Sunrise of Chandler

Based on documentation review and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities, including annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents and staff. Findings include: 1. A review of the facility’s documentation revealed an incomplete annual assessment of the facility's TB risk assessment for 2024, with no signatures. No other current documentation of an annual assessment was available. 2. In an interview, E9 acknowledged that an assessment of the health care institution's risk of exposure to infectious TB was not conducted. 3. In an exit interview, the findings were reviewed with E8 and E9, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for eight of eight residents sampled. The deficient practice posed a high potential health and safety risk to residents and staff of TB exposure. 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 R1's, R2’s, R3’s, R4’s, R5’s, R6’s, R7’s, and R8’s medical records revealed no documentation of an assessment of the residents' risk of exposure to infectious TB. Based on the acceptance dates, this documentation was required. 3. A review of the facility's policies and procedures revealed a policy titled “TB Screening.” The policy stated, “ For states/provinces requiring TB screening/testing, requirements may include: Risk evaluation, symptom screening, and IGRA blood test.” 4. In an interview, E9 acknowledged that an assessment of the resident’s risk of exposure to infectious TB was not conducted. 5. In an exit interview, the findings were reviewed with E8 and E9, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order for one of eight residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R3's medical record revealed a current written service plan dated September 3, 2025. This service plan indicated R3 received medication administration. 2. A review of R3's medical record revealed signed medication orders dated June 9, 2025. The medication order stated “Propranolol HCl Oral Tablet 20 mg. Give 1 tablet by mouth two times a day related to Essential Hypertension. Hold for SBP less than 100 or HR less than 60.” 3. A review of R3's medical record revealed a September 2025 medication administration record (MAR). This MAR stated “Propranolol HCl Oral Tablet 20 mg. Give 1 tablet by mouth two times a day related to Essential Hypertension. Hold for SBP less than 100 or HR less than 60.” “Propranolol” was administered on the following dates: September 2, 2025, between 1900-2100 with R3’s heart rate (HR) at 56 September 15, 2025 between 0700 - 0900 with R3’s HR at 58 September 21, 2025 between 0700 - 0900 with R3’s HR at 57 September 22, 2025 between 0700 - 0900 with R3’s HR at 47 4. In an interview, E8 acknowledged that “Propranolol” was supposed to be held on those dates. 5. In an exit interview, the findings were reviewed with E8 and E9, and no additional information was provided.

Based on observation and interview, the manager failed to ensure there was a current drug reference guide that was available for use by personnel members which posed a health and safety risk to the resident if the caregiver was unable to reference a medication a resident was taking. Findings include: 1. During the compliance inspection the compliance officer observed the facility was providing medication administration services. The facility's current drug reference guide was the Nursing 2022 Drug Handbook by Wolters Kluwer. 2. A Google search found "Nursing 2023 Drug Handbook by Wolters Kluwer and also the 2024 edition. 3. In an interview, E2 acknowledged the facility's drug reference guide was not current.

Based on observation and interview, the manager failed to ensure that soiled linens stored by the assisted living facility were stored in a closed container away from food storage, kitchen, and dining areas. Findings included: 1. During a tour of the facility's memory care unit, E1, E2, and the compliance officer observed four uncovered hamper/baskets of soiled linen sitting the facility's laundry room. 2. In an interview, E1 and E 2 acknowledged the facility was storing uncovered soiled linen in the memory care unit's laundry room. Technical assistance was provided during the compliance inspection on July 6-7, 2022.