Valley Assisted Living LLC

Based on record review and interview, the manager failed to maintain a standardized form for each resident that included the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder was contacted, for one of two residents sampled. Findings include: 1 . A review of R2's medical record revealed documentation of a standardized form for emergency medical services. However, the form was blank. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident had a service plan, when updated, was signed and dated by the resident's representative, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed R2 received directed care services. 2. A review of R2's medical record revealed a service plan dated October 16, 2025. However, the service plan was not signed by the resident representative. 3. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery, for two of three staff members sampled. The deficient practice posed a risk if a staff member was unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a policy titled "Orientation and In-Service Training." The policy stated, "Fall Prevention and Recovery Training is required upon hire and at least every 12 months thereafter." 2. A review of and E3's personnel records revealed documentation of fall prevention and fall recovery training was not available for review. 3. In an interview, E1 acknowledged E3 had no documentation of fall prevention and fall recovery training available at the time of inspection.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver's or assistant a caregiver's skills and knowledge were verified and documented, according to policies and procedures for two of two caregivers sampled. Findings include: 1. A review of facility documentation revealed a policy titled "Employees and Volunteers Qualifications." The policy stated, "The hiring individual will check and document qualifications, skills and knowledge for each employee and volunteer to ensure they meet criteria and are able to perform the job duties before starting to provide assisted living services to the residents. Documentation of such check is going to be kept in the employees' records upon hiring ("Employee Orientation" and Employee Training, Qualifications and Skills.") 2. A review of E2's personnel record revealed documentation of the first page of "Employee Training, Qualifications and Skills." However, documentation of the second page which included signature of the trainer who verified the skills for the trainee was not available for review at the time of inspection. 3. A review of E3's personnel record revealed documentation of "Employee Training, Qualifications and Skills" was not available for review at the time of inspection. 4. In an interview, E2 acknowledged E2 and E3 skills and knowledge documentation was not completed according to policies and procedures.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) as specified in Arizona Administrative Code (A.A.C.) R9-10-113, for one of three sampled employees. Findings include: 1. A review of E3's personnel records revealed documentation of one negative two-step TB skin test. However, documentation of second negative two-step TB skin test was not available for review at the time of inspection. 2. In an interview, E1 acknowledged E3's personnel records did not contain documentation of freedom from TB as specified in A.A.C. R9-10-113.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver or an assistant caregiver received orientation specific to the duties to be performed before providing assisted living services to a resident, for one of two caregivers sampled. The deficient practice posed a risk to the health and safety of residents if E3 was not orientated to the specific duties to be performed. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(155) states "Orientation" means "the initial instruction and information provided to an individual before the individual starts work or volunteer services in a health care institution." 2. A review of E3's personnel records revealed E3 was hired as a caregiver. However, documentation of orientation specific to the duties to be performed was not available for review. 3. In an interview, E1 acknowledged E3 had no documentation of orientation in E3's personnel record at the time of inspection.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of cardiopulmonary resuscitation training (CPR) and first aid training, for one of three employees sampled. The deficient practice posed a risk if an employee was unable to meet the needs of residents. Findings include: 1. A review of E3's personnel record revealed E3 was hired as a caregiver. E3's personnel record contained documentation of a CPR and first aid training card. However, the card expired in January 2024. No updated CPR or first aid training documentation was provided for review for E3. 2. In an interview, E1 acknowledged E3's documentation of CPR and first aid training was expired.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in Arizona Administrative Code (A.A.C.) R9-10-113, for one of two residents sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of R2's medical records revealed documentation of a TB skin test or blood test and documentation of TB screening was not available for review at the time of inspection. 2. In an interview, E1 acknowledged failure to ensure R2's medical record contained documentation of freedom from infectious tuberculosis.

Based on record review and interview, the manager failed to ensure a service plan included documentation of the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated, for two of two residents reviewed receiving directed care services. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated November 12, 2024. This service plan revealed no documentation of R1's weight. In addition, R1's record revealed no documentation of R1's weight or documentation from a medical practitioner stating weighing R1 was contraindicated. 2. Review of R2's medical record revealed a current written service plan for directed care services dated August 20, 2024. This service plan revealed no documentation of R2's weight. In addition, R2's record revealed no documentation of R2's weight or documentation from a medical practitioner stating weighing R2 was contraindicated. 3. During an interview, E1 acknowledged R1's and R2's service plan did not include documentation of R1's or R2's weight and documentation was not available in R1's and R2's record from a medical practitioner stating weighing R1 or R2 was contraindicated.

Based on observation and interview, the manager failed to ensure the means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if staff were unaware of the egress of a resident from the facility. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers observed a sliding glass door leading to the back yard. The door had two white boxes attached to the top for an alert system when the door was opened. However, the alert system did not work when the Compliance Officers opened or closed the door or when a resident opened the door. When E1 arrived at the facility, E1 turned the alert on. 2. In an interview, E1 acknowledged the sliding glass door leading to the back yard did not control or alert employees of the egress of a resident from the facility at the time of the inspection.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the poisonous or toxic materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers observed a can of "Comet" lavender bleach cleaner located in a unlocked cabinet in the kitchen. 2. In an interview, E1 acknowledged poisonous or toxic materials stored by the facility were not stored in a locked area and inaccessible to residents at the time of the inspection.