Visions Senior Living at Apache Junction 2

Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under Arizona Revised Statutes (A.R.S.) § 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. § 36-446.06. The deficient practice posed a risk if the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation revealed O1 was no longer the manager of the facility effective July 15, 2025. 2. While on-site for the complaint investigation, the Compliance Officer observed there was no acting manager's license conspicuously posted. 3. In an interview, E1 reported O1 had been the facility manager until July 15, 2025. 4. In an interview, E1 acknowledged the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under A.R.S. § 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. § 36-446.06. 5. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on a documentation review and interview, the manger failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training. Findings include: 1. A review of facility documentation revealed a training program for all staff regarding fall prevention and fall recovery was not available for review at time of inspection. 2. In an interview, E1 acknowledged a training program for all staff regarding fall prevention and fall recovery was not available for review at time of inspection.

Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under Arizona Revised Statutes (A.R.S.) \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06. The deficient practice posed a risk if the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation revealed O1 was no longer the manager of the facility effective September 20, 2024. 2. During the environmental inspection of the facility, the Compliance Officer observed there was not an acting manager's license conspicuously posted. 3. In an interview, E1 reported O1 had been the facility manager until September 20, 2024. 4. In an interview, E1 acknowledged the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in A.R.S. \'a7 36-411, for one of five personnel records sampled. The deficient practice posed a risk if E3 was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "... as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work." 2. A review of E3's personnel record revealed E3 was hired as a caregiver in May 2019. The personnel record included a fingerprint card with an expiration date of March 8, 2029. 3. A review of the website from the Arizona Department of Public Safety revealed E3's fingerprint card was invalid. 4. In an interview, E1 reported being unaware E3 did not have a valid fingerprint clearance card.

Based on documentation review and interview, the manager failed to submit a documented report to the governing authority that included an identification of each concern about the delivery of services related to resident care, and any change made or action taken as a result of the identification of a concern about the delivery of services related to resident care. The deficient practice posed a risk as a quality management program documents the necessary information required to effectively manage services provided. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled, "Quality Management." The policy stated, "...the report and the supporting documentation for the report are maintained for 12 months after the date the report is submitted to the governing authority by the manager." 2. The Compliance Officer requested to review the facility's quality management reports submitted to the governing authority. However, the reports were not provided for review. 3. In an interview, E1 acknowledged the facility did not have reports and the supporting documentation for the report available at the time of the inspection.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, for one of five employees reviewed. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of E3's personnel record revealed no evidence of freedom from infectious TB on or before the date of hire. 2. In an interview, E1 acknowledged documentation was not available that showed E3 was free from infectious TB.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of four residents reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. Review of R1's medical record revealed no documentation that showed the flu and pneumonia vaccinations were received or refused. Based on R1's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's medical record did not include current documentation that showed the flu and pneumonia vaccinations were received or refused.

Based on observation, documentation review, and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closed, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During a tour of the facility with E2, the Compliance Officer observed an unlocked refrigerator in the dining hall. Inside the refrigerator the Compliance Office observed individual plastic containers containing insulin pens for R5, R6, R7, and R8. 2. A review of facility documentation revealed a policy titled, "Storage and Control of Medication." The policy stated, "All medications stored by the Facility will be maintained in a locked area used only for medications...Insulin and other medication that requires refrigeration will be stored in the refrigerator in a locked container..." 3. In an interview, E2 acknowledged medications were stored in an unlocked manner and accessible to residents.

Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months. The deficient practice posed a health and safety risk to residents and employees if the disaster plan was not up-to-date to adequately meet the needs of the residents during a disaster. Findings include: 1. In documentation review, the facility's disaster plan did not indicate the plan was reviewed at least once every 12 months, as required. 2. During an interview, E1 acknowledged the facility did not have documentation the disaster plan was reviewed at least once very 12 months.

Based on documentation review and interview, the manager failed to ensure that a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. A review of the facility's disaster drills revealed no documentation of disaster drills conduced on each shift at least once every three months for the past 12 months. 2. In an interview, E1 acknowledged documentation was not available that showed a disaster drill for employees was conducted on each shift at least once every three months and documented.

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months and included all individuals on the premises except for a resident whose medical record contains documentation that evacuation from the assisted living facility would cause harm to the resident. The deficient practice posed a risk if employees were unable to implement the evacuation plan. Findings include: 1. A review of the facility's evacuation drills for employees and residents revealed no documentation of evacuation drills conducted at least once every six months for the past 12 months. 2. In an interview, E1 acknowledged documentation was not available that showed an evacuation drill was conducted at least once every six months for the past 12 months.

Based on interview and record review, the manager failed to ensure a resident had a written service completed no later than 14 calendar days after the resident's date of acceptance. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident. Findings include: 1. In an interview, the Compliance Officer requested to review R5's medical record. E6 reported there was a written service plan completed no later than 14 calendar days after R5's acceptance; however, it was stored off-site. E6 went to the storage location and obtained some documention from R5's medical record. 2. A review of documentation, provided by E6, revealed a treatment plan for R5 was not available for review.

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver documented the services provided in the resident's medical record, for six of six residents sampled with a service plan. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed a service plan dated in June 2023. The plan stated R1 was to receive the following services at the indicated frequencies: -Care staff to encourage drinking fluids at mealtimes and in between meals with snack to support adequate hydration; -Care staff to assist R1 with dressing/undressing twice per day; -Care staff to assist R1 with grooming twice per day; -Care staff to check and change R1 approximately every two hours for incontinence; -Care staff will check R1's whereabouts and safety regularly, throughout the day, around the clock (six times per day); and -Care staff will encourage R1 to eat and offer fluids every two hours (three times per day). 2. A review of R1's medical record revealed a sample of documents (dated June 2023-August 2023) titled "Visions Assisted Living [Activities of Daily Living] Sheet." Under the heading "Assist [with] Toileting" the documentation indicated R1 received assistance with toileting once per day from June 1, 2023-August 31, 2023. However, the document did not indicate R1 was checked for incontinence and changed every two hours. The documents indicated R1 received assistance with dressing and grooming, oral care, safety checks, and offering and encouraging fluids once per day. However, R1's service plan indicated these services would be provided twice per day or more. 3. A review of R2's medical record revealed a service plan dated in June 2023. The plan stated R2 was to receive the following services at the indicated frequencies: -Care staff to encourage drinking fluids at mealtimes and in between meals with snack to support adequate hydration; -Care staff to assist R2 with dressing/undressing twice per day; -Care staff to assist R2 with grooming twice per day; -Care staff to check and change R2 approximately every two hours for incontinence (five times per day); -Care staff will check R2's whereabouts and safety regularly, throughout the day, around the clock (six times per day); and -Care staff will encourage R2 to eat and offer fluids every two hours (three times per day). 4. A review of R2's medical record revealed a sample of documents (June 2023-August 2023 titled "Visions Assisted Living [Activities of Daily Living] Sheet." The documents indicated R2 received assistance with dressing and grooming, including combing hair, oral care, safety checks, assistance with checking and changing for incontinence, and offering and encouraging fluids once per day. However, R2's service plan indicated these services would be provided twice per day or more. 5. A review of R3's medical record revealed a service plan dated in October 202