The Rest Ranch, LLC

Based on documentation review, observation, and interview, the licensee failed to submit an updated floor plan as required for an initial health care institution license, which must include the room layout, room usage, all doors and windows, plumbing fixtures, exits, and fire protection devices for each story of the facility. This deficient practice posed a risk because the floor plan on file was not updated as required by the Department. Findings include: "R9-10-105.A.5.b.vi: A. A person applying for an initial a health care institution license shall submit to the Department an application packet that contains: 5. Except for a home health agency, a hospice service agency, or a nursing-supported group home, one of the following: b. If the health care institution or a part of the health care institution is not required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in R9-101.04.01: vi. A floor plan showing, for each story of a facility, the room layout, room usage, each door and each window, plumbing fixtures, each exit, and the location of each fire protection device;" 1. During the environmental inspection, the Compliance Officers observed a room next to the dining area that contained two beds; one was occupied by R3 and the other was unoccupied. The space resembled a living room that had been converted into a resident's bedroom. This room did not have floor-to-ceiling walls with at least one door; it opened directly to the interior hallway, which was not appropriate for use as a resident's sleeping area. 2. A review of the Department's records revealed this room was classified as a "Resident Room" on the facility's floor plan submitted during the initial application process. 3. In an interview, E1 reported that the room was the facility's living room converted into a residents' room. 4. In an exit interview, the findings were reviewed with E1 and E2, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort that monitored 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 egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officers observed ambulatory residents. 3. During the environmental inspection, the Compliance Officers observed a door from the living room that led to the backyard. The outside area allowed residents to be at least 30 feet away from the facility. However, the door was not monitored and did not have a mechanism to alert employees to the egress of a resident to the outside area. 4. During the environmental inspection, the Compliance Officers observed another double door from the facility that led to the front yard, which led to the road. The outside area allowed residents to be at least 30 feet away from the facility. However, the door was not monitored and did not have a mechanism to alert employees to the egress of a resident to the outside area. 5. In an exit interview, the findings were reviewed with E1 and E2, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in a locked area separate from food preparation and storage, dining areas, and medications, and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officers observed ambulatory residents. 3. During an environmental inspection of the facility, the Compliance Officers observed that the following chemicals were accessible throughout the facility; -2 bottles of laundry detergent on top of the washing machine. -An unlocked cabinet had five Comet bleach Cleaners, toilet bowl cleaners, fabric refreshers, 2-gallon jugs of laundry detergents, 3-gallon jugs of bleach, Clorox multi-purpose cleaners, glass cleaners, 1 bottle Woolite Oxy Deep Steam, 1 bottle PAW Sense Apothecary, 1 can Stainmaster Carpet High Traffic Cleaner, and a gallon jug of Fabuloso. -A kitchen counter had essential pest control spray and Method antibac all-purpose cleaner. 4 . In an exit interview, the findings were reviewed with E1 and E2, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to provide each resident with a sleeping area in a bedroom. The deficient practice posed a potential privacy rights violation to the residents. Findings include: 1. During the facility environmental inspection, the Compliance Officers observed a room next to the dining area that contained two beds. One of the beds was occupied by R3, and the other bed was unoccupied. 2. A review of the Department's records revealed this room was classified as a "Resident Room" on the facility's floor plan submitted during the initial application process. 3. In an interview, E1 reported that the room was the facility's living room converted into a residents' room. 4. In an exit interview, the findings were reviewed with E1 and E2, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure a resident's sleeping area had floor-to-ceiling walls with at least one door. The deficient practice posed a potential privacy rights violation to the residents. Findings include: 1. During the facility environmental inspection, the Compliance Officers observed a room next to the dining area that contained two beds. One of the beds was occupied by R3, and the other bed was unoccupied. This room did not contain floor-to-ceiling walls with at least one door; it opened directly to the interior hallway. 2. A review of the Department's records revealed this room was classified as a "Resident Room" on the facility's floor plan submitted during the initial application process. 3. In an interview, E1 reported that the room was the facility's living room converted into a residents' room. 4. In an exit interview, the findings were reviewed with E1 and E2, and no additional information was provided.

Based on observation, documentation review, record review, and interview, a person established, conducted, and maintained a health care institution without a current and valid license issued by the Department. The deficient practice posed a risk as the unlicensed operation or maintenance of a health care institution is prohibited and is declared a nuisance inimical to the public health and safety, per A.R.S. § 36-430. Findings include: 1. The Compliance Officer observed residents on site at the initial inspection conducted on May 29, 2025. 2. A review of Department documentation revealed the address did not have a current license issued by the Department. 3. In an interview, E1 reported the facility currently had six residents. 4. A review of R1’s medical record revealed a personal level service plan dated October, 2024 signed by R1’s representative. The service plan documented R1 needing support with the following activities of daily living (ADL): - Full assistance with bathing and showering; - Some Assistance with Toileting; - Some Assistance with Dressing; - Some Assistance with Shaving; - Some Assistance with Walking; and - Assistance with Medication Reminders. 5. A review of R2’s medical record revealed a personal level service plan from May 2024 updated November 2024 signed by R2. The service plan documented R2 as bedbound which required support with the following ADL: - Complete Dependence for Dressing, Bathing, and Eating; - Needs some Assistance for Hair Care, Oral Hygiene, and Self-Preservation; and - Incontinence of bladder and bowel. 6. A review of R3’s medical record revealed a directed level service plan from May 2024. The service plan documented R3 as bedbound which required support with the following ADL: - Complete Dependence for Dressing, Toileting, Bathing, Hair Care, Oral Hygiene, Shaving, and Self-Preservation; and - Needs Some Assistance for Eating and Transferring. However, an update note for the service plan from November 2024 reported R3 increasing needs to full assist for “all ADL’s.” 7. A review of R4’s medical record revealed a personal level service plan dated March 2024 signed by R4. The service plan documented R4 required support with the following ADL: - Complete Dependence for Bathing two times per week, Hair Care, and Shaving; - Needs Some Assistance for Dressing, Toileting, Oral Hygiene, Transferring, Ambulation, and Self-preservation. 8. A review of R5’s medical record revealed a personal level service plan from May 2024 signed by R5. The service plan documented R5 required support with the following ADL: - Two showers per week with total physical assistance; - Assisted toileting; - Dressing with total physical assistance; and - Assisted Medications. 9. A review of R6’s medical record revealed a directed level service plan from April 2024 signed by R6’s representative. The service plan documented R6 required support with the following ADL: - Complete Dependence for Dressing, Toileting, Bathing, Hair Care, Oral