Regency Adult Home Care LLC

Based on record review and interview, the assisted living home failed to maintain a copy of documentation provided to an emergency responder. The deficient practice posed a risk if the Department was unable to verify the required documentation was provided during a resident emergency. Findings include: 1. 36-420.04. requires: 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: 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 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. In documentation review, the Department received a report which documented the facility contacted emergency medical services (EMS) on August 15, 2024, for R1 who was nonresponsive. The Department received a second report which documented the facility contacted EMS on August 20, 2024, for R2, who reported being constipated and with shoulder pain. During the incidents, R1 and R2 were transported to the hospital for medical services. 3. In documentation review

Based on documentation review, record review, and interview, for two of two residents reviewed, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a direct health and safety risk of or potential TB exposure, to residents and staff. 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. In record review, the medical records for R1 and R2's medical record included documentation of a negative TB skin test; however, did not include documentation of a risk assessment of prior exposure to infectious TB, or a determination if the residents had signs or symptoms of TB. Based on R1 and R2's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged the residents' medical records did not include documentation of a risk assessment of prior exposure to infectious TB or a determination if the residents had signs or symptoms of TB.

Based on record review, and interview, for one of two residents reviewed, the manager failed to ensure a resident had a written service plan which included a description of the resident's medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments. The deficient practice posed a risk to residents, if the service plan did not include documentation of the resident's condition, and services to be provided for the resident. Findings include: 1. In observation, the Compliance Officer observed R2 was confined to the bed, and had a leg amputation. R2's back was reddened down to the buttocks. 2. In record review, R2's medical record included a document, titled "Plan of Care Effective 8/12/2024," from Arizona Life Hospice, which documented, "... Assess wound at each dressing change for healing, infection... educate family on frequent brief changes as necessary to keep wound and surrounding area clean and dry. Educate pt/family/cg's on expectations of wound healing in regards to advanced disease, nutritional state, circulation. Instruct CG/family on frequent position changes to off-load wound, promote healing and prevent further break down. Perform appropriate wound care per orders..." 3. In record review, R2's medical record included a service plan signed, and dated on August 16, 2024, (received directed care services). The service plan did not include R2's skin condition. 4. During an interview, E1 acknowledged R2's service plan did not include documentation of R2's skin condition.

Based on record review and interview, for one of two residents reviewed, the manager failed to ensure a written service plan included the amount, type and frequency of assisted living services provided to the resident. The deficient practice posed a health and safety risk to residents should services not be provided as required to meet the residents' needs. Findings include: 1. In observation, the Compliance Officer observed R2 had a Foley catheter. 2. In record review, R2's service plan, dated August 16, 2024, (received directed care services) included documentation, "... Foley..." The service plan did not include the amount, type and frequency of services provided for R2's Foley catheter care. 3. During an interview, E1 and E2 acknowledged R2 had a Foley catheter and received services; however, R2's service plan did not include the amount, type and frequency of services provided for R2.

Based on observation, record review and interview, for one of two residents reviewed, and receiving directed care services, the manager failed to ensure the service plan included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. Findings include: 1. In observation, the Compliance Officer observed R2 was confined to the bed, and had a leg amputation R2's back was reddened down to the buttocks. 2. During an interview, E1, E2 and E3 reported R2 was confined to a bed or chair and unable to walk. R2's skin was reddened on the back and buttocks, and was being treated by the caregivers with Nystatin cream. Hospice services provided care for R2. 3. In record review, R2's medical record included a document, titled "Plan of Care Effective 8/12/2024," from Arizona Life Hospice, which documented, "... Assess wound at each dressing change for healing, infection... educate family on frequent brief changes as necessary to keep wound and surrounding area clean and dry. Educate pt/family/cg's on expectations of wound healing in regards to advanced disease, nutritional state, circulation. Instruct CG/family on frequent position changes to off-load wound, promote healing and prevent further break down. Perform appropriate wound care per orders..." 4. In record review, R2's medical record included a service plan signed and dated on August 16, 2024, (received directed care services). The service plan did not include R2's skin condition or skin maintenance services provided for R2. 5. During an interview, E1 and E2 acknowledged R2's service plan did not include skin maintenance services provided for R2.

Based on observation, documentation review, and interview, the manager failed to ensure policies and procedures were implemented for discarding medication. The deficient practice posed a health and safety risk if medications, including narcotics, were not disposed of as required. Findings include: 1. During an environmental inspection, a refrigerated medication container included the following medications for residents no longer residing at the facility: -R3 residency terminated "a long time ago": Lantus 100 unit/ML vial and Lantus Solostar Pen -R4 residency terminated "December 2023 or January 2024": Humalog and Semiglee Insulin 2. In documentation review, a facility policy, titled, "Medication Services," on page 13, documented "Part IV - Disposal of Medication, Recall... 1. The facility manager or manager designee will check monthly all medication in the facility to identify and locate any discontinued medication, by ... medical practitioners order, expired medication, including deceased resident's medication, 2. Such medication will be disposed of by the facility manager or manager designate the last day of the month as follows: a. Offer to return the medication to the resident's representative, b. Return to the pharmacy, c. Dispose of by mixing the pills with hot water and cooking flour, coffee grinds, or kitty litter also may be used..." 3. During an interview, E1 and E2 reported the residents no longer resided at the facility, and the medications were not discarded per the facility's policy and procedures.

Based on observation, documentation review, record review, and interview, for two of two residents reviewed, who received a controlled substance, the manager failed to ensure policies and procedures were implemented for inventorying controlled substances. The deficient practice posed a risk if controlled substances were not inventoried and accounted for by the facility. Findings include: 1. In observation, the Compliance Officer (CO) observed R1 had Oxycodone 5-325 mg (a schedule II controlled substance), 180 tablets dispensed on August 6, 2024, (172 tablets remained), and Oxycodone 5 mg, (a schedule II controlled substance), 30 tablets dispensed on August 22, 2024, (20 tablets remained) . 2. In documentation review, R1's medical record indicated R1 received the Oxycodone medications several times in August 2024; however, the record did not include documentation of an inventory of the medication. 3. In observation, the CO observed R2 had Oxycodone HCI 5mg tablets, (a schedule II controlled substance). 4. In record review, R2's medical record indicated R2 received the medication seven times in August 2024; however, the record did not include an inventory of the medication. 5. In documentation review, facility policy, titled, "Medication Services," on page 12, documented; "...As soon as possible medication will be inventoried and placed in the resident's medication box and removed from the short supply list if applicable. On page 14, "... Narcotics and controlled substances will be controlled and stored by the facility is specified in part three mentioned above. 2. Daily narcotic administration will be recorded on each resident's MAR or Narcotic Administration record or both. 3. As needed narcotic administration will be recorded in the Narcotic Administration Record separate for each resident to ensure proper inventorying..." 6. During an interview, E1, E2 and E3 reported R1 was administered a controlled substance, and acknowledged the facility did not maintain an inventory of the controlled substances.

Based on documentation review, record review, and interview, for one of two residents who had an emergency resulting in the need for medical services, the manager failed to ensure when a resident had an accident, emergency, or injury resulting in the resident needing medical services, a caregiver documented the date and time of the accident, emergency, or injury; a description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver, and any action taken to prevent the accident, emergency, or injury from occurring in the future. The deficient practice posed a risk if the facility did not take action to prevent an accident, emergency, or injury from occurring in the future to ensure the health and safety of residents. Findings include: 1. In documentation review, the Department received a report which documented the facility contacted emergency medical services (EMS) on August 15, 2024, for R1 who was nonresponsive. 2. In record review, R1's medical record did not include documentation of the emergency, including the date and time of the accident, emergency, or injury; a description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver, and any action taken to prevent the accident, emergency, or injury from occurring in the future. 3. During an interview, E2 and E3 reported the caregivers were present during R1's emergency. E2 reported R1's hospice agency was contacted during the incident, and emergency medical services was contacted. E1 and E2 acknowledged the caregiver did not complete the required documentation; including the date and time of the accident, emergency, or injury; a description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver, and any action taken to prevent the accident, emergency, or injury from occurring in the future.

Based on observation, and interview, the manager failed to ensure the premises were free from a condition or situation that could pose a hazard. The deficient practice posed a safety risk to residents if they were unable to move through the hallway. Findings include: 1. During an environmental inspection with E2, the Compliance Officer observed a hallway by resident rooms. A Hoyer lift and two portable toilets lined the wall of the hallway; and obstructed the hallway, and exit door to the back yard. 2. During an interview, E2 acknowledged the equipment stored in the hallway posed a hazard by partially blocking the hallway and exit.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident if toxic materials were accessible. Findings include: 1. During an environmental inspection with E2, the Compliance Officer observed a hallway by resident rooms had an unlocked door to the garage. The garage contained several cans of paint on the floor by the door. A shelf had cleaning supplies to include but not limited to Glass Cleaner, Bleach and Anti Bacterial cleaner. 2. During an interview, E2 and E3 acknowledged the toxic material were not stored in a locked area and inaccessible to residents.