicting the paper copy of the MAR; and -E6 and E8 administered medication on November 4, 2023. 5. A review of facility documentation revealed the aforementioned personnel schedules dated between November 1, 2022, and November 9, 2023. The schedules revealed the following: -E3 did not work at 6:00 AM on November 1-2 and 6-8, 2023, as documented on the newly printed MAR; -E7 did not work at 6:00 AM on N

Based on documentation review, interview, and record review, the manager failed to ensure a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation training certification specific to adults before providing assisted living services to a resident, for two of six personnel members sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "FIRST AID AND CPR TRAINING" dated August 1, 2022. The policy and procedure stated: "In order to keep First Aid and CPR training and skills up to date, it is required that each employee that is a caregiver and volunteer if volunteer has scheduled time of more than 8 hours per week and/or is not a minor, to provide the following: Documentation that verifies that the employee or volunteer has received CPR and First Aid training." 2. In an interview, E2 reported E5 and E6 were caregivers. 3. A review of the personnel records of E5 and E6 revealed the following: -A CPR and first aid training certificate for E5 dated as expired on October 10, 2023; -No current CPR and first aid training certificate for E5 dated after October 10, 2023; -A CPR and first aid training certificate for E6 dated as expired on April 9, 2023; -A CPR and first aid training certificate for E6 dated as issued on July 10, 2023; and -No CPR and first aid training certificate for E6 dated between April 9, 2023, and July 10, 2023. 4. A review of facility documentation revealed daily staffing schedules dated between April 9, 2023, and November 9, 2023. The schedules revealed E5 worked alone on several shifts each week between October 10, 2023, and November 9, 2023. 5. A review of R4's medical record revealed E6 administered medication to R4 on June 16, 2023. 6. In an interview, when the Compliance Officer asked if E5 had another CPR and first aid certification after the certification dated as expired on October 10, 2023, E2 stated, "If it's not in there, no." E2 offered no comment regarding E6's CPR and first aid certifications.

Based on observation, record review, and interview, the manager failed to ensure a resident had a documented residency agreement with the assisted living facility, for one of two residents sampled. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. The Compliance Officer observed R1 at the facility. 2. A review of R1's medical record revealed a residency agreement. However, the agreement stated it was between R1 and a different assisted living facility, not AL11999 Paradise Living Centers Camelback LLC. 3. In an interview, E2 reported R1 "recently" transferred to this facility from the other facility noted on R1's residency agreement. E2 acknowledged R1 did not have a residency agreement with this facility.

Based on documentation review, observation, interview, and record review, 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 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 this facility was authorized to provide directed care services. 2. During the environmental inspection of the facility, the Compliance Officer observed two sliding glass doors next to each other leading from a common area out to the back yard. The Compliance Officer observed the doors had alerts installed but the alerts were missing the magnet portions. Upon opening the door, the alerts did not sound. The Compliance Officer observed R1 exit from the facility through the sliding glass doors multiple times during the inspection. Additionally, in bedrooms 4, 5, 7, and 8, the Compliance Officer observed doors leading from said bedrooms out into the back yard. The Compliance Officer observed each of the four doors had an alert installed. However, the alerts could only be heard in some parts of the facility and not throughout the entire facility. 3. In an interview, E2 reported the sliding glass doors had magnets at one point. 4. A review of R2's medical record revealed a current service plan. The service plan stated, "Door Alarms Always On." 5. In an interview, the Compliance Officer reviewed the findings with E2 and E2 provided no additional information. This is a repeat citation from the previous compliance inspection conducted on September 8, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order and documented in the resident's medical record, for two of two residents sampled. The deficient practice posed a risk as the Department was provided false or misleading information. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Medications" dated August 1, 2022. The policy and procedure stated: "Medication administration records will be filled by the authorized personnel that are doing medication administration and/or assisting in self-administration only after observing the resident taking the medication. Time and date will be recorded as well as the initials of the person that administered the medication or assisted in the self-administration of medication." 2. A review of R1's medical record revealed a current service plan indicating R1 received medication administration services. R1's medical record also contained medication orders for "MIRTAZAPINE 15 MG (milligrams) TABS Take 1 tablet (15 mg) by mouth every night at bedtime" and "QUETIAPINE FUMARATE (100 MG) TABS Take 1 tablet (100 mg) by mouth every night at bedtime." 3. In an interview, E2 reported the facility had a paper copy of all medication administration records in case the computer system was not working properly as well as a digital copy that could be printed from the computer system itself. E2 reported E2 would have another personnel member print off the medication administration records for R1 and R2 from the computer system and provide them to the Compliance Officer. 4. A review of R1's medical record revealed the newly printed copy of R1's medication administration record (MAR) for November 2023 from the computer system. The newly printed MAR revealed no documentation demonstrating R1 received R1's "Mirtazapine" or "Quetiapine" on November 5, 2023, until after the MAR was printed and an unknown individual wrote in E3's initials for both medications. 5. A review of R2's medical record revealed a current service plan indicating R2 received medication administration services. R2's medical record also contained the following medication orders: -"BRIMONIDINE TARTRATE 0.15 % SOLN Instill 1 drop ophthalmic Eye 3 times daily," -"DORZOLAMIDE HCL 2 % DROPS INSTILL 1 DROP...THREE TIMES...DAILY AT 07:00, DAILY AT 13:00, DAILY AT 21:00," -"DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE TAKE 1 CAPSULE TWICE A DAY," -"LEVOTHYROXINE SODIUM 175 MCG (micrograms) TABLET 1 TAB BY MOUTH EVERY DAY...DAILY AT 05:00," -"MIDODRINE HCL 10 MG TABLET TAKE 1 TABLET 3 TIMES A DAY," -"QUETIAPINE FUMARATE 25 MG TABLET TAKE 1 TABLET TWICE A DAY," -"TRAMADOL HCL F/C 50 MG TABLET TAKE 1 TABLET EVERY 8 HOURS ...DAILY AT 06:00, DAILY AT 14:00, DAILY AT 20:00," and -"WARFARIN SODIUM 4 MG TABLET TAKE 2 TABLETS ...BY MOUTH DAILY." 6. Further review of R2's medical record revealed the newly print

Based on documentation review, observation, and interview, the manager failed to ensure medication stored by an assisted living facility was stored in a separate locked room, closet, cabinet, or 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. A review of facility documentation revealed a policy and procedure titled "Medications" dated August 1, 2022. The policy and procedure stated, "All resident medications must be secured in a locked storage area." 2. During the environmental inspection of the facility, the Compliance Officer observed an open door missing its top half leading into an office area. In the office area, the Compliance Officer observed two unlocked cabinets, one with a bottle of "Polyethylene Glycol" inside and the other with a bottle of "Acetaminophen" inside. The Compliance Officer further observed an unlocked refrigerator with medications belonging to residents inside, including controlled substances. 3. In an interview, the Compliance Officer reviewed the findings with E2 and E2 offered no further comment.

Based on record review and interview, the manager failed to ensure a caregiver or assistant caregiver documented the individuals notified by the caregiver or assistant caregiver for an accident, emergency, or injury resulting in a resident needing medical services. The deficient practice posed a risk if the resident did not receive adequate follow-up care. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-818(D)(1) states: "D. When a resident has an accident, emergency, or injury that results in the resident needing medical services, a manager shall ensure that a caregiver or assistant caregiver: 1. Immediately notifies the resident's emergency contact and primary care provider;" 2. A review of R3's medical record revealed an "Accident/Incident Report" dated April 2, 2023. The report stated R3 fell, "sustained a head injury," "911 was called," and emergency medical personnel "[took R3] to the hospital." The report revealed no documentation demonstrating a caregiver or assistant caregiver documented the individuals notified by the caregiver or assistant caregiver other than facility personnel, including the resident's emergency contact and primary care provider as required in A.A.C. R9-10-818(D)(1). 3. In an interview, E2 reported R3's emergency contact and primary care provider were notified. However, E2 acknolwedged the notification was not documented.

Based on documentation review, observation, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area separate from medications and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the materials. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Environmental Standards" dated August 1, 2022. The policy and procedure stated, "Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation areas." 2. During the environmental inspection of the facility, the Compliance Officers observed an open door missing its top half leading into an office and laundry area. In the laundry area, the Compliance Officer observed a variety of poisonous or toxic materials accessible to residents, including air freshener, "Comet" cleaner, fabric softener, floor cleaner, furniture polish, glass cleaner, laundry soap, multi-purpose cleaner, stainless steel cleaner and polish, and toilet bowl cleaner. Additionally, in a hall bathroom accessible to residents, the Compliance Officer observed a spray can of air freshener. 3. In an interview, the Compliance Officer reviewed the findings with E2 and E2 offered no further comment. This is a repeat citation from the previous compliance inspection conducted on September 8, 2022.