ARMADA CARE HOMES

Based on record review and interview, the manager failed to ensure the assisted living home maintained a standardized form for each resident that included the information prescribed in subsection A of this section for two of two residents reviewed.

Findings include:

1. Review of R1's and R2's medical record revealed a document titled "Resident Face Sheet". This document contained some of the information required in subsection A of ARS 36-420.04, however it was missing the following:
- The name, address and telephone number of the resident's current pharmacy;
-A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge.

2. A review of the facility's emergency documentation revealed a form titled "Assisted Living Resident Transfer Checklist." However, the form was blank at the time of review and was not completed for each individual resident.

3. In an interview, E2 reported that the "Resident Face Sheet" document was the documentation meant to comply with ARS 36-420.04, and that other documentation to comply with ARS 36-420.04 had not been prefilled for each resident. E2 acknowledged that the assisted living home did not maintain a standardized form for each resident.

Based on record review, observation and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of two residents reviewed. The deficient practice posed a health and safety risk.

Findings include:

1. A Review of R2's medical record revealed a current written service plan for directed care services dated December 8, 2024 . This service plan stated the following services were needed:
- Hydration: Water is offered to each resident with every meal - Encourage sufficient fluids to prevent dehydration;
- Hygiene - Dependent - Daily - PRN;
- Nails - Clean and check with showers; and
- Skin Care - PRN Lotion - Monitor skin integrity.
However, documentation was not available indicating these services were provided.

3. The Compliance Officer observed R2's nails appeared to be cleaned and maintained.

4. During an interview, E2 acknowledged R2's medical records did not include documentation of the services provided.

Based on record review, observation and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order for two of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication.

Findings include:

1. A review of R1's and R2's medical record revealed R1 and R2 received medication administration.

2. A review of R1's medical record revealed a medication list dated June 18, 2024 discontinuing the order for the following medication:
- Valsartan-hydroCHLOROthiazide 80-12.5 milligram (MG) Tablet - 1 tablet Orally Once a day.

3. A review of R1's medication administration record (MAR) for December 2024 revealed R1 received the following medication from December 1, 2024 to December 19, 2024:
- Hydrochlorothiazide/Valsartan - Take 1 tab 12.5MG/80MG by mouth daily.

4. An observation of R2's medications revealed a bottle of "Eliquis 5 MG Tab" with a fill date of December 2, 2024. A review of the medication revealed a 5 imprinted on one side of the tablet and 894 imprinted on the other side of the tablet.

5. A review of R2's medication organizer revealed one Eliquis 5 MG Tablet prefilled in following days morning medication slots:
- Sunday
- Monday
- Tuesday
- Friday
- Saturday

6. A review of R2's medical record revealed a medication list signed and dated August 2, 2024. However, Eliquis 5 MG Tab was not included on the orders.

7. A review of R2's medical record revealed a MAR for review. However, Eliquis 5 MG Tab was not documented on the MAR.

8. In an interview. E2 reported that R2 had been administered the prefilled medication including Eliquis 5 MG Tab from the medication organizer on December 18, 2024 and December 19, 2024. E1 reported R2's medication was changed when R2 went to an appointment with family and the order was not provided. E2 acknowledged medication administered to R1 and R2 were not administered in compliance with a medication order.

Based on documentation review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not developed and implemented, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

1. A review of facility documentation revealed a policy and procedure for fall prevention and fall recovery was not available for review.

2. A review of facility documentation revealed a training program for fall prevention and fall recovery was not available for review.

3. In an interview, E3 acknowledged a fall prevention and recovery training program had not been developed.

Based on observation, documentation review, record review, and interview, the manager failed to implement policies and procedures to protect the health and safety of a resident covering cardiopulmonary resuscitation (CPR) including the method and content of cardiopulmonary resuscitation training, to include a demonstration of the employee's or volunteer's ability to perform cardiopulmonary resuscitation. The deficient practice posed a risk as the standards expected of employees in the policies and procedures were not followed, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

1. The Compliance Officer observed E1 and E2 working at the facility upon arrival at 9 AM.

2. A review of facility documentation revealed a policy and procedure titled "Caregiver Employment Requirements" (dated in 2022). The policy and procedure stated, "...A caregiver at the date of hire: ...6. Has Current CPR and First Aid Cards- specifically for adults, from a valid classroom provider ...(no online-training courses are accepted) ..."

3. A review of E1's (hired in 2023) personnel record revealed a "ProCPR" training card with an issue date of June 24, 2021 and renewal date of June 24, 2023. However, documentation of E1's demonstration of CPR was not available for review.

4. In an interview, E1 reported E1 completed E1's CPR training online.

5. In an interview, E3 acknowledged E1's CPR training was not in compliance with the facility's policy and procedure.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of cardiopulmonary resuscitation (CPR) training, to include demonstration, for one of three caregivers sampled. The deficient practice posed a risk if the employee was unable to ensure a resident's health and safety, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

1. A review of facility documentation revealed a policy and procedure titled "Caregiver Employment Requirements" (dated in 2022). The policy and procedure stated, "...A caregiver at the date of hire: ...6. Has Current CPR and First Aid Cards- specifically for adults, from a valid classroom provider ...(no online-training courses are accepted) ..."

2. A review of E1's (hired in 2023) personnel record revealed a "ProCPR" training card with an issue date of June 24, 2021 and renewal date of June 24, 2023. However, documentation of E1's demonstration of CPR was not available for review.

3. In an interview, E1 reported E1 completed E1's CPR training online.

4. In an interview, E3 acknowledged E1's CPR training was from an online program and documentation of current CPR training, with demonstration, was not available for review.

Based on record review and interview, the manager failed to ensure a resident had a written service plan signed and dated by the resident or resident's representative and the manager, when updated, for one of two residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

1. A review of R2's (admitted in 2022) medical record revealed a service plan dated in January 2023 for personal care services. However, the service plan was not signed and dated by the R2 or the resident's representative and the manager.

2. In an interview, E3 reported E3 forgot to sign R2's service plan and acknowledged R2's service plan had not been signed and dated by R2 or R2's representative and the manager.

Based on record review and interview, the manager retained a resident who was unable to ambulate even with assistance, without meeting the requirements in R9-10-814(B)(2)(b), for one of two residents sampled. The deficient practice posed a health and safety risk if the facility was unable to meet the resident's needs, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

R9-10-814(B)(2)(b) states: The following requirements are met at the onset of the condition or when the resident is accepted by the assisted living facility: The resident's primary care provider or other medical practitioner:
i. Examines the resident at the onset of the condition, or within 30 calendar days before acceptance, and at least once every six months throughout the duration of the resident's condition;
ii. Reviews the assisted living facility's scope of services; and
iii. Signs and dates a determination stating that the resident's needs can be met by the assisted living facility within the assisted living facility's scope of services and, for retention of a resident, are being met by the assisted living facility;

1. A review of R1's (admitted May 2021) medical record revealed a document titled "REQUEST FOR ACCEPTED / CONTINUED RESIDENCY AGREEMENT" dated in December 2020. The document stated "...Confined to a bed or chair staff must assistance/Non-/ambulatory." However, documentation of the facility's compliance with R9-10-814(B)(2)(b) was not available for review.

2. In an interview, E3 reported R1 was chair bound and acknowledged R1 was retained as a resident without the facility being in compliance with R9-10-814(B)(2)(b).

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed an accessibility risk to residents who were not prescribed the accessible medication, and the Department was unable to determine substantial compliance during the inspection.

Findings include:

1. The Compliance Officer observed three ambulatory residents on the premises.

2. The Compliance Officer observed a lock box in the kitchen refrigerator. The lockbox contained the following medications:
-One box of Lantus Solostar injection belonging to R2; and
-Bisacodyl 10 MG suppository belonging to another resident.
However, the lock box was unlocked.

3. In an interview, E3 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.