Paradise Senior Living, LLC

Based on record review and interview, the healthcare institution failed to ensure initial training was documented for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. A review of E2's personnel record revealed no initial fall prevention and fall recovery training. Based on E2's hire date, this documentation was required. 2. In an interview, E1 acknowledged that E2's personnel record did not include documentation of initial fall prevention and fall recovery training.

Based on record review and interview, the manager failed to ensure that a personnel record for each employee included documentation of compliance with the requirements in A.R.S. § 36-411 (C)(1), for two of three personnel records sampled. The deficient practice posed a risk if the employees were a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411(C) states: "C. Each residential care institution, nursing care institution and home health agency 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. The Compliance Officers observed that E2 and E3 were present at the facility and actively providing services to residents. 2. A review of E2's and E3's personnel records revealed a valid fingerprint clearance card. However, documentation of compliance with A.R.S. § 36-411(C)(1) was not available for review. 3. In an interview, E1 acknowledged documentation of compliance with A.R.S. § 36-411(C)(1) for E2 and E3 was not available for review.

Based on observation, 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 three personnel sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings included: 1. The Compliance Officers observed that E2 and E3 were present at the facility and actively providing services to residents. 2. A review of E3's personnel record revealed no documentation of first aid and CPR training in E3's personnel record. 3. In an interview, E1 acknowledged that E3 did not have current documentation of first aid and CPR training.

Based on observation, record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided health services, for one of three personnel sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs Findings include: 1. The Compliance Officers observed that E2 and E3 were present at the facility and actively providing services to residents. 2. A review of E3's personnel record revealed documentation of a skills and knowledge checklist. However, the checklist was blank. 3. In an interview, E1 reported that E1 had not been able to put E3's record together yet and acknowledged that E3's personnel record did not include documentation of verifying E3's skills and knowledge before E3 provided physical health services.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of evidence of freedom from infectious tuberculosis (TB), as specified in R9-10-113, for one of three personnel sampled. The deficient practice posed a potential TB exposure risk to residents. 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, provides volunteer services for the health care institution, or is admitted to 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 (CDC) website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative 3. A review of E3's personnel record revealed a negative TB skin test that was less than 12 months old, however, no documentation of a second negative TB skin test was available for review. Based on E3's hire dates, this documentation was required. 4. In an interview, E1 acknowledged that E3's personnel record did not contain documentation of freedom from TB as specified in A.A.C. R9-10-113.

Based on observation, record review, and interview, the manager failed to ensure that a caregiver received orientation that was specific to the duties to be performed by the caregiver before providing assisted living services to a resident, for one of three personnel sampled. The deficient practice posed a risk if the employees were unable to meet residents' needs. Findings include: 1. The Compliance Officers observed that E3 was present at the facility and actively providing services to residents. 2. A review of E3's personnel record revealed no documentation of E3's orientation before providing health services. 3. In an interview, E1 acknowledged that documentation was not available showing E3 received orientation before providing assisted living services to a resident.

Based on record review and interview, the manager failed to ensure a service plan included documentation of the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated, for one of two residents sampled. The deficient practice posed a health and safety risk to the residents. Findings include: 1. A review of R1's service plan dated March 10, 2025, revealed R1 received directed care services. This service plan did not include documentation of R1's weight. The service plan stated "see no weight order." However, no documentation was available during the inspection for a no weight order. 2. In an interview, E1 acknowledged R1's service plan did not include documentation of R1's weight, and documentation was not available in R1's medical record from a medical practitioner stating weighing R1 was contraindicated.

Based on documentation review, observation, and interview, for a facility authorized to provide directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area 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 general or specific whereabouts of a resident. Findings include: 1. A review of the facility license revealed the facility was licensed for directed care. 2. The Compliance Officers observed multiple ambulatory residents. 3. During an environmental tour, the Compliance Officers observed the sliding door leading to the backyard. The door leading out to the backyard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the door was not secured, and the door chime was turned off. 4. In an interview, E1 acknowledged that a means of exiting the facility to an outside area did not control or alert employees of the egress of a resident from the facility.

Based on record review and interview, the manager failed to ensure that a medication administered to a resident was documented in the resident's medical record, for one of two residents sampled. The deficient practice posed a risk as medication could not be verified as administered against a medication order, and the Department was provided false or misleading documentation. Findings include: 1. A review of R1's medical record revealed a service plan for directed care services dated March 2025. This service plan indicated R1 received medication administration. 2. A review of R1's medical record revealed a signed medication order (dated March 19, 2025) for the following medication: -Quetiapine 50MG 1Tablet by mouth at noon. 3. The Compliance Officers observed that Quetiapine 50 mg was available. 4. A review of R1's medical record revealed a May 2025 Medication Administration Record (MAR), and R1's aforementioned medication was documented as administered on May 1 - 12 at 8:00 am and 1:00 pm. 5. In an interview, E1 reported R1’s medication was administered correctly, however, the MAR was documented inaccurately. This is a repeat deficiency from the inspection conducted on June 30, 2023.

Based on observation and interview, for two common bathrooms, the manager failed to ensure the bathroom contained paper towels in a dispenser or a mechanical air hand dryer. The deficient practice posed a potential risk to infection control. Findings include: 1. During the environmental tour, the Compliance Officers observed that there were no paper towels in a dispenser or a mechanical air hand dryer available for two of the common area bathrooms in the facility used by residents and visitors. 2. In an interview, E1 acknowledged the bathrooms used by more than one resident did not contain paper towels in a dispenser or a mechanical air hand dryer.

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. Findings include: 1. Review of R1's medical record revealed no documentation stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1's acceptance date, this documentation was required. 2. During an interview, E1 reviewed R1's medical record. E1 acknowledged R1's medical record included a signed authorization for R1 to be admitted to the assisted living facility. E1 acknowleded however, R1's medical record 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 record review and interview, the manager failed to ensure a caregiver documents the services provided in the resident's medical record. Findings: 1. Review of R1's personal care service plan dated February 14, 2023, identified "Peri care daily, requires repositioning every 2-3 hours, brush teeth daily, and comb hair daily." A review of R1's record revealed no documentation to demonstrate R1 received the identified services on June 28, 2023 and June 29, 2023. 2. Review of R2's directed care service plan dated June 12, 2023, identified ""Peri care daily, requires repositioning every 2-3 hours, brush teeth daily, and comb hair daily." A review of R2's record revealed no documentation to demonstrate R2 received the identified services on June 28, 2023 and June 29, 2023. 3. In an interview, E1 reported E2 provided the identified services to R1 and R2 however E2 reported to E1 that E2 did not document the services in the medical records. E1 acknowledged the manager failed to ensure a caregiver documents the services provided in the resident's medical record.

Based on documentation review, record review, observation, and interview, the manager accepted and retained a resident who were confined to a bed or chair because of an inability to ambulate even with assistance, without a determination from a medical practitioner which stated that the resident's needs could be met by the facility. Findings include: 1. A review of the facility records revealed the facility is licensed for Directed level of care. 2. A review of R1's medical record revealed a personal care service plan completed on August 16, 2022, and February 14, 2023. The service plans identified R1 as "non ambulatory." The medical record contained a document dated August 7, 2022, provided to a medical practitioner which stated that the resident's needs could be met by the facility. However this documentation did not include a signature from the medical practitioner. 3. In an interview, E1 reviewed R1's medical record. E1 acknowledged R1 was admitted to the facility and identified as "non-ambulatory." E1 contacted R1's medical provider by phone during the inspection. E1 reported E1 provided the requested documentation to the medical practioner however it was not signed and returned to the facility. E1 acknowledged R1's medical record did not contain a determination from a medical practitioner which stated that the residents' needs could be met by the facility.

Based on documentation review, record review, observation, and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record. Findings include: 1. A review of the facilities policies and procedures titled "Recording Medications." The policy states; " The Medication Administration (MAR) must be immediately updated each time the medication is offered or administered." 2. A review of R2's medical record revealed R2 receives medication administration. 3. A review of R2's medical record revealed signed medication orders for the following medications; Amiodarone 200 mg 1 tab QD PO, Eliquis 5 mg 1 tab BID PO, Midodrine HCL 10 mg 1 tab TID PO, Olanzapine 5 mg 1 tab QHS PO, Atorvastatin 40 mg 1 tab QHS PO, Quetapine Fumurate 100 mg 1 Tab QHS PO, Trazodone 100 mg 1 tab QHS PO, Folic Acid 1 mg 1 tab QD PO, Cyanocobalamin 1000 MCG 1 tab QD PO, and Ferrous Sulfate 325 mg 1 tab QD PO. A review of R2's medical record revealed the identified medications were not documented as administered to R2 on June 28, 2023, June 29, 2023, and June 30, 2023, am dosage. 4. The compliance officer observed R2's medications were available at the facility. 5. In an interview, E1 reported E2 reported to E1 that E2 administered the identified medications, and that E2 forgot to document the administration of medication on the dates identified. E1 acknowledged the manager failed to ensure medication administered to a resident was documented in the resident's medical record.