Tropical Senior Living Care LLC

Based on record review, documentation review, and interview, the manager failed to ensure that medication administered to a resident was administered in compliance with a medication order, for one 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 records revealed R1 received medication administration. 2. A review of R1's medical record revealed an unsigned medication order for Insulin Aspart 100 units/Milliliters (mL), inject 6 units subcutaneous before lunch and 9 units before dinner daily (qd). 3. A review of R1's medication administration record (MAR) for February 2025 indicated R1 received 6 units inject subcutaneous before dinner February 1, 2025 - present. However, the medication order indicated R1 should have received 9 units injected subcutaneously before dinner February 1, 2025 - present. 4. A review of R1's MAR for February 2025 did not indicate R1 received 6 units injected subcutaneously before lunch in the month of February 2025. 5. In an interview, E1 acknowledged medication administered to R1 was not administered in compliance with a medication order.

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 revealed R1 received medication administration. 2. A review of R1's medical record revealed an unsigned medication list for the following medications: - Metformin 500 milligrams (mg), 2 tablets by mouth (po) twice a day (bid); - Ezetimibe 10 mg, 1 tablet po daily (qd); - Resuvastatin 20 mg, 1 tablet po qd; - Bupropion 100 mg, 2 tablets po bid; - Carvedilol 25 mg, 1 tablet po bid; - Insulin Glargine 25 units, inject subcutaneous bid; - Pantoprazole 40 mg, 1 tablet po qd; - Apixaban 5 mg, 1 tablet po bid; - Aspirin 81 mg, 1 tablet po qd; - Gabapentin 300 mg, 1 capsule po in the morning, 1 capsule po in the afternoon, and 3 capsules at bedtime (qhs); and - Insulin Aspart 100 units/Milliliters (mL), inject 6 units subcutaneous before lunch and 9 units before dinner. However, the medication list was not signed by a medical practitioner as required. 3. A review of R1's medication administration record (MAR) for February 2025 revealed the administration of the aforementioned medications. 4. In an interview, E1 acknowledged R1's medical record did not contain a medication order from a medical practitioner for each medication that was administered to the resident.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113 for one of one personnel sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. R9-10-113.A states, "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. A review of E2's personnel record did not include documentation of R2's evidence of freedom from infectious TB. 4. In an interview, E1 acknowledged E2 did not provide evidence of freedom from infectious TB as specified in R9-10-113.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of one personnel sampled. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411(C)(1-2) states, "Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person ' s fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person ' s fingerprint clearance card." 2. Review of E2's personnel file revealed no documentation of good faith efforts to contact previous employers. 3. A review of E2's personnel record revealed documentation of a fingerprint clearance card (FPCC), dated prior to E2's date of hire. However, documentation of the facility's verification of E2's FPCC was not available for review. 4. In an interview, E1 acknowledged E2's personnel record did not contain documentation of compliance with A.R.S. \'a7 36-411.