CAMELBACK RESIDENTIAL ASSISTED LIVING, LLC

R9-10-803.D.1-4. Administration D. A manager shall ensure that the following are conspicuously posted: 1. A list of resident rights; 2. The assisted living facility ' s license; 3. Current phone numbers of: a. The unit in the Department responsible for licensing and monitoring the assisted living facility, b. Adult Protective Services in the Department of Economic Security, c. The State Long-Term Care Ombudsman, and d. The Arizona Center for Disability Law; and 4. The location at which a copy of the most recent Department inspection report and any plan of correction resulting from the Department inspection may be viewed.

Based on observation and interview, the manager failed to ensure the posting of the current phone numbers of: the unit in the Department responsible for licensing and monitoring the assisted living facility, Adult Protective Services in the Department of Economic Security, the State Long-Term Care Ombudsman, and the Arizona Center for Disability Law; and the location at which a copy of the most recent Department inspection report and any plan of correction resulting from the Department inspection may be viewed were conspicuously posted. Findings include: 1. In observation, the facility did not have the required telephone numbers posted for the Department, Adult Protective Services, the State Long-Term Care Ombudsman, and the Arizona Center for Disability Law. The facility also did not have posted the location of the recent Department inspection report and plan of correction for viewing. 2. During an interview, E1 and E2 acknowledged the required telephone numbers were not posted and the location of the Department's inspection report and plan of correction was also not posted.

Based on documentation review, record review, and interview, for one of two residents reviewed, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents and staff. 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. In record review, R1's medical record included documentation of a screening and risk assessment (not completed timely); however, did not include documentation of a TB skin test or blood test showing freedom from TB. Based on R1's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged R1's medical record did not include documentation of freedom from infectious TB.

R9-10-807.B.1.a-b. Residency and Residency Agreements B. A manager shall ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: 1. If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: a. Includes whether the individual requires: i. Continuous medical services, ii. Continuous or intermittent nursing services, or iii. Restraints; and b. Is dated and signed by a: i. Physician, ii. Registered nurse practitioner, iii. Registered nurse, or iv. Physician assistant; and

Based on record review and interview, for two of two residents reviewed, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation, signed and dated by a Physician, Registered nurse practitioner, Registered nurse, or Physician Assistant, which included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints. The deficient practice posed a safety risk, if residents were not appropriately assessed on acceptance. Findings include: 1. In record review, the medical records for R1 and R2 (received directed care services) did not include the required documentation, signed and dated by a Physician, Registered Nurse Practitioner, Registered Nurse or Physician's Assistant, which included whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on the resident's date of acceptance, this documentation was required. 2. During an interview, E1 acknowledged the residents' records did not include the signed and dated documentation to indicate whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.