Pura Vida Assisted Living

Based on record review and interview, the assisted living home failed to maintain a copy of the document provided to the emergency responder and documentation of the actions required by subsection B of this section. Findings include: 1. A review of R2's medical record revealed documentation indicating the facility had contacted emergency responders on R2's behalf on August 1, 2025. 2. During the on-site inspection, the Compliance Officer requested to review a copy of the documentation provided to the emergency responder. A copy of the facility’s standardized form was provided; however, copies of R2’s medications at the time of transport, the resident’s health insurance portability and accountability act release, advanced directives, or documentation R2’s authorized representative had been contacted was unavailable for review. 3. In an interview, E1 reported the caregiver had not made a copy of all of the documents given to the emergency responder. 4. 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 an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, as specified in R9-10-113, for three of nine employees sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. During a tour of the facility, the Compliance Officer observed E3 working in the facility and providing assisted living services. 2. A review of E3’s personnel record revealed evidence of documentation of baseline screening for signs and symptoms, and an assessment of risk of exposure to active TB was unavailable for review. Further review revealed evidence of documentation of two negative skin tests for TB. Documentation for the initial skin test indicated placement of the test on September 5, 2025, and a negative reading was obtained on September 8, 2025. Documentation pertaining to the second skin test indicated the test was read on September 6, 2025; documentation of the date of placement was unavailable for review. 3. In an interview, E1 agreed E3’s two-step skin test for infectious TB was not performed at least seven days apart, and E3’s personnel record did not contain evidence of baseline screening. 4. In an exit interview, the findings were discussed with E1, and no additional information was provided. E1 acknowledged E3 did not provide documentation of freedom from infectious TB as specified in R9-10-113 on or before the date E3 began providing services at or on behalf of the assisted living facility.

Based on documentation review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented an event in which a resident had an accident, emergency, or injury and needed medical services, as required per R9-10-818.D.2. Findings include: 1. A review of facility incident reports from July 1, 2025, through August 31, 2025, revealed one incident report involving R2 having been involved in an unwitnessed fall. The incident report indicated the date and time R2 was discovered, and a brief description of the accident, but did not include a description of any injury. Furthermore, the report did not include any actions taken by the caregiver, nor did it include documentation of immediate notification of R2’s emergency contact or primary care provider. 2. In an interview, E1 recalled R2 may have hit their head when they fell, and as a precaution, emergency medical services were called; R2 was transported to the hospital. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided. E1 acknowledged the incident report dated January 28, 2025, did not contain all documentation as required per R9-10-818.D.2.

Based on documentation review, observation, record review, and interview, the governing authority failed to designate a manager who had either a temporary or permanent manager's certificate from the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers, which posed a health and safety risk. The deficient practice posed a risk as the assisted living facility was unable to ensure compliance with applicable rules. Findings include: 1. On May 8, 2024, the Compliance officer observed E2's manager's license posted on the wall in the entryway of the facility. After entering the facility the Compliance Officer asked the caregiver who answered the door if the manager was here. The caregiver stated yes. While waiting for E2 the Compliance Officer observed E1 walking in the hallway. After a few minutes E2 came out and greeted the Compliance Officer. 2. In an interview, E2 reported to the Compliance Officer and E1 that E2's manager's license had been suspended, and E2 just found out the night before. 3. In an online search of the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers website the Compliance Officer observed the following: - Complaint No. 2022-NCI-0223, from the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers, the document revealed "Consent Agreement And Order For Stayed Suspension, Probation And Continuing Education" signed and dated by E2 on January 6, 2023. - Complaint No. 2022-NCI-0223, from the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers, the document revealed "Findings Of Fact, Conclusions Of Law, And Order", as of June 12, 2023, E2's managers license was put into Probation for a period of six months. The document stated E2 was present at a hearing. 4. The Compliance Officer sent an email request to the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers, requesting a copy of the most recent letter sent to E2 about the suspension. 5. On May 13, 2024, the Compliance Officer received an email from O1. The document revealed "Findings Of Fact, Conclusions Of Law, And Order For Revocation, Of Manager Certificate". This document stated E2's managers had been revoked on April 16, 2024. 6. In an interview, E1 reported being unaware of E2's manager's license being revoked.

Based on record review and interview, the manager failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. On May 8, 2024, at 2:40 pm the Compliance Officer requested the following documents during the on-site inspection: - The individual's completed orientation and in-service education required by policies and procedures for E1 and E2; - Completed TB documentation no signs and symptoms screening forms for E1, E2, E3, E4, R1, R2 and R3; - Fall Prevention and Fall Recovery Training Program/Training for E1, E2, E3 and E4; - TB Training and Continuing Education documentation for E1, E2, E3, and E4; - HCI annual report; - Policy and procedure on job descriptions, duties, and qualifications, including required skills and knowledge, education, and experience for employees and volunteers; - Documentation of assistance with activities of daily living (ADLs); - Documentation of R3's 90 day determination of residency; - Documentation of smoke detector tests; - Menu for 30 days; - Resident Activity calendar for 12 months; - Pest Control Program; - Quality Management Program and report; - First Aid Kit; - Toxicology Book, and - Pill Book. 2. In an interview, E1 acknowledged this information was not provided to the Compliance Officer within two hours after a Department request. This is a repeat citation from the compliance survey conducted on May 1, 2024.

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver provided current documentation of cardiopulmonary resuscitation (CPR) training before providing assisted living services, for one of four caregivers and managers 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 E4's personnel record revealed E4 was hired as an assistant caregiver in March 2024. 2. A review of E4's personnel record revealed a National CPR Foundation CPR/Automated External Defibrillator (AED)/First Aid training certification. The document stated " Standard - First-Aid". The course was taken on March 4, 2024. 3. An online search of the National CPR Foundation revealed this is an online course. No hands-on CPR training is included. 4. In an interview, E1 acknowledged the CPR/first aid document in E4's personnel record was from the National CPR Foundation.

Based on record 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, and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, 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 one of three residents sampled. This deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R3's, medical records revealed no documentation dated within 90 calendar days before the residents were accepted by the facility, and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, 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. 2. In an interview, E1, acknowledged being unable to locate documentation dated within 90 calendar days before the individual was accepted by the facility.

Based on record review and interview, the manager failed to ensure that a caregiver or an assistant caregiver documents the services provided in the resident's medical record for three of three residents sampled. Findings include: 1. A review of R1's medical record revealed no documentation of evidence to indicate a caregiver documented the services provided to a resident. 2. A review of R2's medical record revealed no documentation of evidence to indicate a caregiver documented the services provided to a resident. 3. A review of R3's medical record revealed no documentation of evidence to indicate a caregiver documented the services provided to a resident. 4. In an interview, E1 acknowledged documentation of evidence to indicate a caregiver documented the services provided to a resident was not provided to the Compliance Officer.

Based on record review and interview, the manager failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. On May 1, 2023, the Compliance Officer requested the following documents during the on-site inspection at 2:00 pm: - the most recent medication order from R1's doctor. 2. A review of documentation provided by E1 revealed a copy of R1's most recent medication order from R1's doctor. The document has a faxed date and time of May 1, 2023 at 16:31. 3. In an interview, E1 acknowledged this information was not provided to the Compliance Officer within the two hours after a Department request.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative when initially developed and when updated, for one of three residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan dated March 1, 2023, for directed care services. However, the service plan was not signed and dated by R2's representative. 2. In an interview, E1 acknowledged the service plan provided for R2 had not been signed and dated by R2's representative when the plan was developed or updated.

Based on record review and interview, the manager failed to ensure the service plan for a resident receiving directed care services included encouragement to eat meals and snacks for two of two directed care residents sampled. Findings include: 1. A review of R2's medical record revealed documentation of a service plan indicating R2 was receiving directed care services. This document was dated March 1, 2023. However, the service plans did not contain the following: - Encouragement to eat meals and snacks. 2. A review of R3's medical record revealed documentation of service plan indicating R3 was receiving directed care services. This document was dated March 1, 2023. However, the service plans did not contain the following - Encouragement to eat meals and snacks. 3. In an interview, E1 acknowledged the service plans did not contain all of the requirements for directed care residents. Technical assistance was provided during the on-site compliance inspection conducted on February 28, 2022.

Based on documentation review and interview, the manager failed to ensure a disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees in the event of an emergency. Findings include: A.A.C. R9-10-818.A.3. states, "A manager shall ensure that documentation of the disaster plan review required in subsection (A)(2) includes: a. The date and time of the disaster plan review; b. The name of each employee or volunteer participating in the disaster plan review; c. A critique of the disaster plan review; and d. If applicable, recommendations for improvement" 1. A review of facility documentation revealed no evidence of annual disaster plan reviews. 2. In an interview, E1 acknowledged an annual disaster plan review was not available for review. This is a repeat citation from the compliance survey conducted on February 28, 2022.