Pleasant Ville Assisted Living Home LLC

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 four of four 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, R2, R3 and R4’s medical records revealed a standardized form that did not include the following: The name, address and telephone number of the resident's current pharmacy; The name and contact information for the resident's primary care physician; The point-of-contact information for the assisted living center or assisted living home; and A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living home to plan for the resident's discharge. 2. In an exit interview, findings were reviewed with E1 and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure an assisted living facility authorized to provide directed care services provided access to an outside area that monitored 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. Documentation review revealed that the facility was licensed at the directed care level. 2. During an environmental inspection, the Compliance Officer observed sliding doors located in two separate residents' rooms of the facility. Each room was assigned as a private room. The doors did not have an egress alert or a monitoring system. Each door provided access to the patio and backyard. 3. In an exit interview, the findings were discussed with E1, and no further information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure an individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility including whether the individual required restraints for two of two residents sampled. Findings include: 1. A review of R1's and R2's medical records revealed a document titled "Admission Orders." This document was signed by a medical practitioner within 90 calendar days before admission and stated each resident did not require continuous medical services or continuous nursing services. However, the document did not state whether each resident required restraints. 2. In an interview, E1 acknowledged the admissions form provided by the facility for R1 and for R2 did not include the required verbiage stating whether the resident required restraints.

Based on observation and interview, the manager failed to ensure the hot water temperature was maintained between 95 \'b0F and 120 \'b0F in areas of the assisted living facility used by residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed the hot water temperature measured at 124.5\'b0 F in a shared bathroom. 2. In an interview, E1 acknowledged the hot water temperature had not been maintained between 95 \'b0F and 120 \'b0F in areas of the assisted living facility used by residents.