Searles Care Home

Based on record review and interview, for two of two sampled residents, the assisted living home failed to maintain a standardized form including all required information in A.R.S. § 36-420.04(A)(1-9). A.R.S. § 36-420.04.A. States: 1-9. 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. Findings include: 1. A review of emergency responder forms for R1 and R2 revealed completed documentation was not available for either resident. 2. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on record review, documentation review,, and interview, the chief administrative officer failed to implement tuberculosis control activities to include baseline screening for each individual employed by or admitted to the health care institution, annual training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by the health care institution, and annually assessing the health care institution's risk of exposure to infectious tuberculosis, for two of two sampled employees and two of two sampled residents. Findings include: 1. A review of E2's personnel record revealed E2's baseline screening was incomplete. E2's documentation of freedom from infectious tuberculosis included a single negative skin test dated within a year prior to E2's date of hire and a second negative skin test dated more than a year prior to the other test. 2. A review of E1's and E2's personnel records revealed documentation of annual training and education related to recognizing the signs and symptoms of tuberculosis was not available for review. 3. A review of R1's medical record revealed documentation of baseline screening with seven calendar days after R1's date of acceptance was not available for review. 4. A review of R2's medical record revealed incomplete documentation of baseline screening. R2's record included documentation of R2's freedom from infectious tuberculosis However, R2's medical record did not include documentation of assessing R2's risks of prior exposure to infectious tuberculosis or of determining if R2 had signs or symptoms of tuberculosis. 5. A review of facility documentation revealed documentation of annually assessing the health care institution's risk of exposure to infectious tuberculosis was not available for review. 6. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on record review and interview, the manager failed to ensure a residency agreement was signed by the resident or resident's representative within five working days after a resident's acceptance, for one of two sampled residents. Findings include: 1. A review of R2's medical record revealed a residency agreement signed by the facility manager on the date of acceptance. However, the residency agreement had been signed by the resident's representative fifteen days after acceptance. 2. In an interview E1 reported R2 was directed care and did not have a representative when R2 was accepted. 3. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on record review and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of two sampled residents. Findings include: 1. A review of R1's medical record revealed a service plan, dated August 1, 2025, for directed care services including medication administration. 2. A review of R1's medical record revealed the following order, "Aspirin 81 MG Tab, Oral 1 tab daily cardiac prophy, start effective date 08/19/2024." 3. A review of R1's medical record revealed a Medication Administration Record (MAR) dated August 2025. The MAR indicated, "Aspirin EC 81 MG Tablet Daily" had been held with the note, "Hold blood urine," between August 4, 2025 until August 19, 2025. 4. A review of R1's medical record revealed a hospice plan of care update dated August 4, 2025, which stated, "Recieved call from facility that [R1] had some blood in brief this morning. Upon arrival to facility, I was informed that [R1] had a fall and sustained small laceration to back of head when [R1] was being changed due to [R1] refusing to let them change [R1] they are trying to make [R1]. Head wound cleansed and left open to air at this time. I did have a discussion with them that if [R1] refuses, they need to walk away, let [R1] settle down and readdress in few minutes. I did change [R1's] brief and clothes while I was there without any difficulty. Head to toes assessment performed and completed." The update indicated no changes were made to the hospice care plan. However, an order to hold Aspirin was not available. 4. In an interview, E1 reported E1 had contacted hospice about the bleeding and advised hospice had not ordered R1's aspirin to be held. E1 reported Aspirin is a blood thinner and E1 would not provide Aspirin to someone that was bleeding. 5. A review of R2's medical record revealed a service plan, dated August 3, 2025, for directed care services including medication administration. 5. A review of R2's medical record revealed orders for the following medications: "Apixaban Oral Tablet 5 MG, Give 5 mg by mouth every 12 hours for a-fib"; "Polyethylene Glycol 3350 Powder, give 17 gram by mouth one time a day for bowel care, hold if loose stools present"; "Metoprolol Tartrate Tablet, Give 12.5 mg by mouth two times a day for HTN, afib hold if HR less than 60 or systolic BP less than 100"; and "Acetaminophen Oral Tablet 500 MG, Give 1000 mg by mouth every 8 hours for pain." 6. A review of R2's medical record revealed a MAR, dated August 2025. The MAR documented the following medication administration errors: for "Apixaban Oral tablet 5 MG, give 5 mg by mouth every 12 hours," the MAR indicated the medication had been administered at 8 AM and 6 PM each day; for "Polyethylene Glycol, give 17 gram by mouth one time a day for bowel care," the medication had been marked, "PRN" and had not been administered to R2 at all in August 2025; for "Metoprolol Tartrate, Give 12.5 mg by mouth two times

Based on observation, record review, and interview, the manager failed to ensure medication was stored in a locked area. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a multi-dose medication container (medi-set) in R2's bedroom. The Compliance Officer observed the medi-set included prescription medications including Apixaban. 2. In an interview, R2 reported R2 had brought the medi-set from home and the medications in it were old. 3. A review of R2's medical record revealed a service plan, dated August 3, 2025, for directed care services including medication administration. 4. During an environmental inspection of the facility, the Compliance Officer observed a refrigerator in the kitchen which was accessible to residents. Inside the refrigerator, the Compliance Officer observed containers of "Kisqali," "Insulin Lispro," "Ozembic," and "Lantus Solostar," were not in a locked area and were accessible to residents. 5. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on observation and interview, the manager failed to ensure the premises at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed the facility had two separate buildings. One building included the kitchen, dining room, and several bedrooms. A second building located in the back yard included three bedrooms, a bathroom, and a small living area. The Compliance Officer observed a paved and fenced walkway connected the back door of the first building to the front door of the second building. 2. During an environmental tour of the facility, the Compliance Officer observed a black futon in the living area of the second building. The Compliance Officer observed when the futon was converted into a bed, it partially blocked the door to exit the second building. 3. In an interview, E1 reported there is a second caregiver always present in the second building and they are a live-in caregiver who sleeps on the futon in the living area. E1 reported the futon blocks the door partially when used as a bed. E1 reported they would no longer block the exit with the futon. 4. In an exit interview with E1, the findings were reviewed and no additional information was provided.

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 inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a shared bathroom adjacent to bedroom #7. The Compliance Officer observed a cabinet below the bathroom sink had a lock, however, the lock was loose and the Compliance Officer was able to open the cabinet without a key. Inside the cabinet, the Compliance officer observed containers of,"Amdro Insect Killer," "Lysol," and "Windex." 2. In an exit interview with E1, the findings were reviewed and no additional information was provided. This is a repeat deficiency from the on-site compliance inspection conducted on April 8, 2024.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. Findings include: 1. A review of the facility's work schedule revealed the facility had two shifts. 2. A review of facility documentation revealed a disaster drill conducted, on March 31, 2024. No other disaster drills were provided for review. 3. In an interview, E1 acknowledged disaster drills were not conducted and documented on each shift at least once every three months. E3 reported the facility recreated their disaster drill form and somehow they missed completing the disaster drills.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. Findings include: 1. During the facility tour, the Compliance Officer observed an unlocked cabinet in a facility bathroom, which contained "Clorox" toilet cleaner, and "Lysol" disinfectant spray. 2. During the facility tour, the Compliance Officer observed an unlocked cabinet under the kitchen sink, which contained, a bucket of "Cascade" dishwashing pods. 3. In an interview, E1 acknowledged the toxic materials were unsecured. E1 was unable t get the lock to re-close on the bathroom cabinet and reported the lock would be replaced. This is a repeat citation from the compliance inspection conducted on April 19, 2023.