Supreme Care at Goodyear LLC

Based on documentation review, observation, record review, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under Arizona Revised Statutes (A.R.S.) § 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. § 36-446.06. The deficient practice posed a risk if the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation revealed an email stating E2 resigned as manager December 31, 2025. 2. The Compliance Officers observed E2’s manager’s license hanging on the wall of the facility. 3. A review of E2’s personnel file revealed E2’s hire date as February 1, 2025, and “date ended” as December 31, 2025. 4. A review of the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board) registry revealed E2’s “Facility Appointments” did not list the current facility. 5. In an interview, E1 reported E2 was rehired on February 1, 2026. However, there was no documentation provided at the time of the inspection showing E2 was rehired as manager or documentation of a temporary manager for the month of January 2026. 6. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident’s service plan included the amount, type, and frequency of assisted living services and ancillary services being provided to the resident, for two of two residents sampled. The deficient practice posed a risk if the residents’ needs were not being met. Findings include: 1. A review of R1’s medical record revealed a service plan dated December 8, 2025. The service plan revealed R1 received personal care services. However, the service plan did not specify the frequency R1 received the following services: a. “Partial bath: At Bedside”; b. “Dressing: Assist in selecting clothes, assist in putting on shoes, assist in removing clothes”; c. “Maintenance of Room: Dependent”; and d. “Laundry Services: Dependent”. 2. A review of R2’s medical record revealed a service plan dated January 21, 2026. The service plan revealed R2 received personal care services. However, the service plan did not specify the frequency R2 received the following services: a. “Oral care: Brush teeth”; b. “Dressing: Assist in putting on shoes, assist in removing clothes”; c. “Maintenance of Room: Dependent”; and d. “Laundry Services: Dependent”. 3. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident’s medical record contained the name and contact information of the resident’s representative and the document signed by the resident consenting for the resident’s representative to act on the resident’s behalf, or if the resident’s representative has a health care power of attorney, a copy of the health care power of attorney, for one of two residents sampled. Findings include: 1. A review of R2’s medical record revealed a service plan dated January 21, 2026. The service plan was signed by R2’s representative. 2. Further review of R2’s medical record revealed the record did not contain a document signed by R2 consenting for R2’s representative to act on R2’s behalf, or a copy of a R2’s representative’s healthcare power of attorney. 3. In an interview, E1 reported R2’s representative had a power of attorney to act on R2’s behalf, however, no power of attorney documentation for R2 was provided during the inspection. 4. In the 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 a written order verifying a verbal order was obtained from a medical practitioner within 14 calendar days after receiving the verbal order, for two of two residents sampled. The deficient practice posed a risk to the resident’s health and safety. Findings include: 1. A review of R1’s current service plan, dated December 8, 2025, revealed R1 received medication administration. 2. A review of R1’s medical record revealed a Patient Medication Record dated December 24, 2025. The record contained a digital signature by a registered nurse (RN). However, there were no signed orders from a medical practitioner verifying the verbal orders in R1’s medical records. The record contained the following medications: a. Lantus SoloStar Subcutaneous Solution Pen-Injector 100 Unit/ML, inject 25 units subcutaneously at bedtime; b. Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG, 1 tab by mouth daily; c. Furosemide Oral Tablet 40 MG, 1 tab by mouth every morning; d. Doxazosin Mesylate Oral Tablet 2 MG, 1 tab by mouth every morning; e. Hydralazine HCl Oral Tablet 100 MG, 1 tab by mouth every 8 hours; and f. Lorazepam Oral Tablet 0.5 MG, take 0.5mg by mouth twice daily. 3. A review of R1’s medical record revealed a medication administration record (MAR) dated January 2026 and February 2026. The MAR revealed R1 received the following medications on the following dates and times: a. Lorazepam 0.5 MG Take 1 Tab PO BID: 8:00 AM and 8:00 PM January 1, 2026 – February 5, 2026; b. Metoprolol Succinate 25 MG Give 1 Tab PO QD: 8:00 AM January 1, 2026 – February 5, 2026; c. Furosemide (Lasix) 40 MG Give 1 Tab PO Q AM: 8:00 AM January 1, 2026 – February 5, 2026; d. Doxazosin Mesylate 2 MG Give 1 Tab PO Q AM: 8:00 AM January 1, 2026 – February 5, 2026; e. Lantus Pen Inj 100 U/ML Inject 20 units intramuscularly: 8:00 PM January 1, 2026 – February 5, 2026; and f. Amiodarone 200 MG Give 1 Tab PO BID: 8:00 AM January 1, 2026 – February 5, 2026. 4. A review of R2’s current service plan, dated January 21, 2026, revealed R2 received medication administration. 5. A review of R2’s medical record revealed a verbal medication list dated October 10, 2025. The list was E-signed by a registered nurse (RN). However, there were no signed orders from a medical practitioner verifying the verbal orders in R2’s medical records. The list contained the following medications: a. Fluoxetine HCI Tablet 20 MG – Administer 1 Tablet Oral once daily (qd); b. Furosemide Tablet 20 MG – Administer 1 Tablet Oral qd c. Gabapentin Capsule 300 MG – Administer 1 Capsule Oral qd; d. Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG – Administer 0.5 Tablet Extended Release 24 Hour Oral qd; e. Montelukast Sodium Tablet 10MG - Administer 1 Tablet Oral qd; f. Potassium Chloride ER Tablet Extended Release 10 MEQ - Administer 1 Tablet Extended Release Oral twice daily (bid); g. Tamsulosin HCI Capsule 0.4MG - Admin