SIERRA DEL SOL

Based on record review and interview, the manager accepted an individual requiring continuous medical services, for one of eight residents sampled. The deficient practice posed a risk as an assisted living facility cannot provide continuous medical services. Findings include: 1. A review of R7's medical record revealed a document titled "Physician's Initial Report and Orders" The document stated "Please also indicated (sic) and list any of the following services needed while in the community: Continuous Medical Services..." A box next to "Continuous Medical Services" was marked to indicate R7 required continuous medical services. The document was signed by a medical practitioner. 2. In an interview, E1 reported R7 does not receive continuous medical services. E1 reported the box indicating R7 required continuous medical services should not have been marked.

Based on observation, record review, and interview, the manager failed to ensure a resident had a written service plan to include the level of service the resident was expected to receive, for four of eight residents sampled. Findings include: A.R.S. \'a7 36-401.48 "Supervisory care services" means general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the self-administration of prescribed medications. A.R.S. \'a7 36-401.39 "Personal care services" means assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to title 32, chapter 15 or as otherwise provided by law. A.R.S. \'a7 36-401.16 "Directed care services" means programs and services, including supervisory and personal care services, that are provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions. 1. A review of R1's medical record revealed a service plan, dated June 7, 2023, for personal care services. However, the service plan included only general supervision and did not include assistance with activities of daily living or medication administration. 2. A review of R2's medical record revealed a service plan, dated July 12, 2023, for personal care services. However, the service plan included only general supervision and did not include assistance with activities of daily living or medication administration. 3. A review of R3's medical record revealed a service plan, dated May 22, 2023, 2023, for personal care services. However, the service plan included only general supervision and did not include assistance with activities of daily living or medication administration. 4. A review of R5's medical record revealed a service plan, dated October 11, 2023. However, the service plan did not include the level of service R5 was expected to receive. 5. In an interview, E1 and E2 acknowledged some of the resident service plans provided for review had not accurately identified if each resident was expected to receive Supervisory care services, Personal Care services, or Directed care services.

R9-10-120. Opioid Prescribing and Treatment F. For a health care institution where opioids are administered as part of treatment or where a patient is provided assistance in the self-administration of medication for a prescribed opioid, including a health care institution in which an opioid may be prescribed or ordered as part of treatment, a medical director, a manager as defined in R9-10-801, or a provider, as applicable to the health care institution, shall: 1. Establish, document, and implement policies and procedures for administering an opioid as part of treatment or providing assistance in the self-administration of medication for a prescribed opioid, to protect the health and safety of a patient, that: a. Cover which personnel members may administer an opioid in treating a patient and the required knowledge and qualifications of these personnel members; b. Cover which personnel members may provide assistance in the self administration of medication for a prescribed opioid and the required knowledge and qualifications of these personnel members; c. Include how, when, and by whom a patient's need for opioid administration is assessed; d. Include how, when, and by whom a patient receiving an opioid is monitored; and e. Cover how, when, and by whom the actions taken according to subsections (F)(1)(c) and (d) are documented;

Based on documentation review, record review, and interview, the manager failed to establish, document and implement policies and procedures for administering an opioid as part of treatment or providing assistance in the self-administration of medication for a prescribed opioid, to protect the health and safety of a patient. Findings include: 1. A review of the facility's policies and procedures revealed a policy and procedure for opioid administration was not available for review.. 2. In an interview, E1 acknowledged a policy and procedure which covered all items required by R9-10-120(F)(1)(a-e) had not been provided for review during the on-site inspection.