Sunrise of Scottsdale

Based on documentation review, record review, and interview, the manager failed to ensure an individual authorized to administer opioids identified the resident's need for an opioid before administering the opioid and monitored the resident's response to the opioid for residents who did not have an active malignancy or an end-of-life condition. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of the facility's policies and procedures revealed a policy titled, “Opioid management,” which stated, “6. Medication Management: a. Prior to administration of an opioid pain medication MCM will ask the resident’s pain level. b. The resident’s rating of current pain level is documented on the (electronic Medication Administration Record) eMAR. c. The resident’s response to the pain medication is documented on the eMAR. d. If the resident reports no improvement in the pain level or a pain level that is not acceptable to the resident, the LN will notify the resident’s physician/ prescriber to obtain further orders.” 2. Review of R3’s medical record revealed a current service plan dated September 8, 2025 which indicated R3 was at the personal level of care and R3 received medication administration. The service plan did not indicate R3 was on hospice, was receiving treatment for an active malignancy, or had an end-of-life condition. 3. Review of R3’s medical record revealed an eMAR which revealed R3 received Tramadol 50 mg oral tablet two times a day from October 1, 2025 to the day of the inspection. 4. Review of R3’s medical record revealed a medication order for Tramadol 50 mg with a start date of September 24, 2025. 5. Review of R3’s medical record revealed “NA” for pain level when Tramadol 50 mg was administered on October 1st, 2nd, 6th, 7th, 8th, 9th, 13th, 15th, 16th, and 19th 2025 for both times Tramadol 50 mg was administered. It was unclear if the pain level was recorded before or after. There was sometimes one number or “NA” for the hour of administration. 6. In an interview, E1 reported that “NA” meant “Not Applicable” because the resident did not have pain. However, on October 14, 2025 in the evening “0” was recorded for the pain level. 7. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, for seven of seven employees reviewed, the governing authority failed to ensure compliance with A.R.S. § 36-411. The deficient practice posed a risk if a personnel member was a danger to a vulnerable population. Findings Include: 1. A.R.S. § 36-411 states: "C. Each residential care institution, nursing care institution, and home health agency shall make documented, good-faith efforts to: 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee. 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459." 2. A review of E1's, E2's, E3's, E4's, E5's, E6's, and E7's personnel records did not include documentation of verification that E1, E2, E3, E4, E5, E6, and E7 were not on the adult protective services registry. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to immediately report suspected abuse according to A.R.S. § 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: 1. A.R.S. § 46-454(A) stated "A. A health professional, emergency medical technician, home health provider, hospital intern or resident, speech, physical or occupational therapist, long-term care provider, social worker, peace officer, medical examiner, guardian, conservator, fire protection personnel, developmental disabilities provider, employee of the department of economic security or 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 central intake unit. The guardian or conservator of a vulnerable adult shall immediately report or cause reports to be made of such reasonable basis to the superior court and the adult protective services central intake unit. All of the above reports shall be made immediately by telephone or online..." 2. R9-10-101.111 stated "Immediate" means without delay. 3. Review of R6’s medical record revealed a document titled, “Progress Note”. In the progress note, an entry dated October 2, 2025, stated, “This incident was mentioned in reference to another incident that was being discussed in Standup meeting at 9:30 am on 9/29. At the time [E1] thought that if I reported this then it would be past the time of the 24 hour reporting standard. I also thought I remembered hearing about this before but wasn’t sure of the details of time frame, whether I had heard it from staff or the resident or elsewhere. At 3:30 PM on 10/1 I discussed this with [R4’s family member] and I called APS at around 4:30PM on 10/1.” The progress note further stated, “I understand that this report is not as immediate as it should have been.” The progress note went on to describe the incident that happened which stated, "In the vestibule there were \"a lot of people\" and they were all in a line and [R4] was right behind [R6] and pushed [R6] with [R4's] walker. [R6] then said \"Stop pushing me\" [R4] was pushing [R6] from behind and [R6] could feel that." 4. Review of Department documentation revealed a report regarding R4 and R6, which stated, “RS reported on 10/01/25 about an incident that took place around 09/17/25 but RS just became aware of the incident yesterday 09/30/25.” 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager retained a resident who was confined to a bed or chair without meeting the requirements of R9-10-814(B)(2), for one of seven residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. R9-10-814(B)(2) states, "A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who is confined to a bed or chair because of an inability to ambulate even with assistance if: the resident's primary care provider... examines the resident... at least once every six months throughout the duration of the resident's condition; reviews the assisted living facility's scope of services; and signs and dates a determination stating that the resident's needs can be met by the assisted living facility..." 2. A review of R2's service plan (dated July 30, 2024) revealed R2 received personal care services, and was confined to a bed or chair. 3. A review of R2's medical record revealed a determination for continued residency dated February 28, 2024. No further documentation was available for Compliance Officer review. 4. In an interview, E1 acknowledged R2's medical record did not include the required determination per R9-10-814(B)(2) updated at least once every six months.

Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. A review of the facility's policies and procedures revealed the facility's disaster plan, however no documentation of a review was available. 2. In an interview, E1 acknowledged that the facility's disaster plan was not reviewed at least once every 12 months.