AZ LIFE ASSISTED LIVING HOME II, LLC

Based on record review and interview, the manager failed to ensure, before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility to include the manager's signature and date signed, for four of four residents sampled. Findings include: 1. A review of R1's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 2. A review of R2's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 3. A review of R3's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 4. A review of R4's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 5. In an interview, E2 acknowledged R1's, R2's, R3's, and R4's residency agreements did not include E1's signature and the date signed.

Based on record review and interview, the manager failed to ensure a resident had a written service plan signed and dated by the manager, for two of four residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R1's medical record revealed a current written service plan dated in July 2023, for personal care services. However, the service plan was signed by E2 and not signed and dated by the manager. 2. A review of R3's medical record revealed a current written service plan dated in March 2023, for personal care services. However, the service plan was signed by E2 and not signed and dated by the manager. 3. In an interview, E2 acknowledged R1's and R3's service plans were not signed and dated by E1.