The Right Care Assisted Living LLC

Based on record review and interview, the manager failed to ensure a written service plan included the signature and date from the resident or representative, for two of two residents sampled. The deficient practice posed a health and safety risk if the resident or representative did not acknowledge the services that were to be provided. Findings include: 1. A review of R1's medical record revealed a written service plan for directed care services dated October 01, 2024. However, the service plan did not include a signature and date from the resident or representative. 2. A review of R2's medical record revealed a written service plan for directed care services dated October 01, 2024. However, the service plan did not include a signature and date from the resident or representative. 3. In an interview, E1 and E4 acknowledged R1's and R2's, service plans did not include a signature and date from the resident or representative.

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. The Compliance Officer observed two ambulatory residents. 3. During the environmental tour, the Compliance Officer observed the kitchen sliding glass door leading to the backyard. The door leading out to the back yard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the door was not secured and the door chime was not functioning. 4. A review of facility policies and procedures revealed a policy titled "Wandering," the policy stated "5. If alarms are being used on doors and or windows, the caregiver will check them daily for operation and security. a. Alarms that are triggered will be investigated immediately by the caregiver on duty." 5. In an interview, E1 and E4 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 documentation review, observation, and interview, the manager failed to ensure a resident's medical record was protected from loss, damage, or unauthorized use. The deficient practice posed a risk of protected and sensitive resident health information being disclosed without the resident's consent or knowledge. Findings include: 1. A.R.S. \'a7 12-2291(6) "Medical records" means all communications related to a patient's physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of patient diagnosis or treatment, including medical records that are prepared by a health care provider or by other providers. 2. During the environmental tour, the Compliance Officer observed that medical records for R1, R2, R3, and R4 were stored on a counter top located in a hallway to the right of the front door. The Compliance Officer also observed two ambulatory residents and visitors walking through this hallway to resident rooms multiple times. 3. In an interview, E1 and E4 acknowledged that resident medical records were not protected from loss, damage, or unauthorized use. Technical assistance was provided on this Rule during the compliance inspection conducted April 27, 2023.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R2's medical record revealed a current written service plan dated January 27, 2023. This service plan indicated R2 received medication administration. 2. Review of R2's medical record revealed signed medication orders dated March 16, 2023. These medication orders stated the following: "Losartan 50mg 1 tab once daily, hold if BP less 110, and pulse less 60" "Metoprolol Tartrate 25mg 0.5 tab, by mouth, twice daily" "Novolog Flexpen U-200 Insulin 200 unit/ml 4 units plus sliding scale 3 times daily with meals 4 units and plus sliding scale: BG 150-200 give 1 unit, 201-250 give 2 units, 251-300 give 4 units, 301-350 give 6 units, 351-400 give 8 units, 401 and over give 10 units and notify provider" 3. Review of R2's medical record revealed an April 2023 medication administration record (MAR). This MAR stated the following: "Losartan 50mg 1 tab 1 tab once daily, hold if BP less than 110, and pulse less that 60" and indicated R2's pulse was <60 April 13th-14th, and 16th - 27th. However, Losartan 50mg was administered at "morning". "Metoprolol Tartrate 25mg 0.5 tab twice daily, hold if BP less than 110, and pulse less than 60" and indicated Metoprolol Tartrate 25mg was not administered due to blood pressure parameters in the "morning" April 1st-2nd, 4th, 6th,9th, 15th, and 18th and in the "evening" April 3rd. However, blood pressure parameters were not listed in the signed medication order. "Novolog Flexpen U-200 Insulin 200 unit/ml, 4 units plus sliding scale 4 units 3 times daily with meals 4 units plus sliding scale: BG 150-200 give 1 unit, 201-250 give 2 units, 251-300 give 4 units, 301-350 give 6 units, 351-400 give 8 units, 401 and over give 10 units and notify provider" and indicated R2's blood glucose was 156 at "noon" April 4th, however indicated only 4 units were administered and R2's blood glucose was 151 at "evening" April 4th, however indicated only 4 units were administered. 4. During an observation of R2's medications, the following was observed: Losartan 50mg was observed. Metoprolol Tartrate 25mg was observed. Novolog Flexpen was observed. 5. During an interview, E1 reported the medications were administered per the MAR and acknowledged R2's medications were not administered in compliance with the available medication orders.

Based on observation, interview, and documentation review, the manager failed to ensure a resident bedroom was not used as a passageway to a common bathroom. The deficient practice posed a potential privacy rights violation to the residents. Findings include: 1. During the facility tour with E1, the Compliance Officer observed a Jack and Jill bathroom in between R2's and R3's bedrooms. The only access to this bathroom was through the residents' bedrooms. 2. During an interview, R2 reported R2's and R3's bathroom was used for other residents in the facility. 3. During an interview, E1 reported R2's and R3's bathroom was used for other residents to shower. 4. Review of Department records revealed the facility was originally licensed February 18, 2021, therefore an exception from the Department before October 1, 2013 would not apply.

Based on record review, observation, and interview, the manager failed to ensure a written order verifying the verbal order was obtained from the medical practitioner within 14 calendar days after receipt of the verbal order, for one of two residents reviewed. The deficient practice posed a health risk to the resident. Findings include: 1. Review of R1's medical record revealed a current written service plan dated December 3, 2022. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed verbal medication orders. These verbal orders stated the following: -Dated May 23, 2022 - "Aspirin 1 tablet 1 times a day oral (325mg tablet)" "Gabapentin 1 capsule every 6 hours oral (300mg tablet)" "Losartan Potassium 1 tablet 1 times a day oral (100mg tablet)" "Metformin HCL 2 tablets 2 times a day oral (500mg tablet)" "Metoprolol Tartrate 1 tablet 1 times a day orals (50mg tablet)" "Protonix 1 tablet soluble 1 times a day oral (40mg tablet soluble)" "Insulin Glargine 30 units 1 times a day subcutaneous (100unit/ml unit)" -Dated February 3, 2022 - "Bacitracin 1 ointment topical 2 times a day (500 unit/gm ointment) apply ointment to inner thigh two times a day" However, documentation was not available showing written orders were obtained from the medical practitioner within 14 days. 3. Review of R1's medical record revealed an April 2023 medication administration record (MAR). This MAR stated the following: "Aspirin 325mg tab 1 tab once daily" and indicated one tab was administered at "morning" April 1st - present. "Gabapentin 300mg cap 1 cap Q6H, 4 times daily" and indicated one cap was administered at "morning," "noon," "evening," and "night" April 1st - present. "Losartan Potassium 100mg tab once daily" and indicated one tab was administered at "morning" April 1st - present. "Metformin HCL 500mg 2 tabs twice daily" and indicated two tabs were administered at "morning" and "evening" April 1st - present. "Metoprolol Tartrate 50mg tab 1 tab once daily" and indicated one tab was administered at "morning" April 1st -3rd, 4th - 16th, and 18th - present. "Pantoprazole 40mg tab 1 tab once daily" and indicated one tab was administered at "morning" April 1st - present. "Basaglar 100 unit/ml Kwikpen 30 units once daily at bedtime" and indicated 30 units were administered at "evening" April 1st - present. "Bacitracin 500 unit/gm 1 ointment apply ointment to inner thigh 2 times a day" and indicated one application was administered at "morning" and "evening" April 1st - present. 4. During an observation of R1's medications, the following was observed: Aspirin 325mg was observed. Gabapentin 300mg was observed. Losartan Potassium 100mg was observed. Metformin HCL 500mg was observed. Metoprolol Tartrate 50mg was observed. Pantoprazole 40mg was observed. Basaglar 100 unit/ml Kwikpen was observed. Bacitracin 500 unit/gm was observed. 5. During an interview, E1 reported the medication was administered per the verbal medication

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. During the facility tour with E1, the Compliance Officer observed an open container of Great Value strawberry syrup and Berryhill chocolate syrup in a kitchen cabinet. These containers stated "Refrigerate after opening". 2. During an interview, E1 acknowledged the foods were stored in the cabinet and required refrigeration.