MARIGOLD AT REDWOOD ASSISTED LIVING HOME

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for one of one resident reviewed receiving personal care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed.

Findings include:

1. Review of R1's record revealed a current written service plan for personal care services dated September 25, 2023. However, a service plan after September 25, 2023 was not available for review.

2. During an interview, E1 acknowledged R1 received personal care services and the service plan was not updated at least once every six months.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for one of one resident reviewed receiving directed care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed.

Findings include:

1. Review of R3's record revealed a current written service plan for directed care services dated October 16, 2023. However, a service plan after October 16, 2023 was not available for review.

2. During an interview, E1 acknowledged R3 received directed care services and the service plan was not updated at least once every three months.

Based on record review and interview, the manager failed to ensure a written service plan included the signature and date from the resident or representative, for two of three residents reviewed. The deficient practice posed a health and safety risk if the resident or representative did not acknowledge the services that were to be provided.

Findings include:

1. Review of R2's record revealed the most recent written service plan for personal care services dated January 21, 2023. However, this service plan did not include a signature and date from the resident or representative.

2. Review of R3's record revealed the most recent written service plan for directed care services dated October 16, 2023. However, this service plan did not include a signature and date from the resident or representative.

3. During an interview, E1 acknowledged R2's and R3's service plan did not include a signature and date from the resident or representative.

Based on record review and interview, the manager failed to ensure a written service plan included the signature and date from the manager, for two of three residents reviewed. The deficient practice posed a health and safety risk if the manager did not acknowledge the services that were to be provided.

Findings include:

1. Review of R2's record revealed the most recent written service plan for personal care services dated January 21, 2023. However, this service plan did not include a signature and date from the manager.

2. Review of R3's record revealed the most recent written service plan for directed care services dated October 16, 2023. However, this service plan did not include a signature and date from the manager.

3. During an interview, E1 acknowledged R2's and R3's service plan did not include a signature and date from the manager.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents.

Findings include:

1. A.R.S. \'a7 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director."

2. Review of R1's record revealed R1 received the flu vaccination March 10, 2023. However, current documentation was not available showing the flu vaccination was offered or received.

3. During an interview, E1 acknowledged R1's record did not include current documentation showing the flu vaccination was offered or received.

Based on record review and interview, the manager failed to ensure a service plan included documentation of the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated, for one of one resident reviewed receiving directed care services. The deficient practice posed a health and safety risk to the residents.

Findings include:

1. Review of R3's record revealed a current written service plan for directed care services dated October 16, 2023. This service plan revealed no documentation of R3's weight. In addition, R3's record revealed no documentation of R3's weight or documentation from a medical practitioner stating weighing R3 was contraindicated.

2. During an interview, E1 acknowledged R3's service plan did not include documentation of R3's weight and documentation was not available in R3's record from a medical practitioner stating weighing R3 was contraindicated.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members.

Findings include:

1. The Compliance Officer observed the facility's drug reference guide was the "Nursing 2019 Drug Handbook".

2. A review of the publisher's website revealed the "Nursing 2025-2026 Drug Handbook" was the most recent edition.

3. In an interview, E1 acknowledged that a current drug reference guide was not available for use by personnel members.

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 a risk to residents who could access the medication.

Findings include:

1. During the facility tour with E2, the Compliance Officer observed a cabinet in the kitchen that held four resident's medications unlocked. This cabinet had a magnetic locking device, however the device was not locked.

2. During the facility tour with E2, the Compliance Officer observed a box in the refrigerator containing Lantus Solostar insulin and Morphine syringes. The box was equipped with a combination lock, however the box was not locked.

3. In an interview, E1 and E2 acknowledged medications were not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on observation and interview, the manager failed to ensure garbage and refuse were stored in covered containers lined with plastic bags.

Findings include:

1. During the facility tour with E2, the Compliance Officer observed a garbage container that was not lined with a plastic bag in a resident bedroom.

2. During the facility tour with E2, the Compliance Officer observed a garbage container that did not have a cover in a resident bedroom.

3. In an interview, E1 acknowledged garbage and refuse were not stored in covered containers lined with plastic bags.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. During the facility tour, the Compliance Officer observed a container of "Clorox wipes" and "Bic Cover-it Correction fluid" which both stated "Keep out of reach of children" on a desk in the dining room.

2. In an interview, E1 acknowledged toxic materials stored by the facility were not stored in a locked area and inaccessible to residents.