Veranda Assisted Living LLC

Based on observation, record review, and interview, the manager failed to ensure a written service plan was completed no later than 14 calendar days after the resident's date of acceptance for one of two residents reviewed. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident. Findings Include: 1. A review of R1's medical record revealed no documentation of a service plan. Based on R1's date of admission, this documentation was required. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on interview and record review, the manager did not ensure a caregiver or assistant caregiver provided assistance with activities of daily living according to the resident's service plan. Findings include: 1 . During an environmental inspection, the Compliance Officer observed R2 had a catheter with a catheter bag hanging from the end of the bed. 2 . In an interview, R2 reported personnel empty the catheter bag two times per day. However, R2 reported the catheter bag had not been emptied since the day prior. 3 . A review of R2's medical record revealed a service plan from October 2025. However, no documentation of the amount, type, or frequency of catheter needs was included in the service plan. A review of R2's "ADL Sheet" revealed R2 was to receive catheter services. However, no documentation of catheter services provided was available for review.

Based on record review and interview, the manager did not ensure that a service plan for a resident receiving personal care services included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections for one of two residents reviewed. Findings include: 1 . A review of R1's medical record revealed R1 was expected to receive personal level of care services. A further review of R1's medical record revealed no service plan documentation was available for review. 2 . In an interview, E3 reported R1 was personal level of care. The findings were reviewed with E3, no additional information was provided.

Based on record review and interview, the manger did not ensure a medication administered to a resident was administered in compliance with a medication order for two 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 record revealed a medication administration record (MAR). The document revealed R1 was administered the following medication from January 1, 2026 to January 31, 2026: Simvastatin 20 milligram (MG) - One tab by mouth (PO) at bedtime; Lorazepam - 2 MG/milliliter (ML) - Give one ML by mouth at bedtime; Morphine Sulf ER 30MG - Take one tab PO three times a day; Lidocaine 4% Patch - Two patches, transdermal, every twenty four hours, on for twelve hours, off for twelve hours in any 24 hour period; Diclofenac (Voltaren) - Two gram transdermal two times daily to left knee; Trazadone 100MG Tablet - Take one half tab PO at bedtime; and Cetrizine 10 MG tablet - One tab PO at bedtime. However, the record included the following verbal orders received without signed confirmation from a medical practitioner: A discontinue order from January 23, 2026 to discontinue "Morphine Sulf ER 30MG - Take one tab PO three times a day"; and A medication order to start "Morphine Sulfate ER Capsule Extended Release twenty four hour 50MG - Administer one capsule extended release twenty four hour oral three times daily". A further review of R1's medical record revealed medication orders dated December 13, 2025. However, no orders signed by a medical practitioner were available for review. 2. A review of R2's medical record revealed a MAR for February 2026. The MAR documented R1 received the following medication February 1, 2026 through February 4, 2026: Aspririn 81MG Chew Tablet - Chew 1 tablet by mouth and swallow once daily; Cetirizine HCL 10 MG Tabl - Take one tablet PO once daily; Finasteride 5 MG Tablet - Take one tablet PO once daily; Januvia 25 MG Tab - Take one tablet PO once daily; Levothyroxine 75 MCG Tabl - Take one tablet PO every morning; Tamsulosin HCL 0.4MG Cap - Take one capsule PO once daily; Carvedilol 25MG Tablet - Take one tablet PO twice daily with food; and Hydralazine 50MG Tablet - Take one tablet PO twice daily with food. However, no medication orders signed by a medical practitioner were available for review. 3 . In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on observation and interview, the manager did not ensure the sleeping area, not furnished by a resident, contained clean linen, including a mattress pad, and sheets large enough to tuck under the mattress. Findings include: 1 . During an environmental inspection, the Compliance Officer observed R1's bed did not contain clean linen, a mattress pad, or sheets large enough to tuck under the mattress. 2 . In an interview, R2 reported the facility provided the furnishings. 3 . In an interview, E3 acknowledged R2's sleeping area was furnished by the facility. The findings were reviewed with E3, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a standardized emergency responder patient information form as described in subsection A of this section, was completed and maintained for one of two residents sampled. The deficient practiced posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A review of R1's medical records revealed a standardized emergency responder patient information form. However, the form was not prefilled and did not contain R1's information required by rule. 2. In an interview, E1 reported E1 was not aware of the need for the HIPAA form requirement. E1 acknowledged the information required in A.R.S. § 36-420.04 was not prepared in a standardized emergency responder patient information form as required.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of evidence of freedom from infectious tuberculosis (TB), as specified in R9-10-113, for three of four personnel sampled. The deficient practice posed a potential TB exposure 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 "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. A review of facility documentation revealed a staff schedule for November 2025. The schedule revealed E2, E3, and E4 were scheduled to work throughout the month of November 2025. 4. Review of E2’s personnel record revealed a TB skin test dated October 23, 2025 included with a screening and risk assessment. However, no other TB skin test in E2’s personnel record was available for review. 5. Review of E3's personnel record revealed a TB skin test dated February 1, 2025 included with a screening and risk assessment. However, no other TB skin test in E3’s personnel record was available for review. 6. Review of E4's personnel record revealed a TB skin test dated August 27, 2025 included with a screening and risk assessment. However, no other TB skin test in E4’s personnel record was available for review. 7. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a service plan was signed and dated by the resident or the resident's representative when the service plan was initially developed or when updated, for two of two sampled residents. Findings include: 1. A review of R1's medical record revealed a service plan, dated October 2, 2025, for personal care services. However, the service plan had not been signed by the resident or the resident's representative. 2. A review of R2's medical record revealed a service plan, dated August 17, 2025, for personal care services. However, the service plan had not been signed by the resident or the resident's representative. 3. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on observation, record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, upon acceptance and every six months thereafter, that stated the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. During an environmental inspection, the Compliance Officer observed R1 was bed bound due to being an amputee. 2. A review of R1's medical record revealed a document titled, "Determination for Residency/Continued Residency" which documented R1 was unable to ambulate and was confined to a bed or chair. The document was signed by a doctor and dated February 12, 2025. However, no further documentation of R1's needs able to be met within the facility's scope of services was available for review. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review, observation, and interview, the manager failed to ensure that medication was administered in compliance with a medication order and documented in the resident’s medical record, for one of two residents sampled. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a signed medication order dated October 10, 2025 for the following medication: Miconazole Topical (Miconazole topical 2% powder) - One application topical - Twice daily. 2. A review of R1's medical record revealed a document titled "Medication Administration Record" (MAR) for the month of November 2025. The MAR revealed Miconazole Topical was not documented included on the MAR and was not documented as administered in November 2025. 3. In a review of R1's medications, Miconazole Topical 2% powder was available. 4. In an exit interview, E1 reported the medication was being used with R1 during toileting assistance. E1 acknowledged a medication was not administered and documented in the R1's medical record.