Spring Gardens Peoria

Based on documentation review, record review, and interview, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04.A., for three of three residents sampled. Findings include: 1. A.R.S. 36-420.04.A states, "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. A review of R1, R2, and R3's medical records revealed no documentation of a standardized form. 3. In an interview, E1 reported the facility had a standardized form available for review. However, the form was not filled in with the necessary information for each resident. 4. In an exit interview, the findings were discussed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure a manager and caregiver provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of two personnel sampled. The deficient practice posed a potential illness risk to residents. 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. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. A review of E1's personnel record revealed two negative TB skin tests that were more than 12 months old; however, no additional documentation of freedom from infectious TB was available for review. Based on E1’s date of hire, this documentation was required. 4. A review of E2's personnel record revealed one tuberculosis skin test completed after E2's date of hire. However, a second tuberculosis skin test was not available for review. Based on E2’s date of hire, this documentation was required. 5. In an exit interview, the findings were discussed with E1, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour, the Compliance Officers observed the following: In the kitchenette cabinets in the main entry room of the facility, a bottle of Windex and a box of Propak dish fuel. In a private dining area separated by a curtain, a bottle of stainless steel cleaner. A cleaning cart left unlocked and unattended in the residents' hallway. The cart contained stainless steel cleaner, bathroom cleaner, and window cleaner bottles. A bottle of disinfectant cleaner in the unlocked salon room. 2. A review of the facility's policies and procedures revealed a policy titled "Environmental Quality, Comfort and Safety." This policy stated, "9. Poisonous or toxic materials stored by the assisted living community are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications are inaccessible to residents." 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, document review, and interview, the manager failed to ensure pets in the assisted living facility were licensed consistent with local ordinances. Findings include: 1. A review of pet records revealed current rabies vaccinations for O1 and O2. However, documentation of current annual licenses, were not available for review. 2. A review of the Maricopa County licensing website revealed the following, "ll dogs in Unincorporated Maricopa County, Apache Junction, Avondale, Buckeye, Carefree, Cave Creek, Chandler, El Mirage, Fountain Hills, Gila Bend, Gilbert, City of Glendale, Goodyear, Guadalupe, Litchfield Park, Mesa, Paradise Valley, Peoria, Phoenix, Queen Creek, Scottsdale, Surprise, Tempe, Tolleson, Wickenburg, Youngtown must be licensed and vaccinated against rabies." 3. In an exit interview with E1, the findings were reviewed and no additional information was provided.