CLEARWATER AGRITOPIA

Based on record review and interview, the manager failed to ensure that a resident's medical record contained documentation of notification of the availability of the vaccination for influenza (flu) according to A.R.S. \'a7 36-406(1)(d), which required the facility to make the vaccination available to the resident on site on a yearly basis; for two of seven sampled residents records reviewed who had resided at the assisted living facility for more than 12 months, which posed a health and safety risk. Findings include: 1. Based on the dates of acceptance and review of R2's and R4's medical records, the compliance officer requested and was not provided documentation to indicate R2 and R4 had received the flu vaccine. There was no other documentation available in R2's and R4's medical records to indicate the vaccine was offered, given, refused, or contraindicated within the past 12 months. 2. In an interview, E1 and E2 acknowledged there was no documentation available that the flu vaccine had been made available to R2 and R4 during the past 12 months.

Based on observation, record review, and interview, the manager failed to ensure that a service plan for a resident who is receiving personal care services included the treatment of bruises, injuries, pressure sores, and infections, which posed a health and safety risk; for two of two sampled residents. Findings include: 1. Review of R2's current service plan dated February 15, 2024 did not document the lateral leg wounds and the treatment of these wounds that were being treated by an outside service. 2. Review of R3's current service plan dated January 25, 2024 did not document the lateral heel wounds and the treatment of these wounds that were being treated by an outside service. 3. In an interview, E1 and E2 acknowledged the residents' wounds. However, these sampled residents' service plans did not document the wounds and the treatment of these wounds.

Based on record review and interview, the manager failed to ensure that for one two sampled resident who were unable to ambulate even with assistance, the resident's primary care provider (PCP) or other medical practitioner signed a determination stating that the resident's needs were being met. This determination was to be completed at least once every six months throughout the duration of the resident's condition to determine if the resident's needs could be met which was based upon a current resident examination and the assisted living facility's scope of services which posed a health and safety risk. The facility is licensed to provided directed care services. Findings include: 1. In an interview, E2 reported that R6 has been unable to ambulate even with assistance for at least the past twelve months. 2. Review of R6's medical record found a documented determination completed that was dated November 22, 2023. However, there was no documented determination completed by R3's medical practitioner prior to November 2023. The determination should have been based on a current examination of the resident, the facility's scope of services, and a statement that the resident's needs could be met by the facility. 3. In an interview, E2 acknowledged there was no documentation of the required determinations available for review prior to November 2023 which could pose a health risk to the resident.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted at least once every three months on each shift and documented which posed a safety risk. Findings include: 1. During an interview, E1 and E2 reported the facility had three shifts: First shift from 6:00 AM to 2:00 PM, the second shift from 2:00 PM to 10:00 PM, and the third shift from 10:00 PM to 6:00 AM. 2. Review of the first shift employee disaster drills documentation for the past 12 months revealed drills were conducted on: May 28, 2023, July 26, 2023, and November 1, 2023. 3. In an interview, E1 acknowledged the facility's employee disaster drills were not conducted at least once every three months on the first shift as required.

Based on observation and interview, the manager failed to ensure the premises and equipment used at the assisted living facility was cleaned according to policies and procedures designed to prevent, minimize, and control illness or infection. Findings include: 1. During a tour of randomly selected residents' units, E1 and the compliance officer observed in R1's unit there were numerous dog potty pads laying on the floor throughout the unit. A number of them appeared to have pet urine and feces on the pads. It was difficult to know where to walk. The few areas of the floor that were not covered with dog potty pads one could see urine like stains on the carpet. The unit had a strong urine and unclean odor. E1 and the compliance officer observed a small dog in the unit with the resident. 2. In an interview, E1 acknowledged that R1's unit did not did not appear clean which could pose a health risk to the resident.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials that were stored by the facility were in a locked area and inaccessible to residents. Findings include: 1. During a facility tour of the memory care unit, E1 and the compliance officer observed an unlocked storage room in the common hall where residents could walk that contained paint cans, unlabeled spray bottles with a clear solution in them, Resolve Stain Remover, and insect spray. The unlocked storage room in memory care unit near the entrance of the unit there was stored cans of paint. 2 . In the Signature Unit there was an unlocked storage room near the kitchenette that contained sanitizer spray. 3. In an interview, E1 acknowledged the unlocked poisonous or toxic materials being stored by the facility.