Peachtree Assisted Living Home

Based on record review and interview, the assisted living home failed to maintain written documentation of emergency responder (EMS) information that included the items listed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1-9) for two of two residents sampled. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident. Findings include: 1. A review of R1 and R2's medical records revealed no documentation of the standardized EMS form that includes the following: The reason or reasons the emergency responder was requested; Whether the resident receives medication services and, if the resident had provided this information to the assisted living center, a list of all the resident's prescription and over-the-counter medications, their dosages, and how frequently they were administered; The name, address, and telephone number of the resident's current pharmacy; A list of any known allergies to any medications, additives, preservatives, and materials like latex or adhesive; The name and contact information for the resident's primary care physician and power of attorney or authorized representative; Basic information about the resident's physical and mental conditions and basic medical history, as well as dates of recent episodes, if known; The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number, and email address; A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge; A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. 2. In an exit interview, findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in A.R.S. § 36-411(C)(1), for one of two personnel sampled. The deficient practice posed a risk to the health and safety of residents. Findings include: 1. A.R.S. § 36-411(C)(1) 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. 2. Review of E2’s personnel record revealed no work history to confirm the references checked were previous employers. On the reference checks there were no titles to the references to confirm the references were previous employers. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of a resident, an individual submitted documentation that was dated within 90 calendar days before the resident was accepted by an assisted living facility and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services it included whether the individual required continuous medical services, continuous or intermittent nursing services, restraints; and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant for two of the four residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2’s medical record revealed that the required elements were documented; however, the documentation was not completed within 90 days of acceptance. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident had a written service plan which included the amount, type, and frequency of assisted living services being provided, for two of two residents sampled. Findings include: 1. A review of R1 and R2’s medical records revealed a written and signed service plan. R1 and R2's service plan included the services “Bathing,” “Hygiene/Grooming,” “Activity,” and “Nutrition/Hydration,” which identified the services to be provided; however, the service plan did not indicate the amount of assistance the resident required or the frequency of either service. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that oxygen containers were secured in an upright position. The deficient practice posed a potential explosion or leak of a compressed gas. Findings include: 1. During the environmental inspection of the facility with E2, the Compliance Officers observed an unsecured oxygen tank in R1's room against the wall in R1's closet. 2. The Compliance Officers also observed an oxygen tank leaning against another oxygen tank and not secured in an upright position. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure medication was administered in compliance with a medication order, for one of three residents reviewed. The deficient practice posed a health risk to the resident. Findings include: 1. Review of R3’s medical record revealed a signed service plan dated February 20, 2025. This service plan indicated R3 received medication administration. 2. Review of R3’s medical record revealed a medication administration record (MAR) for the month of May 2025. This MAR revealed Tramadol HCL 50 mg was administered May 1st - May 14th. 3. Review of R3’s medical record revealed a signed medication order dated May 1, 2025. This order stated, “tramadol HCL oral tablet 50 mg, take one tablet by mouth every night at bedtime”. 4. In an interview, E2 reported the order for Tramadol HCL 50 mg was only for 14 days. However, there was no order provided at the time of the inspection that stated Tramadol was only to be administered for 14 days. A discontinuation order was not provided at the time of inspection. 5. In an interview, E1 and E2 acknowledged a medication was not administered in compliance with a medication order.

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 used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During the tour of the facility, the Compliance Officer observed a cabinet that held six residents' medications unlocked. The cabinet door had a locking device, however was not locked. 2. The Compliance officer observed a tube of Triple Antibiotic Ointment on the kitchen counter. 3. A review of the facility's policies and procedures revealed a policy titled, "Safe Storage of Medicine," which stated in section two, "When medications are stored in a locking container such as a bin or a cabinet, both the container and the medication room should be kept locked when not in use." 4. In an interview, E2 acknowledged medications were not stored in a separate locked room, closet, cabinet, or self-contained unit.

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During a tour of the facility, the Compliance Officer observed a storage cabinet locked with a padlock in the facility. However, the Compliance Officer was still able to partially open the doors and reach into the cabinet. The Compliance Officer was able to pull out the toxic materials that were stored within. The following toxic materials were stored on the top shelf of the cabinet: - A spray canister of Roach & Ant Killer - Lysol Toilet Bowl Cleaner - A spray bottle of Great Value All Purpose Cleaner with Bleach 2. A review of the facility's policies and procedures revealed a policy titled "Environmental Standards" which stated in section two, "Poisonous or toxic materials stored by the facility are stored in the original labeled containers or safety containers in a locked area inaccessible to residents." 3. In an interview, E2 acknowledged poisonous or toxic materials were not maintained in a locked area inaccessible to residents.

Based on interview and documentation review, 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. During an interview, R1, R2, and R3 reported E3 and E4 worked at the facility on the weekends. 2. Review of the June 2023 personnel schedule revealed no hours worked for E3 and E4. 3. During an interview, E1 acknowledged documentation was not maintained of the caregivers and assistant caregivers working each day, including the hours worked by E3 and E4. 4. Technical assistance was provided on this Rule during the compliance inspection conducted February 16, 2022.

Based on interview and record review, the manager failed to ensure a personnel record was established and maintained for each employee as required. The deficient practice posed a risk as required information could not be verified for E3 and E4. Findings include: 1. During an interview, R1, R2, and R3 reported E3 and E4 worked at the facility on the weekends. 2. Review of the personnel records revealed no record for E3 and E4. 3. During an interview, E1 acknowledged a personnel record was not available for E3 and E4.

Based on observation and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. Findings include: 1. The Compliance Officer observed a notice on the back door that stated "Door - Open - 7:00AM Close - 6:00PM". 2. During an interview, R1 and R2 reported the back door was locked at 6pm and the residents were not allowed to go outside after that. R1 and R2 additionally reported everyone in the facility had to go to bed at 6pm. R1 and R2 reported feeling like they were treated like babies and would like to have the ability to choose their own bedtime. 3. During an interview, E1 reported E3 enforced locking the back door at 6pm and the 6pm bedtime.

Based on documentation review and interview, the manager failed to ensure a food menu included any food substitutions no later than the morning of the day of meal service with a food substitution. Findings include: 1. Review of the facility's posted menu revealed a menu dated June 2023. The Tuesday, June 6th breakfast menu stated: "Eggs, oatmeal, sausage, milk/juice/coffee, fruits" 2. During an observation, the Compliance Officer observed R1 eating waffles and a banana for breakfast. 3. During an interview, R2 and R3 reported R2 and R3 had frosted flakes and a banana for breakfast. 4. During an interview, E1 acknowledged the substitutions were not documented on the food menu.

Based on documentation review and interview, the manager failed to ensure a pest control program that complied with A.A.C. R3-8-20l(C)(4) was implemented and effective. Findings include: 1. R3-8-201.C.4. stated "An individual may not provide pest management services at a school, child care facility, health care institution, or food-handling establishment unless the individual is a certified applicator in the certification category for which services are being provided." 2. During an interview, E1 and R2 reported E4 had sprayed the facility with chemicals in an attempt to treat for bed bugs. E1 reported E4 was not a licensed applicator. 3. Review of the facility's pest control records revealed the facility was treated for bed bugs on May 9, 2023 and May 25, 2023 by Arizona Heat Pest Services. 4. During an interview, R2 reported R2 had seen a few bed bugs and R4 had bites all down R4's arm. 5. During an interview, R3 reported R3 had bed bug bites on R3's knee. 6. During an interview, E1 acknowledged bed bugs were observed in the facility.

Based on observation and interview, the manager failed to ensure equipment used was maintained in working order. Findings include: 1. During the facility tour with E1, the Compliance Officer observed an inoperable shower nozzle in the only common bathroom. 2. During an interview, E1 acknowledged the common bathroom shower nozzle was not maintained in working order.

Based on observation, documentation review, and interview, the administrator failed to ensure a resident bedroom was not used as a passageway to a common area, another sleeping area, or common bathroom before October 1, 2013 unless written consent was obtained from the resident or the resident's representative. The deficient practice posed a potential privacy rights violation to the resident. Findings include: 1. During the investigation, the Compliance Officer observed R3's bedroom, bathroom, and closet. The surveyor observed a bed, luggage, and personal belongings in the closet. 2. During an interview, R3 reported E1 and E2 slept in the closet. 3. A review of Department documentation revealed AL7402 was licensed in 2009. 4. Review of R3's record revealed no documentation of written consent for E1 and E2 to pass through R3's bedroom to use the closet. 5. During an interview, E1 acknowledged E1 and E2 slept in the R3's closet and a resident bedroom was used as a passageway and written consent was not obtained. 6. Technical assistance was provided on this Rule during the compliance inspection conducted February 16, 2022.