Skyline at Mina Vista Assisted Living

Based on documentation review and interview, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery. Findings include: 1. A review of E3's personnel record revealed documentation of fall prevention and fall recovery training was not available for review. 2. In an interview, E1 acknowledged E3's personnel record did not include documentation of a fall prevention and fall recovery training.

Based on documentation review, record review, and interview, the manager failed to ensure, for one of two caregivers sampled, before providing assisted living services to a resident, a manager or caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of the facility work schedule revealed E2 had worked on the 7 PM to 7 AM shift on September 29 and September 30, and had worked on the 7 PM to 7 AM shift on October 1,2,6,7,8,9,13,14,15,and October 16, 2024. 2. A review of E2's personnel record revealed a Basic First Aid certification issued on August 21, 2022, with a marked expiration of August 2024. However, documentation of current CPR and First Aid training was not available for review. 3. In an interview, E1 acknowledged E2's personnel records did not include documentation of current CPR and First Aid training certification.

Based on record review and interview, the manager failed to ensure before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility which included the manager's signature and date signed, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed a documented residency agreement. However, the residency agreement had been signed and dated by the manager five days after the date of acceptance.. 2. In an interview, E1 acknowledged the manager had not signed and dated the residency agreement for R2 before or at the time of R2's acceptance.

Based on observation, record review, and interview, the manager failed to ensure that medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a refrigerator in the kitchen. Inside the refrigerator, the Compliance Officer observed an unsecured container "Latanoprost" on the top shelf, stored along side food items. 2. During an environmental inspection of the facility, the Compliance Officer observed unlocked closet in the entrance area. Inside the closet, the Compliance Officer observed hygiene items for each resident, and also observed a bottle of, "Hibiclens (Clorhexidine Gluconate solution)." 3. In an interview, E1 acknowledged medications stored by the assisted living facility had not been stored in a separate locked area.

Based on documentation review and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver immediately notified the resident's emergency contact and primary care provider, for three of three residents reviewed who had an incident resulting in the resident needing medical services. Findings include: 1. A review of facility incident reports revealed an incident report for R2, dated October 8, 2024 at 2:30 PM. The incident report stated, "Went in to give [R2] breakfast and noticed [R2] was shaking and vomiting, [R2] also said [R2's] head hurt and also [R2's] throat, and [R2] was very pale...sent to [a hospital]." The incident report documented R2's emergency contact was notified at 2:40 pm, however, documentation of the immediate notification of R2's primary care provider was not available for review. 2. A review of facility incident reports revealed an incident report for R3, dated October 23, 2024 at 6:30 PM. The incident report stated, "Resident said help me really low and when [E4] walked in resident was on floor with a puddle of blood w/ a big knot. Help resident up (sit) and held resident up and helped [R3] lean on the bed. [E2] called 911, hospice, and hospice wanted [E3] sent out to hospital." The incident report documented a hospice was contacted immediately, however, documentation of the immediate notification of R3's emergency contact was not available for review. 3. A review of facility incident reports revealed an incident report for R4,, dated September, 2024 at 3:40 PM. The incident report stated, "[R4] was asking to lay in bed prior to accident but [R4] was already throwing up, about 10 min prior [R4] starting stiffing arms and legs, jerking, staring, biting [R4's] tongue / having a seizure....bit tongue, still having seizure when ambulance came." The incident report documented 911 was contacted immediately, however, documentation of the immediate notification of R4's emergency contact and primary care physician were not available for review. 4. In an interview, E1 acknowledged documentation of the immediate notification of R2's, R3's, and R4's emergency contacts and primary care providers, when each resident had an emergency, were not available for review.

Based on observation and interview, the manager failed to ensure the hot water temperature was maintained between 95 \'b0F and 120 \'b0F in areas of the assisted living facility used by residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed the water temperature measured at 137.2\'b0 F in a shared resident bathroom. 2. In an interview, E1 acknowledged the hot water temperature had not been maintained between 95 \'b0F and 120 \'b0F in and area of the assisted living facility used by residents.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in labeled containers in a locked area and inaccessible to residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed the laundry room door did not have a lock and was accessible to residents. Inside the laundry room, the Compliance Officer observed two cabinets above the washer and dryer had magnetic locks, however, both locks were broken and could not be secured. Inside the cabinets, the Compliance Officer observed containers of, "Endust," "Comet with Bleach," "Sprayway Glass Cleaner," "Easy Off Oven Cleaner," "Simple Green All Purpose Cleaner," "Great Value Bathroom Cleaner with Bleach," and bleach. 2. During an environmental inspection of the facility, the Compliance Officer observed a shared resident bathroom, marked "Bath #1" on the facility floor plan. The Compliance Officer observed a closet in the bathroom had been left open and accessible to residents. Inside the closet, the Compliance Officer observed containers of paint, caulk, "Bondo putty," and "Blaster Penetrating Catalyst." 3. During an environmental inspection of the facility, the Compliance Officer observed a shared resident bathroom, marked "Bath #4" on the facility floor plan. The Compliance Officer observed a cabinet below the sink did not have a lock. Inside the cabinet, the Compliance Officer observed a container of,"Comet with Bleach." 4. In an interview, E1 acknowledged poisonous or toxic materials had not been maintained in labeled containers in a locked area and inaccessible to residents.

Based on record review and interview, the assisted living home failed to maintain a copy of documents provided to an emergency responder. Findings include: 1. A review of R3's medical record revealed a document titled, "Medical Administration Record," (MAR) dated June 2024. The MAR documented medications had been administered to R3 at 8 AM on June 29, but was marked, "HOSP" at 6 PM on June 29, 2024. 2. A review of R3's medical record revealed documentation of the accident, emergency of injury which results in R3's hospitalization was not available for review. 3. A review of R3's medical record revealed documentation of compliance with A.R.S. 36-420.04 during R3's emergency on June 29, 2024 was not available for review. 4. In an interview, E1 acknowledged a copy of the documentation given to the emergency responders for R3 on June 29, 2024 had not been provided for review.

Based on observation, interview, documentation review, and record review, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility premises. Findings include: 1. Upon arriving at the facility, the Compliance Officer observed E2 and E4, both caregivers, were working at the facility. 2. The Compliance Officer observed a posting by the front door designated E2, E6, and E8 to be accountable for the facility when E1 was not present. However, E5 and E7 were not designated. 3. In an interview, E2 reported E2 had just returned to work after being on leave. However, E2 did not state what date E2 had left or had returned. 4. The Compliance Officer observed a binder in a cabinet in the kitchen contained work schedules and time cards. 5. A review of the facility's work schedules revealed three weekly schedules, covering June 9, 2024 through June 29, 2024, and documentation of the hours worked by caregivers and assistant caregivers for the remainder of the year were not available. These schedules indicated E2 had worked each Thursday, Friday, and Saturday from 7 PM to 7 AM on the weeks of June 9, June 16, and June 23, 2024. The schedule did not include E5 or E7. 6. A review of the facility's time cards revealed a time card for E2 for June 2024 was not available for review. A review of all available time cards revealed time cards documenting who had worked from 7 PM to 7 AM on Thursday, Friday, or Saturday in June 2024 were not available for review. 7. On July 3, 2024 at 12:41 PM, the Compliance Officer requested staff schedules for the previous 12 months from E3. 8. On July 3, 2024 at 2:36 PM, E3 provided a partial time card for E5, which documented E5 worked the overnight shift on June 19, 20,21, 27, and 28. 9. In an interview, E3 reported E5 works for E3 at a different facility but covered Skyline at Mina Vista Assisted Living while E2 was out. However, E3 reported E5 was not able to work on Saturdays. E3 reported not knowing exactly how long E2 was on leave. 10. A review of R3's medical record revealed a form titled, "ADL LOG," dated June 2024. The form documented the services provided to R3 and included caregiver initials for each service. The form included a task, "Give water every 2 hours." The ADL Log indicated the following: - E2 had not provided services to R3 during the month of June 2024; - E7 had provided services to R3 on June 1, June 8, and June 22. 11. In an interview, E1 reported E2 was gone for about 2 months and had just returned, but was not sure of the dates. E1 reported they had used a staffing agency to cover some of the shifts E5 was not able to cover, and E7 was an agency staff member. E1 was not sure of E7's name or the staffing agency. E1 was not sure which dates E7 had worked. 12. In an interview, E1 acknowledged E5 and E7 had been present at the facility when E1

Based on observation, interview, documentation review, and record review, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. Findings include: 1. Upon arriving at the facility, the Compliance Officer observed E2 and E4, both caregivers, were working at the facility. 2. In an interview, E2 reported E2 had just returned to work after being on leave. However, E2 was not sure what date E2 had left or had returned. 3. The Compliance Officer observed a binder in a cabinet in the kitchen contained work schedules and time cards. 4. A review of the facility's work schedules revealed three weekly schedules, covering June 9, 2024 through June 29, 2024, and documentation of the hours worked by caregivers and assistant caregivers for the remainder of the year were not available. These schedules indicated E2 had worked each Thursday, Friday, and Saturday from 7 PM to 7 AM on the weeks of June 9, June 16, and June 23, 2024. The schedule did not include E5 or E7. 5. A review of the facility's time cards revealed a time card for E2 for June 2024 was not available for review. A review of all available time cards revealed no time card documenting who had worked from 7 PM to 7 AM on Thursday, Friday, or Saturday in June 2024. 6. On July 3, 2024 at 12:41 PM, the Compliance Officer requested staff schedules for the previous 12 months from E3. 7. On July 3, 2024 at 2:36 PM, E3 provided a partial time card for E5, which documented E5 worked the overnight shift on June 19, 20,21, 27, and 28. 8. In an interview, E3 reported E5 works for E3 at a different facility but covered Skyline at Mina Vista Assisted Living while E2 was out. However, E3 reported E5 was not able to work on Saturdays. E3 reported not knowing exactly how long E2 was on leave. 9. A review of R3's medical record revealed a form titled, "ADL LOG," dated June 2024. The form documented the services provided to R3 and included caregiver initials for each service. The form included a task, "Give water every 2 hours." The ADL Log indicated the following: - E2 had not provided services to R3 during the month of June 2024; - E7 had provided services to R3 on June 1, June 8, and June 22. 10. In an interview, E1 reported E2 was gone for about 2 months and had just returned, but was not sure of the dates. E1 reported they had used an agency to cover some of the shifts E5 was not able to cover, and E7 was the agency staff member. E1 was not sure of E7's name or the staffing agency. E1 was not sure which dates E7 had worked. 11. A review of the facility's policies and procedures, reviewed by E1 on December 27, 2023, revealed a policy titled, "Staffing and Work Schedule." This policy stated, "The Certified Manager will ensure that a personnel schedule indicates the date, scheduled work hours, and name of each caregiver assigned; reflects actual work hour

Based on observation, interview, documentation review, and record review, the manager failed to ensure a personnel record was available for one of three employees reviewed. The deficient practice posed a risk as required information could not be verified for E1. Findings include: 1. Upon arriving at the facility, the Compliance Officer observed E2 and E4, both caregivers, were working at the facility. 2. In an interview, E2 reported E2 had just returned to work after being on leave. However, E2 did not state what date E2 had left or had returned. 3. The Compliance Officer observed a binder in a cabinet in the kitchen contained work schedules and time cards. 4. A review of the facility's work schedules revealed three weekly schedules, covering June 9, 2024 through June 29, 2024, and documentation of the hours worked by caregivers and assistant caregivers for the remainder of the year were not available. These schedules indicated E2 had worked each Thursday, Friday, and Saturday from 7 PM to 7 AM on the weeks of June 9, June 16, and June 23, 2024. The scheduled did not document E5 or E7 had worked at any time. 5. A review of the facility's time cards revealed a time card for E2 for June 2024 was not available for review. A review of all available time cards revealed no time card documenting who had worked from 7 PM to 7 AM on Thursday, Friday, or Saturday in June 2024. 6. On July 3, 2024 at 12:41 PM, the Compliance Officer requested staff schedules for the previous 12 months from E3. 7. On July 3, 2024 at 2:36 PM, E3 provided a partial time card for E5, which documented E5 worked the overnight shift on June 19, 20,21, 27, and 28. 8. In an interview, E3 reported E5 works for E3 at a different facility but covered Skyline at Mina Vista Assisted Living while E2 was out. However, E3 reported E5 was not able to work on Saturdays. E3 reported not knowing exactly how long E2 was on leave. 9. A review of R3's medical record revealed a form titled, "ADL LOG," dated June 2024. The form documented the services provided to R3 and included caregiver initials for each service. The form included a task, "Give water every 2 hours." The ADL Log indicated the following: - E2 had not provided services to R3 during the month of June 2024; - E7 had provided services to R3 on June 1, June 8, and June 22. 10. In an interview, E1 reported E2 was gone for about 2 months and had just returned, but was not sure of the dates. E1 reported they had used an agency to cover some of the shifts E5 was not able to cover, and E7 was the agency staff member. E1 was not sure of E7's name or the staffing agency. E1 was not sure which dates E7 had worked. 11. The Compliance Officer requested to review E7's personnel record. However, a personnel record was not provided for review. 12. In an interview, E1 reported being unaware caregivers provided to the facility by a staffing agency needed to have personnel records. E1 reported no documentation was available for E7, to include E7's caregi

Based on documentation review, record review and interview, 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 incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of one resident reviewed who had an incident resulting in the resident needing medical services. Findings include: 1. A review of R3's medical record revealed a document titled, "Medical Administration Record," (MAR) dated June 2024. The MAR documented medications had been administered to R3 at 8 AM on June 29, but was marked, "HOSP" at 6 PM on June 29, 2024. 2. A review of R3's medical record revealed documentation of the accident, emergency of injury which results in R3's hospitalization was not available for review. 3. In an interview, E2 reported R3 had had some kind of seizure or stroke at the facility and was sent to the hospital. 4. In an interview, E1 acknowledged R3's record did not include documentation showing the date and time of the incident; a detailed description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future.