Rainbow Acres

Based on documentation review, record 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 two of two resident sampled who received an opioid. Findings include: 1. A review of facility documentation revealed a policy and procedure titled “Opioid Prescribing and Treatment” revised October 11, 2022. The Policy stated “2. The Clinical Manager will ensure: - There is a documented diagnosis of the use of the opioid - The patient’s response to the opioid is beneficial and outweighs the medication’s risks. - The patient’s pain level is monitored before, during, and after using the medication. - Licensed Personnel or Certified Caregivers administer opioids.” 2. A review of R3's medical record revealed a service plan for personal care services and medication administration. A review of R3's medication orders dated February 2025 revealed "Tramadol HCL Tab 50mg (Control Cycle) Take 1 Tablet By Mouth Three Times Daily For Pain Relief. Opioid, Risk Of Overdose And Addiction." A review of R3's medication administration record (MAR) for March 2025 revealed "Tramadol HCL Tab 50mg," was documented as administered. However, documentation to include an identification of R3's need for the opioid before the opioid was administered and the effectiveness of the opioid administered was not available for review. 3. A review of R7's medical record revealed a service plan for personal care services and medication administration. A review of R7's medication orders dated February 2025 revealed "Tramadol HCL Tab 50mg (Control Cycle) Take 1 Tablet By Mouth Twice Daily In The Morning And Bedtime (7am, 7pm) Opioid, Risk Of Overdose And Addiction." A review of R7's MAR for March 2025 revealed "Tramadol HCL Tab 50mg," was documented as administered. However, documentation to include an identification of R7's need for the opioid before the opioid was administered and the effectiveness of the opioid administered was not available for review. 4. A review of R3's and R7’s medical records revealed no documentation stating residents had an end of life condition or an active malignancy. 5. In an interview, E12 reported that routine opioid administration was not monitored before and after an opioid was administered. 6. In separate interviews, E10 and E12 acknowledged R3’s and R7’s medical records did not contain documentation of identification of the need for the opioid before the opioid was administered, and the effectiveness of the opioid administered.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) § 36-411(C)(2), for two of seven personnel sampled. The deficient practice posed a risk if the employees were a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411(C) states: "C. Owners shall make documented, good faith efforts to: 2. Verify the current status of a person's fingerprint clearance card." 2. A review of E2’s personnel record revealed no documented good faith efforts to verify the current status of E2’s fingerprint clearance card issued May 10, 2021. Based on E2's date of hire this was required. 3. A review of E7’s personnel record revealed no documented good faith efforts to verify the current status of E7’s fingerprint clearance card issued March 30, 2023. Based on E7’s date of hire this was required. 4. In an interview, E9 and E10 acknowledged E2’s and E7’s personnel records did not have documented, good faith efforts to verify the current status of the fingerprint clearance cards.

Based on documentation review, record review, and interview, the manager failed to ensure policies and procedures were established, documented, and implemented covering job descriptions, duties, and qualifications, including required skills and knowledge, education, and experience for caregivers as specified in R9-10-806 (A)(3). The deficient practice posed a risk as there were no policies and procedures to reinforce and clarify the health care institution's standards. Findings include: “R9-10-806 (A)(3) 3. The qualifications, skills, and knowledge required for a caregiver or assistant caregiver: a. Are based on: i. The type of assisted living services, behavioral health services, or behavioral care expected to be provided by the caregiver or assistant caregiver according to the established job description; and ii. The acuity of the residents receiving assisted living services, behavioral health services, or behavioral care from the caregiver or assistant caregiver according to the established job description; and b. Include: i. The specific skills and knowledge necessary for the caregiver or assistant caregiver to provide the expected assisted living services, behavioral health services, or behavioral care listed in the established job description; ii. The type and duration of education that may allow the caregiver or assistant caregiver to have acquired the specific skills and knowledge for the caregiver or assistant caregiver to provide the expected assisted living services, behavioral health services, or behavioral care listed in the established job description; and iii. The type and duration of experience that may allow the caregiver or assistant caregiver to have acquired the specific skills and knowledge for the caregiver or assistant caregiver to provide the expected assisted living services, behavioral health services or behavioral care listed in the established job description;” 1. A review of department records revealed the facility's scope of services was “A residential community and personal care for adults with developmental disabilities.” 2. In an interview, E12 reported that some residents received behavioral care services from outside health care institutions. 3. A review of personnel records revealed E2, E3, and E5 were caregivers and E7 and E8 were assistant caregivers. 4. A review of the facility’s policy and procedures revealed a policy titled, “Verification of Caregiver’s Skills & Knowledge," which stated, “Policy: Before a caregiver or caregiver assistant provides physical health services to a resident, the caregiver’s or assistant caregiver’s skills and knowledge will be verified and documented by obtaining a copy of any certificates the caregiver or assistant caregiver obtained from a Caregiver Training Courses. Procedure: 1. Copies of certificates or verifications will be kept in the caregiver’s or assistant caregiver’s personnel file.” However, the policy and procedure did not include the job descriptions, duties, and q

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, for five of seven residents sampled. The deficient practice posed a risk as the service plans did not reinforce and clarify services to be provided to a resident. Findings include: 1. A review of R2's medical record revealed a service plan for personal care services. The service plan stated the following services we needed; - Diet/Hydration: Needs Prompt - Daily Hygiene: Needs Assistance - Shower/Bath: Needs Assistance - Dressing: Needs Prompt - Foot/Nail Care: Needs Assistance - Skin Care: Needs Assistance - Oral Care: Needs Prompt However, the service plan did not include the frequency of the above mentioned services. 2. A review of R3's medical record revealed a service plan for personal care services. The service plan stated the following services were needed; - Daily Hygiene: Needs Prompt - Shower/Bath: Needs Prompt - Foot/Nail Care: Needs Assistance - Skin Care: Needs Assistance - Oral Care: Needs Prompt However, the service plan did not include the frequency of the above mentioned services. 3. A review of R4's medical record revealed a service plan for personal care services. The service plan stated the following services were needed; - Foot/Nail Care: Needs Assistance - Skin Care: Needs Assistance - Oral Care: Needs Prompt However, the service plan did not include the frequency of the above mentioned services. 4. A review of R6's medical record revealed a service plan for personal care services. The service plan stated the following services were needed; - Diet/Hydration: Needs Assistance - Shower/Bath: Needs Assistance - Dressing: Needs Assistance - Bladder/Bowel: Needs Assistance - Foot/Nail Care: Needs Assistance - Skin Care: Needs Assistance - Oral Care: Needs Assistance However, the service plan did not include the frequency of the above mentioned services. 5. A review of R7's medical record revealed a service plan for personal care services. The service plan stated the following services were needed; - Daily Hygiene: Needs Prompt - Shower/Bath: Needs Assistance - Bladder/Bowel: Needs Assistance - Foot/Nail Care: Needs Assistance - Skin Care: Needs Assistance However, the service plan did not include the frequency of the above mentioned services. 6. In an interview, E12 acknowledged R2’s, R3’s, R4’s, R6’s, and R7’s written service plans did not include the amount, type, and frequency of the above mention services being provided to the residents.

Based on documentation review, record review, and interview, the manager failed to ensure a resident's medical record contained documentation of notification of the resident of the availability of vaccination for pneumonia, according to A.R.S. § 36-406(1)(d), for six of seven residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. § 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. A review of R1’s, R2’s, R3’s, R4’s, R6’s, and R7’s medical records revealed no documentation that showed the pneumonia vaccinations were received or refused. Based on the resident’s acceptance dates, this documentation was required. 3. In an interview, E12 acknowledged R1’s, R2’s, R3’s, R4’s, R6’s, and R7’s medical records did not include documentation that showed the pneumonia vaccination was received or refused.

Based on documentation review, record review and interview, the manager failed to ensure that a behavioral health professional or medical practitioner completed and signed a written determination, 30 days prior to acceptance or before the resident begins receiving behavioral care and at least once every six months thereafter, stating that the resident’s behavioral health needs could be met by the facility and were within the facility’s scope of services, for two of two residents sampled who were receiving behavioral care. The deficient practice posed a health and safety risk by potentially retaining a resident whose needs were not properly assessed or supported by the facility. Findings include: 1. R9-10-101(29) defines "Behavioral care" a. means limited behavioral health services, provided to a patient whose primary admitting diagnosis is related to the patient's need for physical health services, that include: i. Assistance with the patient's psychosocial interactions to manage the patient's behavior that can be performed by an individual without a professional license or certificate including: (1) Direction provided by a behavioral health professional, and (2) Medication ordered by a medical practitioner or behavioral health professional; or ii. Behavioral health services provided by a behavioral health professional on an intermittent basis to address the patient's significant psychological or behavioral response to an identifiable stressor or stressors; and b. Does not include court-ordered behavioral health services. 2. A review of R1's medical record revealed a current written service plan for supervisory care services dated September 2024. This service plan revealed R1 had a diagnosis of Developmentally delayed, depression, Paranoid Schizophrenia. In addition, R1's medical record revealed R1 had a behavioral health professional, and received administration of psychotropic medications. However, no documentation indicating R1's behavioral health professional or medical practitioner examined R1 at least once every six months, signed and dated a determination stating R1's needs were being met by the facility, and reviewed the facility's scope of services was available. 3. A review of R2's medical record revealed a current written service plan for personal care services dated August 2024. This service plan revealed R2 had a diagnosis of Autism, ADHD, Asperger’s, and Schizophrenia. In addition, R2's medical record revealed R2 had a behavioral health professional, and received administration of psychotropic medications. However, no documentation indicating R2's behavioral health professional or medical practitioner examined the resident before receiving behavioral care and at least once every six months, signed and dated a determination stating R2's needs were being met by the facility, and reviewed the facility's scope of services was available. 4. In an interview, E12 acknowledged R1's and R2’s behavioral health professional or medical practiti

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area, labeled and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental tour with E11, the Compliance Officers observed the following poisonous and toxic materials around the facility unlocked: - one spray bottle of "Rapid multi surface disinfectant cleaner" - one spray bottle of "Peroxide multi surface disinfectant cleaner" - one spray bottle of “ Bathroom Acid disinfectant cleaner" - one spray bottle of "Windex" - one canister of "Lemishine dish detergent" - one canister of "EASY-OFF Oven cleaner" - one canister of "AJAX with Bleach" 2. In an interview, E10 and E11 acknowledged poisonous and toxic materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on observation and interview, the manager failed to ensure combustible or flammable liquids and hazardous materials stored by the assisted living facility were stored 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 an environmental tour with E11, the Compliance Officers observed two propane grills with propane tanks accessible to residents. 2. In an interview, E10 and E11 acknowledged combustible or flammable materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on documentation review, record review, and interview, for seven of seven residents sampled, the facility failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04. The deficient practice posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A.R.S. 36-420.04.A states, "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: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. 7. 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 point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. A copy of the resident's health insurance portability and accountability act (HIPAA) release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. 9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives." 2. A review of R1's, R2's, R3's, R4's, R5's, R6's and R7's medical records revealed no documentation of the standardized emergency responder patient information documentation required in Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1) through (9). 3. In separate interviews, E10 and E12 acknowledged the information required in A.R.S. § 36-420.04 was not prepared in a standardized emergency responder patient information form as required.