Tender Loving Carehome of Surprise, LLC

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents. The deficient practice posed a potential burn risk to residents. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed the hot water temperature measured 130.4\'b0 F in a shared resident bathroom. 2. In an interview, E4 and E5 acknowledged the hot water temperature was not maintained between 95\'b0 F and 120\'b0 F in the shared resident bathroom. This is a repeat citation from the compliance and complaint inspection conducted on May 18, 2023.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a health and safety risk to residents with access to the poisonous or toxic materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed Lysol toilet cleaner and Lysol all purpose cleaner stored in an unlocked cabinet under the bedroom sink of a shared resident bedroom. The cabinet did not have a locking device installed. 2. In an interview, E4 and E5 acknowledged the aforementioned poisonous or toxic materials were not stored in a locked location and inaccessible to residents.

Based on record review and interview, the manager 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. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of E4's personnel record revealed no documentation indicating E4 completed fall prevention and fall recovery training. 2. During an interview, E1 acknowledged documentation was not available showing E4 had completed training in fall prevention and fall recovery.

Based on record review and interview, the manager failed to ensure the written notice of termination of residency in subsection (G) included a copy of the resident's current service plan and documentation of the resident's freedom from infectious tuberculosis. Findings include: 1. Review of R3's medical record revealed a termination notice dated February 1, 2023. However, this written notice did not include a copy of R3's current service plan and documentation of R3's freedom from infectious tuberculosis. 2. During an interview, E1 reported R3's termination notice included the service plan, however did not document it. E1 reported R3 was not provided with documentation of R3's freedom from infectious tuberculosis as required.

Based on record review and interview, the manager failed to ensure if written notice of termination of residency in subsection (G) was because the resident needed services the assisted living facility was either not licensed to provide or was licensed to provide but not able to provide, that the written notice of termination of residency included a description of the specific services that the resident needed that the assisted living facility was either not licensed to provide or was licensed to provide but not able to provide. Findings include: 1. Review of R3's medical record revealed a termination notice dated February 1, 2023. This written notice stated termination was provided due to "The assisted living facility does not have the ability to provide the assisted living services needed by the individual." However, the notice did not include a description of the specific services that the resident needed that the assisted living facility was either not licensed to provide or was licensed to provide but not able to provide. 2. During an interview, E1 reported R3's family wanted R3 to have a bedrail and the facility was not able to accommodate that. E1 acknowledged the termination notice did not include a description of the specific services that the resident needed that the assisted living facility was either not licensed to provide or was licensed to provide but not able to provide.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for pneumonia, according to A.R.S. \'a7 36-406(1)(d), to two of two residents reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 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 licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. Review of R1's medical record revealed R1 refused the pneumonia vaccination June 12, 2020. However, current documentation was not available showing the pneumonia vaccination was offered or received. Based on R1's acceptance date, this documentation was required. 3. Review of R2's medical record revealed R2 refused the pneumonia vaccination December 17, 2021. However, current documentation was not available showing the pneumonia vaccination was offered or received. Based on R2's acceptance date, this documentation was required. 4. During an interview, E1 acknowledged R1's and R2's medical records did not include current documentation showing the pneumonia vaccination was offered or received.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the facility tour with E1, the Compliance Officer observed Atropine, Lorazepam, Morphine, and Glargine unlocked in a box in the kitchen refrigerator. This box had a locking device, however the device was not locked. 2. During an observation, E2 and E3 were the only employees at the facility when the Compliance Officer arrived and were not accessing the medications at the time of arrival. 3. During an interview, E1 acknowledged medications were stored unlocked.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents. The deficient practice posed a health and safety risk to the residents. Findings include: 1. During the facility tour with E1, the Compliance Officer observed the hot water temperature at 135.7\'b0 F in the hall bathroom. 2. During an interview, E1 acknowledged the hot water temperature was not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.