R & D Marathon Assisted Living Home V LLC

Based on documentation review, record review, and interview, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1-9). The deficient practice posed a risk if the emergency responder was not aware of critical health information for a resident. Findings include: 1. A.R.S. § 36-420.04.A.1-9 states, “Emergency responders; patient information; hospitals; discharge planning; patient screenings; discharge document A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: (...).” 2. A review of R1’s, R2’s, R3’s, and R4’s medical records revealed no standardized form to provide to emergency responders. 3. In an interview, E5 acknowledged that a standardized form for emergency responders for R1’s, R2’s, R3’s, and R4’s were not completed. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review and interview, the health care institution failed to implement tuberculosis (TB) infection control activities, including annually assessing the health care institution's risk of exposure to infectious tuberculosis. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance. Findings include: 1. A review of the facility’s documentation revealed no annual assessment of the facility's TB risk assessment. 2. In an interview, E5 acknowledged that the annual assessment of the facility's TB risk assessment was not completed. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered, and the effect of the opioid administered, for one of four residents receiving an opioid and not considered to be end-of-life. Findings include: 1. A review of R4's medical record revealed a current service plan for personal care services. R4's service plan revealed that R4 received medication administration. 2. A review of R4's medical record revealed a medication order dated October 14, 2025. The medication order stated, "Tramadol HCl 50 mg, take one tablet by mouth twice a day." 3. A review of R4's medical record revealed a medication administration record (MAR) for October 2025. “Tramadol HCL 50 mg one tablet by mouth TID” was documented as administered every day in October 2025. However, documentation of the identification of R4's need for the opioid before the opioid was administered, and the effect of the opioid administered, was not filled out. 4. In an interview, E5 acknowledged that there was no documentation of the need for the opioid before the opioid was administered, and the effect of the opioid administered. 5. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation, documentation review, and interview, 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. Upon arrival at the facility, E2 let the Compliance Officer (CO) in. E2 and E3 were the only employees present in the facility. E4 was observed arriving at the facility at 9:36 am. 2. During an environmental inspection of the facility with E4, the CO observed the August 2025 work schedule posted with no employees listed to work. 3. A September 2025 work schedule was not available for review. 4. A review of the personnel schedule for October 2025 revealed the following: E2 worked from October 1, 2025, to October 5, 2025; October 11, 2025, to October 16, 2025; and October 24, 2025, to October 25, 2025. E3 worked from October 6, 2025, to October 10, 2025; October 17, 2025, to October 23, 2025; and October 26, 2025, to October 30, 2025. E7 worked from October 1, 2025, to October 10, 2025; October 13, 2025, to October 18, 2025; October 21, 2025, to October 24, 2025; October 26, 2025, to October 30, 2025. No documentation of E4 on the work schedule. 5. In an interview, E5 acknowledged that August and September personnel work schedules were not completed. 6. In an exit interview, the findings were reviewed with E5, 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 evidence of freedom from infectious tuberculosis (TB), as specified in R9-10-113, for two of four 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 website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. The Compliance Officer observed E2 working the day of the inspection. E4 was observed arriving at the facility at 9:36 am. 4. A review of the facility’s October 2025 work schedule revealed the following: E2 worked from October 1, 2025, to October 5, 2025; October 11, 2025, to October 16, 2025; and October 24, 2025, to October 25, 2025. No documentation of E4 on the work schedule. 5. A review of E2’s personnel record revealed an approximate hire date of early 2025. E2 had one TB skin test administered and read that was less than 12 months old. However, there was no second TB skin. 6. A review of E4’s personnel record revealed an approximate hire date of 2025. E4 had one TB skin test administered and read that was less than 12 months old. However, there was no second TB skin. In addition, E4 had a “TB screening and risk assessment form” that was signed by E5, not a medical practitioner. 7. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation, record review, documentation review, and interview, the manager failed to ensure a caregiver or an assistant caregiver received orientation that was specific to the duties to be performed before providing assisted living services to a resident, for four of four employees sampled. The deficient practice posed a risk if the employees were unable to meet residents' needs. Findings include: 1. The Compliance Officer observed E2 and E3 working at the facility during the inspection. E4 was observed arriving at the facility at 9:36 am. 2. A review of E2's personnel record revealed E2’s hire date of January 30, 2025. However, the record revealed no documentation showing E2 had received orientation specific to the duties to be performed. 3. A review of E3's personnel record revealed E3’s hire date of January 30, 2025. However, the record revealed no documentation showing E3 had received orientation specific to the duties to be performed. 4. A review of E4's personnel record revealed E4’s approximate hire date of October 9, 2025. However, the record revealed no documentation showing E4 had received orientation specific to the duties to be performed at this facility. 5. A review of the facility’s policies and procedures revealed a policy titled "Employee Orientation and CEU’s" (dated March 1, 2024). The policy and procedure stated, "No individual should work unsupervised or alone in the Facility until thoroughly familiar with all items listed on the New Employee Orientation form." 6. In an exit interview, the findings were reviewed with E5, and no additional information was provided. 7. Technical assistance was provided during the compliance inspection conducted on July 11, 2024.

Based on documentation review, observation, record review, and interview, the manager failed to ensure that as part of the policies and procedures required in R9-10-803(C)(1)(h), a plan was implemented to ensure that the manager or a caregiver was available as back-up to provide assisted living services to a resident if the caregiver assigned to work was not available or not able to provide the required assisted living services. The deficient practice posed a risk to the health and safety of the residents. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled "Staffing Policy and Work Schedule." The policy stated, "1. A caregiver is available as back-up to provide assisted living services to a resident if the caregiver assigned to work is not available or not able to provide the required living services. 2. The manager is available as back-up to provide assisted living services to a resident if the caregiver or the manager assigned to work is not available or not able to provide the required living services." 2. Upon arrival at the facility at 9:11 am, E2 let the Compliance Officer (CO) in. E2 and E3 were the only employees present in the facility with ten residents. E3 asked the CO to wait until E5 arrived. At 9:36 am, E4 was observed arriving at the facility. 3. In an interview, E4 reported that E4 was the certified caregiver to assist the CO during the inspection. E4 also reported that it was E4’s first day at the facility. E4 reported that E4 worked at another facility. 4. The Compliance Officer observed E4 leaving the facility at 10:22 am. E5 arrived at the facility at approximately 10:30 am. 5. A review of E2’s and E3’s personnel records revealed that E2 and E3 were assistant caregivers. 6. In an interview, E5 reported that E7 left early at approximately 9:10 am, leaving E2 and E3 alone with the residents. 7. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review, observation, interview, and record review, the manager failed to ensure that at least the manager or a caregiver was present at an assisted living home when a resident was present in the assisted living home. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. The facility is licensed at the directed care level. 2. Upon arrival at the facility at 9:11 am, E2 let the Compliance Officer (CO) in. E2 and E3 were the only employees present in the facility with ten residents. E3 asked the CO to wait until E5 arrived. At 9:36 am, E4 was observed arriving at the facility. 3. In an interview, E4 reported that E4 was the certified caregiver to assist the CO during the inspection. E4 also reported that it was E4’s first day at the facility. E4 reported that E4 worked at another facility. 4. The Compliance Officer observed E4 leaving the facility at 10:22 am. E5 arrived at the facility at approximately 10:30 am. 5. In an interview, E5 reported that E7 left early at approximately 9:10 am, leaving E2 and E3 alone with the residents. 6. A review of E2’s and E3’s personnel records revealed that E2 and E3 were assistant caregivers. 7. In an exit interview, the findings were reviewed with E5, 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 R3’s medical record revealed there was no such documentation with the required elements dated within 90 days of R3's acceptance and signed by a medical practitioner or registered nurse. Based on R3's date of acceptance, this documentation was required. 2. A review of R4’s medical record revealed there was no such documentation with the required elements dated within 90 days of R4's acceptance and signed by a medical practitioner or registered nurse. Based on R4’s date of acceptance, this documentation was required. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure, before or at the time of an individual's acceptance by an assisted living facility, there was a documented residency agreement that included the manager's signature and date signed, for one of four residents sampled. Findings include: 1. A review of R1's medical record revealed a residency agreement. However, the residency agreement was signed and dated by a manager 21 days after R1's date of acceptance. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review, and interview, the manager failed to ensure that within five working days after a resident's acceptance by the assisted living facility, the documented agreement, was signed by the resident's representative, the resident's legal guardian, or another individual who has been designated by the individual under A.R.S. § 36-3221 to make health care decisions on the individual's behalf, for one of two residents sampled. The deficient practice posed a risk if the resident, the required individuals were not informed of the terms of residency. Findings include: 1. A review of R1's medical record revealed that R1 received directed care services. 2. A review of R1's medical record revealed a residency agreement with all required elements, signed by R1’s representative. However, the agreement was not signed within five days of R1's date of acceptance. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident had a written service plan that, when initially developed, was signed and dated by the resident or the resident's representative, and the manager, for two of four residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R1’s medical record revealed the following: A current written service plan dated August 1, 2025. The service plan indicated that R1 received medication administration. The current service plan was not signed by the manager or the resident, or the resident's representative. 2. A review of R4’s medical record revealed the following: A current written service plan dated August 2, 2025. The service plan indicated that R4 received medication administration. The current service plan was not signed by the manager or the resident, or the resident's representative. 3. In an interview, E5 acknowledged that the service plans for R1 and R4 needed to be signed by the manager and resident representative. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as a resident's rights were violated. Findings include: 1. During an environmental inspection of the facility with E4, the Compliance Officer (CO) observed the door to R2’s room was missing a doorknob. 2. In an interview, E5 reported that the doorknob was removed because R2 would lock the door, and the staff could not get in. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation, record review, and interview, the manager failed to ensure that a resident or the resident's representative consented to photographs of the resident before the resident was photographed, for two of four residents sampled. The deficient practice posed a risk as a resident's rights were violated. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed cameras used in the facility to monitor residents' whereabouts. 2. A review of R1's medical record did not contain a photographic consent form signed by the resident or the resident's representative. 3. A review of R4's medical record did not contain a photographic consent form signed by the resident or the resident's representative. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure an entry in a resident's medical record was not changed to make the initial entry illegible, for four of four residents sampled. The deficient practice posed a risk to the residents' health and safety if the documentation in the medical records was not accurate and legible. Findings include: 1. A review of R1's medical record revealed the following change with white corrective tape: Medication Administration Record (MAR) for October 2025 Activities of Daily Living Flowsheet 2. A review of R2's medical record revealed the following change with white corrective tape: Flu/Pneumonia Vaccinations Consent Form Medication Administration Record (MAR) for October 2025 3. A review of R3's medical record revealed the following change with white corrective tape: Medication Administration Record (MAR) for October 2025 4. A review of R4's medical record revealed the following change with white corrective tape: Medication Administration Record (MAR) for October 2025 5. A review of the facility's policies and procedures revealed a policy titled “Medical Records Entry Policy.” The policy stated “An entry in a resident’s medical record is recorded by the persons mentioned in the next policy, dated, legible, and authenticated; and not changed to make the entry illegible. 6. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident's medical record contained a medication order from a medical practitioner for each medication that was administered to the resident, for two of four residents sampled. The deficient practice posed a risk as the medication administered could not be verified against a medication order. Findings Include: 1. A review of R3's medical record revealed the following: A current written service plan dated May 13, 2025. This service plan indicated R3 received medication administration. A medication list dated February 26, 2025. However, the medication list was not signed by a medical practitioner. Medication Administration Record (MAR) for October 2025, signed that medications were administered. 2. A review of R4's medical record revealed the following: A current written service plan dated August 2, 2025. This service plan indicated R4 received medication administration. A medication list dated October 14, 2025. However, the medication list was not signed by a medical practitioner. MAR for October 2025 signed that medications were administered. 3. In an interview, E5 reported that medications were administered to R3 and R4 and that the medication lists were not signed. In addition, E5 reported that it was difficult to get signatures. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of a medication administered to a resident that included the date and time of administration, for one of four residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. A review of R1's medical record revealed a current written service plan dated August 1, 2025. This service plan indicated R1 received medication administration. 2. A review of R1's medical record revealed medication orders signed and dated by a medical practitioner on July 15, 2025, for the following: “Lorazepam tablet 0.5 mg take 1 tablet oral 3 times a day as needed.” No medication order for “Trazodone.” 3. A review of R1’s October 2025 medication administration record (MAR) revealed the following: “Lorazepam tablet 0.5 mg PRN.” “Lorazepam” was administered from October 10, 2025, to October 24, 2025. The time was not documented of when it was administered. “Trazodone” was not listed. 4. The Compliance Officers observed the following medication bottles: “Lorazepam tablet 1 mg.” “Trazodone tab 150 mg.” 5. The Compliance Officers observed the following in the medication organizer: Two half tablets of “Trazodone.” 6. In an interview, E5 reported not being able to verify when the “Lorazepam tablet 0.5 mg” was given. In addition, E5 acknowledged that “Trazodone” was not on the MAR but in the medication organizer. 7. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of a medication administered to a resident that included the name, strength, dosage, and route of administration, for one of four residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. A review of R1's medical record revealed a current written service plan dated August 1, 2025. This service plan indicated R1 received medication administration. 2. A review of R1's medical record revealed medication orders signed and dated by a medical practitioner on July 15, 2025. "Trazodone" was not listed on this medication order. 3. A review of R1’s October 2025 medication administration record (MAR) revealed “Trazodone” was not listed. 4. The Compliance Officers observed a medication bottle for “Trazodone tab 150 mg.” 5. The Compliance Officers observed in the medication organizer two half tablets of “Trazodone.” 6. In an interview, E5 acknowledged that “Trazodone” was not on the MAR. 7. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation, record review, documentation review, and interview, the manager failed to ensure a resident's medical record contained documentation of a medication administered to a resident that included the name and signature of the individual administering the medication, for four of four residents reviewed. The deficient practice posed a health and safety risk to residents if the facility did not properly document medication administration for a resident, and the Department was provided false or misleading information. Findings include: 1. Upon arrival at the facility at 9:11 am, E2 let the Compliance Officer (CO) in. E2 and E3 were the only employees present in the facility with ten residents. E3 asked the CO to wait until E5 arrived. At 9:36 am, E4 was observed arriving at the facility. 2. In an interview, E4 reported that E4 was the certified caregiver to assist the CO during the inspection. E4 also reported that it was E4’s first day at the facility. E4 reported that E4 worked at another facility. 3. A review of R1’s, R2's, R3’s, and R4’s medical records revealed two unknown initials on the August 2025 Medication Administration Records (MAR) from August 1, 2025, to August 3, 2025, and from August 4, 2025, to August 31, 2025. 4. A review of R1’s, R2's, R3’s, and R4’s medical records revealed unknown initials on the September 2025 MAR. 5. A review of R1’s, R2's, R3’s, and R4’s medical records revealed unknown initials on the MAR from October 1, 2025, to October 3, 2025, and from October 4, 2025, to October 29, 2025. 6. A review of the August 2025 personnel schedule revealed that the schedule had not been filled out. 7. A September 2025 work schedule was not available for review. 8. A review of the October 2025 personnel schedule revealed the following: E2 worked from October 1, 2025, to October 5, 2025; October 11, 2025, to October 16, 2025; and October 24, 2025, to October 25, 2025. E3 worked from October 6, 2025, to October 10, 2025; October 17, 2025, to October 23, 2025; and October 26, 2025, to October 30, 2025. E7 worked from October 1, 2025, to October 10, 2025; October 13, 2025, to October 18, 2025; October 21, 2025, to October 24, 2025; October 26, 2025, to October 30, 2025. No documentation of E4 on the work schedule. No documentation of E6 on the work schedule. 9. In an interview, E5 reported that E4 and E6 were the unknown initials on the MAR. The CO asked how E4 could sign the MAR for October when E4 was not on the schedule. E5 reported that E4 did not sign the MAR. E5 reported that E5 thought staff could sign under a certified caregiver's name on the MAR. 10. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that the service plan for a resident receiving directed care services included documentation of the resident’s weight or from a medical practitioner indicating that weighing the resident was contraindicated, for one of four residents sampled. Findings include: 1. A review of R1's medical record revealed a current written service plan dated August 1, 2025. However, R1’s service plan did not include R1’s weight or documentation from R1’s medical practitioner stating that weighing R1 was contraindicated. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order and accurately documented in the resident's medical record, for two of four residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R2's medical record revealed a current written service plan dated May 1, 2025. This service plan indicated R2 received medication administration. 2. A review of R2's medical record revealed a medication order signed and dated January 31, 2025. The medication order revealed “Furosemide (Lasix) 20 mg tablet. Take 1 tablet (20 mg) by mouth in the morning for 3 days.” 3. A review of R2’s October 2025 medication administration record (MAR) revealed “Furosemide (Lasix) 20 mg tablet. PO. QD.” This medication was administered from October 1, 2025, to October 29, 2025. 4. In an interview, E5 acknowledged that “Furosemide 20 mg” was administered pasted the three days per the medication order. 5. A review of R3's medical record revealed a current written service plan dated May 13, 2025. This service plan indicated R3 received medication administration. 6. A review of R3's medical record revealed a medication order dated February 26, 2025. The medication order revealed the following: “Gabapentin Capsule 100 mg. Administer 2 capsules oral three times daily.” “Trazodone HCl Tablet 50 mg. Administer 1 tablet oral at bedtime.” 7. A review of R3’s October 2025 medication administration record (MAR) revealed the following: “Gabapentin Capsule 100 mg. Administer 2 capsules oral three times daily” was administered from October 1, 2025, to October 29, 2025. “Trazodone HCl Tablet 50 mg. Administer 1 tablet oral at bedtime” was administered from October 1, 2025, to October 29, 2025. 8. The Compliance Officer observed the following in the R3’s medication organizer: One “Gabapentin Capsule 100 mg” in the bedtime section. Half a tablet of “Trazodone HCl Tablet 50 mg” in the bedtime section. 9. In an interview, E5 acknowledged that the “Gabapentin” and “Trazodone” were not administered per the MAR or the medication order. 10. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure that a food menu was maintained for at least calendar days 60 calendar days after the last day included in the food menu. The deficient practice posed a risk if the source of a potential food-borne illness could not be identified. Findings include: 1. A review of the facility’s food menu revealed one weekly menu for September and October. There were no dates indicating which week the menu was for. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure the facility's 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. Findings include: 1. A review of the facility's disaster plan revealed a review conducted on March 1, 2024. However, documentation of additional reviews was not available. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. A review of the facility's disaster drill documentation revealed documentation of a disaster drill conducted on March 5, 2025. However, documentation of additional drills was not available for review. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk if employees were unable to implement an evacuation. Findings include: 1. A review of the facility's evacuation drill documentation revealed documentation of a drill conducted on March 3, 2025. However, documentation of additional drills was not available for review. 2. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resiednt received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility, for three of the four residents sampled. The deficient practice posed a risk if a resident was unaware of the evacuation path to be used in an emergency. Findings include: 1. A review of R1's medical record revealed no documentation of orientation to the exits of the facility. 2. A review of R2's medical record revealed no documentation of orientation to the exits of the facility. 3. A review of R3's medical record revealed no documentation of orientation to the exits of the facility. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation and interview, the manager failed to ensure a first-aid kit was maintained in the assisted living facility in a location accessible to caregivers and assistant caregivers. Findings include: 1. The Compliance Officer (CO) requested E4 to provide the facility's first-aid kit. E4 provided the first aid kit. The CO observed that the first aid kit only contained gauze and expired alcohol wipes. 2. In an interview, E5 acknowledged that the first aid kit needed to be restocked. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that there were paper towels in a dispenser or a mechanical air hand dryer in a common area bathroom. The deficient practice posed an infection control risk. Findings include: 1. During the environmental inspection, the Compliance Officer (CO) observed no paper towels in a dispenser or a mechanical air hand dryer in a common area bathroom. 2. During the inspection, the CO observed residents walking to the restroom and using it. 3. In an interview, E5 reported that the paper towels were removed from the bathroom because residents were flushing them. However, no alternative was provided for residents to dry their hands. 4. In an exit interview, the findings were reviewed with E5, and no additional information was provided. 5. Technical assistance was provided during the inspection on July 11, 2024.

Based on observation and interview, the manager failed to ensure that there was paper towels in a dispenser or a mechanical air hand dryer in the common area bathroom. The deficient practice posed an infection control risk. Findings include: 1 . During the environmental inspection, the Compliance Officer observed no paper towels in a dispenser or a mechanical air hand dryer in the common area bathroom. 2. In an interview, E5 reported that the paper towels were removed from the bathroom because residents were flushing them. However, no alternative was provided for residents to dry their hands. 3. In an exit interview, the findings were reviewed with E5, and no additional information was provided. 4. Technical assistance was provided during the inspection on July 11, 2024.