The Greenway Manor II

Based on record review and interview, for two of three residents reviewed, the manager failed to ensure a written service plan included the signature and date from the resident or resident's representative. The deficient practice posed a health and safety risk if the resident or the resident's representative did not acknowledge the services that were to be provided. Findings include: 1. In record review, R1's service plans (received directed care services), dated October 11, 2023, and January 1, 2024, were not signed by R1's representative. 2. In record review, R2's service plan (received directed care services), dated December 28, 2023, was not signed by R2's representative. 3. During an interview, E1 reported R1 and R2 had a representative/Power of Attorney, and acknowledged the residents' service plans were not signed and dated, by the residents' representatives.

Based on record review and interview, for two of three resident reviewed, the manager failed to ensure a resident's medical record contained a copy of the health care power of attorney (POA). The deficient practice posed a risk if the facility did not have the required legal documentation of the resident's responsible party. Findings include: 1. In record review, the medical records for R1 (received directed care services) and R3 (received personal care services) did not include documentation of a copy of their POA documentation. 2. In an interview, E1 reported R1 and R3 both had a POA, and was unable to locate the copy of the POA documentation.

Based on observation, record review, and interview, for one resident reviewed, who was unable to walk and receiving directed care services, the manager failed to ensure the resident's primary care provider (PCP) or other medical practitioner (MP) examined the resident at least every six months throughout the duration of the resident's condition, reviewed the facility's scope of services, and signed and dated a determination stating the resident's needs were being met by the facility. The deficient practice posed a health risk to a resident if a resident's condition was not reviewed by a PCP or MP, to approve a resident's stay at the facility. Findings include: 1. In observation, the surveyor observed R1 in bed during the inspection. 2. In record review, R1's medical record included a signed and dated determination on April 11, 2023; however, did not include documentation of a signed and dated determination every six months since. 3. During an interview, E1 reported R1 was unable to walk since acceptance at the facility, and the condition persisted. E1 and E2 acknowledged R1's record did not include documentation every six months from the PCP or MP, stating the resident's needs were being met by the facility.

Based on observation, documentation, review, and interview, the manager failed to ensure medication stored by the assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed an unlocked refrigerator which stored food, had a package of Lorazepam oral medication (a schedule IV controlled substance) stored on a shelf in the refrigerator. 2. In documentation review, the facility's medication policies, page 3, documented, "...Medications that need refrigeration will be stored in a locked box, in the facility refrigerator or in a separate locked refrigerator dedicated only for medication storage. 3. During an interview, E1 reported the Lorazepam medication belonged to a resident who no longer resided at the facility. E1 and E2 acknowledged the medication was not stored in a separated locked area used only for medication storage. This is a repeat deficiency from the compliance inspection conducted on October 20, 2022.

Based on observation, documentation review, and interview, the manager failed to ensure policies and procedures were implemented for discarding medication. The deficient practice posed a health and safety risk if medications, including narcotics, were not disposed of, as required. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed an unlocked refrigerator which stored food, and had a package of Lorazepam oral medication syringes (a schedule IV controlled substance) stored on a shelf in the refrigerator. 2. In documentation review, a facility policy, titled, "... Disposal (discarding) of Medication Including Opioids and Narcotics..." page 9, documented, "... On a monthly basis the facility manager or ... designee will check all medication in the facility to identify and locate any discontinued medication (by physician's or medical practitioner's order), expired medication, including medication of deceased residents... Such medication will be disposed of by the facility manager or ... designee on the last day of the month, as follows: ... offered back to the resident's representative, ... returned to pharmacy, or ... disposed of by mixing the pills with hot water and cooking flour... The medication disposal will be recorded in the Medication Disposal Form..." 3. During an interview, E1 reported the Lorazepam medication belonged to a resident who was deceased E1 reported the residency was terminated on July 9, 2023. E1 and E2 acknowledged the medication was not discarded per the facility's policies and procedures.

Based on observation, record review, documentation review, and interview, for one of three residents reviewed, who received a controlled substance, the manager failed to ensure policies and procedures were implemented for inventorying controlled substances. The deficient practice posed a risk if controlled substances were not inventoried and accounted for by the facility. Findings include: 1. In observation, R1 had Morphine medication (a schedule II controlled substance) stored by the facility. 2. In record review, R1's medical record (received directed care and medication administration services), included a document titled, "PRN Medication Chart," which documented R2 received the Morphine medication on December 4 x 2, December 18, and December 20, 2023. The documentation did not include an inventory of the medication. 3. In documentation review, the facility's medication policies, page 3, documented, "... When the opioids and narcotic medications is received at the facility the manager designee will check the packaging... The opioids and narcotic medications will be inventoried and placed in the medication storage area. Daily narcotics or controlled substances administration will be recorded on each resident Narcotic Administration Record..." 4. During an interview, E1 and E2 acknowledged an inventory of R1's controlled substance was not maintained.

Based on observation, and interview, the manager failed to ensure soiled linen and soiled clothing stored by the facility were stored in closed containers. Findings include: 1. During an environmental inspection with E1, the compliance officer observed the laundry room had two linen containers including one container filled with soiled linen, which was not stored in a closed container. 2. During an interview, E1 and E2 acknowledged the soiled linen and clothing stored by the facility was not stored in a closed container.

Based on observation, documentation review and interview, for one pet observed on the premises, the manager failed to ensure pets were licensed consistent with local ordinances. Findings include: 1. During an environmental inspection, the surveyor observed one dog on the premises. 3. A review of documentation revealed D1 did not have documentation showing current licensing with the local ordinance (which is required annually by Maricopa County). 3. During an interview, E1 and E2 acknowledged the facility did not have documentation the dog was licensed consistent with the local ordinance.

Based on observation, record review, documentation review, and interview, for one of three residents reviewed, and receiving opioid medication, without an active malignancy or an end of life condition, the manager failed to ensure an individual, authorized to administer opioids, documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered, and the monitoring of the effect of the opioid administered. The deficient practice posed a risk to a resident if a resident's pain was not identified, monitored and documented, as required. Findings include: 1. In observation, R1 had Morphine medication (a schedule II controlled substance and opioid) stored by the facility. 2. In record review, R1's medical record (received directed care and medication administration services) included a medication order for Morphine concentrate 5ml, every 1 hour as needed. R1's record included documentation R1 was administered the Morphine medication on December 4, (x2), December 18, and December 20, 2023. R1's record included documentation of an identification of the resident's need for the opioid before the opioid was administered, as "pain," which was a prefilled typed in statement, and did not include documentation of the monitoring of the effect of the opioid administered. 3. In documentation review, the facility's medication policies, page 6, documented, "... Facility personnel will provided opioid medication... will identify and document the level of pain and/or the resident's need for the opioid medication... all residents who are subject to receiving opioid medication will have their response to the opioid monitored by checking on the resident within the first half an hour after administration, and/or at two hours after administration, and/or then at 4 hours, or as often as is common sense and as the particular case requires. Effectiveness of the opioid administered will be documented in the NAR at the two hour mark or every time a check has been performed... Carefully document when and how much doses given and doses remaining... 4. During an interview, E1 reported the resident received opioid medication, and acknowledged the residents' record did not include documentation of an identification of the residents' need for the opioid before the opioid was administered, and monitoring of the effect of the opioid administered, according to the facility's policies and procedures.