Royal Caribbean Assisted Living Home, LLC

Based on record review, documentation review, and interview, the manager failed to ensure that a personnel record for each employee included initial training and continued competency training in fall prevention and fall recovery for one of four employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E4’s personnel record revealed a certificate titled "Fall Prevention Training" that was completed on August 13, 2024. The training certificate did not document if Fall Recovery was also a component of this training. 2. A review of the facility's staff schedule revealed E4 provided services to the residents. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided. This is a repeat deficiency from the compliance inspection and complaint investigation conducted on August 10, 2023.

Based on documentation review and interviews, the manager failed to ensure that personnel provided appropriate first aid in accordance with its certification training for first aid before the arrival of emergency medical services to a resident who is in distress and to a non-injured resident who has fallen, as required under Arizona Revised Statutes (A.R.S.) 36-420.B.1-3. Findings include: 1. A review of the medical record for R3 revealed a narrative note dated December 16, 2025, that stated "staff show pt on the floor on the hallway. was using walker at the time...Pt fell did not complain of any pain at the time alert and oriented. 911 called. Pt did not want to go to ER." 2. Department documentation revealed an intake report dated December 16, 2025, which stated, "A resident sustained a ground level fall without injury. The resident needed help up and the staff refused until EMS arrived. The resident repeatedly stated that they were not injured and just needed help up." 3. In an interview with E2, E2 stated "There were two staff on shift, but not able to get R3 off the floor as no assistance from the resident, so was dead weight so 911 was called to assist." 4. In an exit interview, the findings were reviewed with E3 for the inappropriate utilization of the 911 system, as 911 was called for a noninjured resident who had fallen, appeared to be uninjured, and was unable to reasonably recover independently. No additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure that documentation of medication administration showed the name and signature of the individual administering or providing assistance in the self-administration of medication for two of three residents reviewed. Findings include: 1. A review of documentation contained a policy and procedure titled “recording of medication assistance provided to residents and maintenance of medication record,” which stated, "The trained caregiver will sign off the medication for the date and time the medication was given to the resident and the medications taken by initialing the medication administration record." 2. A review of R1's medical record contained a Medication Administration Record for February 2026. The MAR did not contain caregiver initials documenting the medication was administered for the following medications on February 12, 2026: Gabapentin 100 mg - 2:00 pm and 7:00 pm administration 3.A review of R2's medical record contained a Medication Administration Record for February 2026. The MAR did not contain caregiver initials documenting the medication was administered for the following medications on February 12, 2026: Seroquel 25 mg - 7:00 pm administration Ferrous Sulfate 325mg - 7:00 pm administration 4. In an interview, E2 reported the medication was provided to the residents but "forgot" to document on the record. 5. In an exit interview, the findings were reviewed with E2 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that; if the assisted living facility was authorized to provide directed care services, an elopement drill for employees was conducted every six months on each shift and document the date, time, and description of each drill. Findings include: 1. A review of the facility's license revealed that the facility was licensed to provide Directed Care services. 2. A documentation review revealed no documentation of elopement drills. 3. In an interview, E2 acknowledged that the manager failed to ensure an elopement drill for employees was conducted every six months on each shift and to document the date, time, and description of each drill. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of March 11, 2022. The personnel record revealed documentation of fall prevention training dated March 11, 2022. However, current documentation was not available indicating E2 completed fall prevention and fall recovery training. 2. Review of E5's personnel record revealed E5 worked as the manager and had a hire date of May 1, 2022. The personnel record revealed documentation of fall prevention training dated May 2, 2022. However, current documentation was not available indicating E5 completed fall prevention and fall recovery training. 3. In an interview, E1 reported the training program required initial training upon hire and every year thereafter. E1 and E2 acknowledged documentation was not available showing E2 and E5 completed current training for fall prevention and fall recovery.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of five employees reviewed. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "...C. Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution..." 2. Review of E4's personnel record revealed E4 worked as an assistant caregiver and had a hire date of August 10, 2022. However, the personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E4's fitness to work in a residential care institution. 3. In an interview, E1 and E2 acknowledged documentation was not available showing E4's work references were obtained upon hire at the facility.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of two residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated June 13, 2023. This service plan stated the following services were needed: "Turn every 2 hours while in bed" "Staff provides ROM to both lower extremities as needed" However, documentation was not available indicating these services were provided August 1st - present. 2. In an interview, E1 reported R1 was repositioned every two hours and range of motion (ROM) exercises were provided approximately two times a day. E1 and E2 acknowledged R1's medical record did not include documentation of the above listed services.

Based on observation, record review, and interview, the manager failed to ensure the premises were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential dangers to the resident. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed R1 lying in bed. R1's bed had half bedrails in the upright position. 2. Review of R1's medical record revealed a current written service plan for directed care services dated June 13, 2023. This service plan stated R1 had a diagnosis of "dementia" and "can't walk". 3. In an interview, E1 reported R1 moved around in the bed and the bedrails were placed in the upright position to prevent R1 from failing out of the bed. E1 reported R1 could not move the rails up or down, and could not move around them. E1 and E2 acknowledged the situation may cause the resident to suffer physical injury.