Prestige Home LLC

Based on the record review and interview, the manager failed to ensure that the facility had a personnel record for one of four sampled employees. Findings include: 1. A review of R1's medical record contained a document titled "Narcotic Record" dated August 2025, which stated E4 administered R1's oxycodone from August 20, 2025, through August 25, 2025. 2. In a request to review E4's personnel record revealed that there was no personnel record available for E4. 3. In an interview, E1 reported being unaware a personnel record was required for E4, since E4 worked for a few days.

Based on record review and interview, the manager failed to ensure, for one of one sampled resident who was unable to ambulate even with assistance, the resident's primary care provider (PCP) or other medical practitioner examined the resident at the onset of the condition or within 30 days before acceptance and at least once every six months throughout the duration of the resident's condition, to determine if the resident's needs could be met based upon a current examination and the assisted living facility's scope of services. Findings include: 1. In an interview, E1 reported R1 was wheelchair-bound due to an inability to ambulate even with assistance since being accepted to the facility. 2. A review of R1's medical record revealed that R1 required personal care services. The medical record contained a documented determination dated April 3, 2024, indicating R1's needs could be met by the facility despite R1 being unable to ambulate even with assistance. There was no more recent documented determination completed by R1's PCP or a medical practitioner at least every six months throughout the duration of the resident's condition. 3. In an interview, E1 acknowledged that the required documentation for R1 was not completed as required.

Based on documentation review and interview, the manager failed to ensure a caregiver provided documentation of completion of 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), for one indiviudal hired as a caregiver. The deficient practice posed a risk if E3 was not qualified to provide the required services to residents. Findings include: 1. A review of documentation provided by E1 revealed a document titled "PARAHEALTH PROFESSIONALS" dated June 3, 2023, with an expiration date of June 3, 2025 for E3. The document stated "...[E3]...has completed all requirements and has been awarded the following designation: CERTIFIED NATIONALLY - CAREGIVER, CN-CG...completed a city, county or state approved caregiver program..." 2. A review of "https://az.tmuniverse.com" revealed E3 had not completed a caregiver training program. 3. In a joint interview, E1 and E2 acknowledged the caregiver certificate was not valid.

Based on observation, record review, documentation review and interview, the manager failed to ensure a personnel record for each employee included documentation of the requirements in R9-10-806(C)(1)(a)(b)(c)(i-iv)(ix) for one of four employees sampled, and documentation of the requirements in R9-10-806(C)(1)(c)(i)(iii) for two of four employees sampled. The deficient practice posed a risk if E1, E3, and E4 were unable to meet a resident's needs, and the required information could not be verified for E3. Findings include: 1. The Compliance Officer observed E3 on the premises and working alone upon arrival to the premises. 2. A review of E1's (hired in 2020) personnel record revealed documentation of E1's skills and knowledge applicable to E1's job duties and E1's completed orientation was not available for review. 3. A review of E4's (hired in 2021) personnel record revealed documentation of E4's skills and knowledge applicable to E4's job duties and E4's completed orientation was not available for review 4. A review of documentation provided by E1, revealed the following documentation for E3: -Documentation of evidence from infectious tuberculosis (TB); and -Cardiopulmonary resuscitation training (CPR) and first aid training. However, documentation of the requirements in R9-10-806(C)(1)(a)(b)(c)(i-iv)(ix) was not available for review. 5. In an interview, E1 acknowledged a personnel record for E1 and E4 to include the requirements in R9-10-806(C)(1)(c)(i)(iii) was not available for review. 6. In an interview, E1 acknowledge a personnel record for E3 to include the requirements in R9-10-806(C)(1)(a)(b)(c)(i-iv)(ix) was not available for review.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for three of 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 (accepted in March 2023) medical record revealed documentation to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was not available for review. 2. A review of R3's (accepted in June 2023) medical record revealed documentation to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was not available for review. 3. A review of R4's (accepted in June 2023) medical record revealed documentation to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was not available for review. 4. In a joint interview, E1 and E2 acknowledged documentation to include whether R2, R3, and R4 required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was not available for review.

Based on documentation review, record review, and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility to include the requirements in R9-10-807(D)(1-10), for one of four residents sampled. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of Department documentation revealed the facility's perpetual license was effective on April 13, 2023. 2. A review of R1's medical record revealed a residency agreement with AL11427 (closed facility) dated in November 2022. However, a residency agreement with AL12516 was not available for review. 3. In a joint interview, E1 and E2 acknowledged R1's residency agreement was not completed for AL12516.

Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after a resident's date of acceptance, for one of four residents sampled. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident. Findings include: 1. A review of R2's (accepted in 2023) medical record revealed a written service plan was not available for review. 2. In a joint interview, E1 and E2 acknowledged a written service plan was not completed within 14 calendar days after R2's acceptance.

Based on documentation review, record review, and interview, the manager failed to ensure a resident's medical record contained documentation of assisted living services provided to the resident, for one of four residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan (dated in May 2023) for personal care services. The service plan stated R1 was to receive assistance in activities of daily living. However, documentation of assisted living services were not available for review. 2. In an interview, E1 reported there were no documented assisted living services for R1. 3. In a joint interview, E1 and E2 reported assisted living services were provided to R1 and acknowledged documentation of assisted living services provided to R1 were not available for review