Royal Paradise Care LLC

Based on documentation review and interview, the manager failed to immediately report suspected abuse according to A.R.S. \'a7 46-454. The deficient practice posed a risk as a peace officer or the adult protective services central intake was unable to assess if there was an immediate health and safety concern for the resident and other residents residing in the assisted living facility. Findings include: A.R.S. \'a7 46-454(A) ... other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services (APS) central intake unit ... All of the above reports shall be made immediately by telephone or online. A.R.S. \'a7 46-454(B) If an individual prescribed in subsection A of this section is an employee or agent of a health care institution as defined in section 36-401 and the health care institution's procedures require that all suspected abuse, neglect and exploitation be reported to adult protective services as required by law... R9-10-101(111) "Immediate" means without delay. 1. A review of facility documentation showed an email was sent to the facility on July 10, 2024 from [O1]. The email reported, "[R1] recently told [O1] that [E1] has told [R1] that [E1] loves [R1]! [R1] has responded with the same feelings. [R1] thinks they are in love and [R1] wants [O1] to be happy for [R1]. [O1] see this as a dangerous situation. [O1] would prefer that [E1] not be allowed to handle any of [R1] personal care ..." 2. A review of facility documentation showed an email was sent to the facility on July 12, 2024. This email revealed that E1 has R1's phone number and has called R1. 3. A review of facility documentation showed E1 was taken off the schedule on July 11, 2024. 4. A review of the police report revealed that R1 reported that it was "consensual" and R1 confirmed that E1 and R1 were intimate. 5. In an interview, E2 acknowledged APS was not notified and E2 was not aware that if there was a suspicion of abuse, neglect or exploitation it has to be immediately reported to APS or a peace officer.

Based on record review, documentation review and interview, the manager failed to ensure a caregiver's skills and knowledge was verified and documented before providing physical health services and according to policies and procedures, for two of two caregivers sampled. The deficient practice posed a risk to the health and safety of residents if caregivers did not have the skills and knowledge before providing services to residents. Findings include: 1. A review of E1's and E2's personnel file revealed documentation of the verification of E1's and E2's skills and knowledge was not available for review. 2. A review of facility policy and procedures revealed a policy titled, "Caregivers, assistant caregivers, and Volunteers" stated in section 2.C) " ... A caregiver's or assistant caregiver's skills and knowledge are verified and documented before the caregiver or the assistant caregiver provides physical health services or behavioral health services, and according to the policies and procedures." 3. During an interview, E2 looked through E1's and E2's personnel record and acknowledged the skills and knowledge verification documentation was not available for review.

Based on record review and interview, the manager failed to ensure a written service plan was signed and dated by the resident or resident's representative, for one of two sampled residents. The deficient practice posed a health and safety risk if the resident or representative did not acknowledge the services that were to be provided. Findings include: 1. A review of R2's medical record revealed a written service plan for personal care services dated February 26, 2024. However, the service plan did not include a signature and date from R2 or R2's representative. 2. In an interview, E1 acknowledged R2's service plan did not include a signature and date from R2 or R2's representative. This is a repeat citation from the previous compliance inspection conducted on February 9, 2023.