Symphony Assisted Living

Based on documentation review, record review, and interview, the health care institution failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training for two of two personnel sampled. The deficient practice posed a health and safety risk for residents. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled “The training program required initial training and continued competency review on an annual basis in fall prevention and fall recovery.” 2. A review of E1’s personnel record revealed documentation of completed fall prevention and fall recovery training conducted on July 30, 2024. However, E1’s personnel record did not include documentation of additional training on fall prevention and fall recovery. 3. A review of E2’s personnel record did not include documentation of completed fall prevention and fall recovery training. Based on E2's date of hire, this documentation was required. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

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. 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 facility documentation did not include a standardized form that included the aforementioned information for each resident of the facility. 3. A review of R1's and R2's medical records revealed all required information; however, a standardized form with all aforementioned information was not available for review. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review and interview, the health care institution's chief administrative officer failed to ensure training and education related to recognizing the signs and symptoms of tuberculosis (TB) was provided annually to individuals employed by the health care institution, for two of two personnel sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A review of E1's personnel record revealed completed training on recognizing the signs and symptoms of TB on July 30, 2024. However, documentation of additional training was not available for review. 2. A review of E2's personnel record did not include documentation of completed training on recognizing the signs and symptoms of TB. Given E2's date of hire, this documentation was required. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that policies and procedures were reviewed at least once every three years and updated as needed. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees. Findings include: 1. A review of the facility's policy and procedure manual revealed an update date of January 1, 2022. There was no documentation indicating a review after that date was completed. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure documentation was maintained for at least 12 months of the caregivers and assistance caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. While on-site for the compliance and complaint inspection, the Compliance Officers observed E2 working at the facility independently at 9:00 AM. 2. A review of the facility's employee work schedule revealed a schedule for 2025. The schedule included the caregivers scheduled to work January 1, 2025 - April 30, 2025. No further documentation of the caregivers scheduled to work and hours worked by each was available for Compliance Officer review. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed a service plan (dated July 30, 2025) that indicated R1 would receive the following services: Encouragement of sufficient fluids to maintain hydration; Shower, twice a week; Partial bath, as needed (PRN); Full assistance with dressing; Reminders for grooming; Assistance with brushing teeth; Nail checks with showers, twice a week; Make bed; Linen change, once a week and PRN; Skin care, PRN; Brief checks, every 2 - 3 hours; Brief changes, PRN; Supervision throughout the day; Night checks, every 3 - 4 hours; Medication administration; and Assistance with transfers. 2. While on-site for the compliance inspection, the Compliance Officers requested R1's current Activities of Daily Living (ADL) documentation for December 2025. However, no documentation of the current ADL services provided was available for review. 3. In an interview, R1 reported that R1 received all services according to R1's service plan. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure that a resident's medical record contained a medication order from a medical practitioner for each medication that was administered to the resident, for one of two residents sampled. The deficient practice posed a risk as medication administered could not be verified against a medication order. Findings include: 1. A review of R1's medical record did not include an order for Acetaminophen 500 milligrams (mg), 2 tablets by mouth (po) at bedtime (qhs). 2. A review of R1's medication administration record (MAR) for December 2025 did not include documentation of administration of Acetaminophen 500 mg, 2 tablets po qhs. 3. The Compliance Officers observed Acetaminophen 500 mg, 2 tablets prefilled in the 8:00 PM slot of R1's medication organizer. 4. In an interview, E2 reported that E2 was unaware that the aforementioned medications required an order. 5. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident's medical record contained documentation of the resident's notification of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. § 36-406(1)(d), for two of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. § 36-406(1)(d) states, "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a license for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. A review of R1's medical record revealed R1 was offered flu and pneumonia vaccinations on October 31, 2021. However, documentation of additional offerings was not available for review. Based on R1's acceptance date, this documentation was required. 3. A review of R2's medical record revealed R2 was offered flu and pneumonia vaccinations on October 5, 2023. However, documentation of additional offerings was not available for review. Based on R2's acceptance date, this documentation was required. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure that a medication administered to a resident was administered in compliance with a medication order, for two of two residents sampled. 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 R1's medical record revealed a signed medication list, dated November 4, 2025, which included Amitriptyline 10 milligrams (mg), 1 tablet nightly at 10:00 PM. 2. A review of R1's medication administration record (MAR) for December 2025 revealed R1 was administered Amitriptyline 10 mg, 1 tablet by mouth (po) at 10:00 PM on December 1, 2025 - present. 3. The Compliance Officers observed Amitriptyline 10 mg, 1 tablet prefilled in the 8:00 PM slot of R1's medication organizer. 4. In an interview, E2 acknowledged the medication was administered at 8:00 PM, not at 10:00 PM as ordered. 5. A review of R2's medical record revealed a signed medication list, dated December 2, 2024, which included the following medications: Aspirin 81 mg, 1 tablet po twice a day (bid); Bisacodyl 5 mg, 1 tablet po bid as needed (PRN); Famotidine 40 mg, 1 tablet po at bedtime (qhs); and Senna 8.6 mg, 2 tablets po qhs. 6. A review of R2's MAR for December 2025 revealed R2 was administered Aspirin 81mg, 1 tablet po qd. However, a second dose was not documented as administered as ordered. 7. The Compliance Officers did not observe a second dose of Aspirin 81mg prefilled in R2's medication organizer. 8. A review of R2's MAR for December 2025 revealed R2 was not administered Bisacodyl 5 mg, 1 tablet po bid PRN. 9. The Compliance Officers observed Bisacodyl 5 mg, prefilled in R2's medication organizer in the 8:00 AM, 12:00 PM, and 5:00 PM slots for administration. 10. A review of R2's MAR for December 2025 revealed Famotidine 20mg was listed on the MAR rather than Famotidine 40 mg, as ordered. There was no documentation that R2 received either dose of Famotidine in December 2025. 11. The Compliance Officers observed Famotidine 40 mg 1 tablet prefilled in R2's medication organizer in the 5:00 PM slot. However, Famotidine 40 mg was not administered at bedtime as ordered. 12. A review of R2's MAR for December 2025 revealed R2 was administered Senna 8.6 mg, 2 tablets po qhs, at 8:00 PM, December 1, 2025 - present. 13. The Compliance Officers observed Senna 8.6 mg 2 tablets prefilled in R2's medication organizer in the 5:00 PM slot. However, Senna 8.6 mg was not administered at bedtime as ordered. 14. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure that medication administered to a resident was accurately documented in the resident's medical record, for two of two residents sampled. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a signed medication list, dated November 4, 2025, which included Quetiapine Fumarate 25 milligrams (mg), 1 tablet by mouth (po) at bedtime (qhs). 2. A review of R1's medication administration record (MAR) for December 2025 revealed R1 was not administered Quetiapine Fumarate 25 mg, 1 tablet po qhs in December 2025. 3. The Compliance Officers observed Quetiapine Fumarate 25 mg, 1 tablet prefilled in R1's medication organizer in the 8:00 PM slot. 4. A review of R2's medical record revealed a signed medication list, dated December 2, 2024, which included the following medications: Bisacodyl 5 mg, 1 tablet po twice a day (bid) as needed (PRN); Buspirone 10 mg, 1 tablet po bid; Famotidine 40 mg, 1 tablet po at bedtime (qhs). 5. A review of R2's MAR for December 2025 revealed R2 was not administered Bisacodyl 5 mg, 1 tablet po bid PRN, in December 2025. 6. The Compliance Officers observed Bisacodyl 5 mg, prefilled in R2's medication organizer in the 8:00 AM, 12:00 PM, and 5:00 PM slots for administration. However, the MAR did not include documentation of administration. 7. A review of R2's MAR for December 2025 revealed R2 was administered Buspirone 10 mg, 1 tablet at 8:00 AM and 5:00 PM, December 1, 2025 - present. 8. The Compliance Officers observed Buspirone 10 mg prefilled in R2's medical organizer in the 8:00 AM and 8:00 PM. However, the MAR documentation did not reflect this time of administration. 9. A review of R2's MAR for December 2025 revealed R2 was not administered Famotidine 20 mg, 1 tablet po qhs, in December 2025. 10. The Compliance Officers observed Famotidine 40 mg 1 tablet prefilled in R2's medication organizer in the 5:00 PM slot. However, MAR documentation did not reflect this dosage or administration. 11. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure that a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. The deficient practice posed a risk if the source of a potential food-borne illness could not be identified. Findings include: 1. While on-site at the facility, the Compliance Officers observed the posted food menu for February 2025. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41° F or below. The deficient practice posed a risk for potential food borne illnesses. ​ Findings include: ​ 1. During an environmental tour of the facility, the Compliance Officers observed the facility’s refrigerator in the kitchen area was used for resident food storage. The thermometer in the refrigerator door read 52°F. ​ 2. In an interview, E2 acknowledged that foods requiring refrigeration were not maintained at 41° F or below.

Based on documentation review and interview, the manager failed to ensure that a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's disaster drill documentation revealed documentation of a drill conducted on April 30, 2025. However, documentation of additional drills was not available for review. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a caregiver documented the individuals notified by the caregiver, and any action taken to prevent the accident, emergency, or injury from occurring in the future, when a resident had an accident, emergency, or injury that resulted in the resident needing medical services. Findings include: 1. A review of R1's medical record revealed R1 had an incident on October 16, 2025, that resulted in R1 needing medical services. However, the documentation did not include the following elements: the individuals notified by the caregiver; and any action taken to prevent the accident from occurring in the future. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure that 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 of the facility, the Compliance Officers observed the following toxic materials stored in an unlocked cabinet within the facility's unlocked laundry room: Great Value Bleach; Lysol Disinfecting Spray; Lysol Disinfecting Wipes; Two bottles of Fabuloso All Purpose Cleaner; Febreze Aerosol Spray; Lysol All Purpose Cleaner; Scrub Free Bathroom Cleaner. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on observation and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. When the Compliance Officer arrived, E2 and O1 were the only personnel members working at the facility. 2. During the environmental tour, the Compliance Officer observed there was no personnel work schedule posted for the months of May, June and July 2024. 3. In an interview, E2 reported to be unaware of the current personnel work schedule, and was not able to provide the documentation to the department. 4. In the interview, E3 acknowledged documentation was not maintained of the caregivers working each day, including the hours worked for the months of May, June and July 2024.

Based on observation, record review, and interview, the manager failed to ensure a complete personnel record was available for one of three employees sampled. The deficient practice posed a risk as required information could not be verified for O1. Findings include: 1. Upon arrival, the Compliance Officer observed O1 at the facility. 2. In an interview, E2, E3 and O1 reported O1 was a cleaner/cook. 3. In an interview, the Compliance Officer requested O1's personnel record, however, E3 reported O1 had no personnel record. 4. In an interview, E3 acknowledged there was no personnel record available for review for O1.

Based on record review and interview, the manager failed to ensure a written service plan was reviewed and updated at least once every three months, for one of one resident sampled who received directed care services. The deficient practice posed a risk as a service plan reinforces and clarifies services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed a written service plan for directed care services dated March 20, 2024. However, a service plan after March 20, 2024 was not available for review. 2. In an interview, E3 acknowledged R1 received directed care services and the service plan was not updated at least once every three months.

Based on documentation review, observation, and interview, for a facility authorized to provide directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area from which a resident could exit to a location at least 30 feet away from the facility and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of Department records revealed the facility was licensed to provide directed care services. 2. During the environmental tour, the Compliance Officer observed five ambulatory residents. 3. During the environmental tour, the Compliance Officer observed the front door leading to the street. However, the door was not controlled and the door chime was not functioning. 4. During the environmental tour, the Compliance Officer observed the back door leading to the backyard. However, the door was not controlled and the door chime was not functioning. 5. A review of facility policies and procedures revealed a policy titled "Residents Monitoring" the policy stated "5. If alarms are being used on doors and or windows, the caregiver will check them daily for operation and security. 6. Alarms that are triggered will be investigated immediately by the caregiver on duty." 6. In an interview, E3 acknowledged a means of exiting the facility to an outside area did not control or alert employees of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During the environmental tour, the Compliance Officer observed an unlocked refrigerator in the kitchen. Inside the unlocked refrigerator, the Compliance Officer observed the following unlocked medications: - TIMOLOL MALEATE, EYE DROPS 5ML - LATANOPROST OPHTHALMIC SOLUTION, EYE DROPS 2.5ML - BRIMONIDINE , EYE DROPS 10ML - LANTUS 100 UNITES/ML - BASAGLAR 100 UNIT/ML KWIKPE 2. In an interview, E2 and E3 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.