EMERALD SPRINGS SENIOR LIVING

<p>Based on documentation review, record review, and interview, the manager failed to immediately report suspected abuse according to A.R.S. § 46-454. The deficient practice posed a risk as the Department was unable to assess if there was an immediate health and safety concern for residents who resided in the assisted living facility.</p><p> </p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p> 1. A.R.S. § 46-454(A) stated "...other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit ... All of the above reports shall be made immediately by telephone or online."</p><p><br></p><p><br></p><p> 2. A.R.S. § 46-454(B) stated "If an individual prescribed in subsection A of this section is an employee or agent of a health care institution as defined in section 36-401 and the health care institution's procedures require that all suspected abuse, neglect and exploitation be reported to adult protective services as required by law..."</p><p> </p><p><br></p><p>3. R9-10-101.111 stated "Immediate" means without delay.</p><p><br></p><p><br></p><p>4. A review of facility documentation revealed an incident report dated June 9, 2025, involving an altercation between R1 and R2 at 1810 hours. The incident report showed the incident was reported at 1550 hours on June 10, 2025, to Adult Protective Services and the Arizona Department of Health. </p><p> </p><p><br></p><p>5. In an interview, E1 stated on June 10, 2025, in the morning meeting that E2 informed E1 of the incident that took place the day before, where E3 had separated R1 and R2. E3 did not inform E1 or E2 until the morning of June 10, 2025. E1 acknowledged that the manager did not immediately report as required by this rule. </p>

<p>Based on record review and interview, for one of six resident records reviewed, the manager failed to ensure a resident's written service plan was reviewed and updated at least once every three months.</p><p><br></p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p><br></p><p>1. A review of R2's medical record revealed a service plan, dated November 22, 2024, for directed care services. However, the service plan update dated February 20, 2025 was not reviewed by the resident's representative, the manager, or a nurse or medical practitioner.</p><p><br></p><p><br></p><p><br></p><p>2. In an interview, E1 acknowledged that R2's record did not include a written service plan update dated at least once every three months and reviewed by the <span style="background-color: rgb(255, 255, 255);">resident's representative, the manager, and a nurse or medical practitioner</span>.</p>

<p>Based on record review and interview, the manager failed to ensure a medication was administered to a resident in compliance with a medication order for two of six resident records reviewed. </p><p><br></p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p> </p><p>1. A review of R3's medical record revealed a service plan for directed care services, including medication administration.</p><p><br></p><p><br></p><p><br></p><p>2. A review of 3's medical record revealed a signed list of medications, dated February 23, 2025, which included the following medications:</p><p>- “AMLODIPINE BESYLATE 5MG TABLET… 1 TAB ORAL DAILY… 8AM”; and </p><p>- “SERTRALINE HCL 50MG TABLET… 2 TABLETS BY MOUTH AT BEDTIME – 8PM”.</p><p><br></p><p><br></p><p><br></p><p>3. A review of R3's medical record revealed an electronic Medication Administration Record (eMAR) dated May 2025. The eMAR documented the medications administered to R3 each day. However, the medications were administered late by more than one hour. Amlodipine Besylate was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 5, 2025, at 9:04 AM, May 10, 2025, at 10:59 AM, and May 13, 2025, at 9:07 AM. Sertraline HCL 50 mg was scheduled to be administered daily at 7:00 PM; however, it was administered late on May 2, 2025, at 8:28 PM, May 5, 2025, at 8:01 PM, and May 10, 2025, at 9:42 PM.</p><p><br></p><p><br></p><p><br></p><p>4. A review of R3’s medical record revealed a signed order for “MELOXICAM 15MG TABLET, Take 1 tab po q am”, which the facility scheduled at 8:00 AM daily. A review of R3’s eMAR revealed Meloxicam was scheduled to be administered at 8:00 AM; however, it was administered late on May 5, 2025, at 9:04 AM, May 10, 2025, at 10:59 AM, and May 13, 2025, at 9:07 AM.</p><p><br></p><p><br></p><p><br></p><p>5. A review of R4’s medical record revealed a service plan for personal care services, including medication administration.</p><p><br></p><p><br></p><p><br></p><p>6. A review of R4's medical record revealed a signed list of medications, dated April 22, 2025, which included the following medications:</p><p>- “Azelastine HCL Nasal Solution 137 MCG/SPRAY… 2 sprays into each nostril twice daily…”;</p><p>- “Cetirizine HCL Oral Tablet 10MG… 1 tablet by mouth once daily in the morning…”;</p><p>- “Latanoprost Ophthalmic Solution 0.005%... Administer 1 drop in each eye once daily in the evening…”;</p><p>- “Losartan Potassium Oral Tablet 25 MG… Give 1 tablet by mouth once daily in the morning…”;</p><p>- “Memantine HCL Oral Tablet 10 MG… Give 1 tablet by mouth once in the morning…”;</p><p>- “Montelukast Sodium Oral Tablet 10 MG… Give 1 tablet by mouth once daily in the morning…”;</p><p>- “Polyethylene Glycol 3350 Oral Powder 17 GM/SCOOP… Dissolve and drink 17 grams (1 scoop) in 8 oz of liquid once daily in the morning…”;</p><p>- “Senna Oral Tablet 8.6 MG… Give 1 tablet by mouth once daily at bedtime…”;</p><p>- “Symbicort Inhalation Aerosol 160-4.5 MCG/ACT… Inhale 2 puffs by mouth twice daily…”;</p><p>- “Tamsulosin HCL Oral Capsule 0.4 MG… Give 1 capsule by mouth once daily in the evening…”; and </p><p>- “Ventolin HFA inhalation Aerosol Solution 108 (90 Base) MCG/ACT…Inhale 2 puffs by mouth four times daily…”.</p><p><br></p><p><br></p><p><br></p><p>6. A review of R4's medical record revealed an eMAR dated May 2025. However, some medications were administered late by more than one hour. Azelastine HCL was scheduled to be administered daily at 8:00 AM and 7:00 PM; however, it was administered late on May 11, 2025, at 9:10 AM and on May 1, 2025, at 8:21 PM. Cetirizine HCL was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 11, 2025, at 9:10 am. Latanoprost was scheduled to be administered daily at 7:00 PM; however, it was administered late on May 1, 2025, at 8:21 pm. Losartan was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 11, 2025, at 9:10 AM. Memantine HCL was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 11, 2025, at 9:10 AM. Montelukast was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 11, 2025, at 9:10 AM. Polyethylene Glycol was scheduled to be administered daily at 8:00 AM; however, it was administered late on May 11, 2025, at 9:10 AM. Senna was scheduled to be administered daily at 7:00 PM; however, it was administered late on May 7, 2025, at 8:24 PM. Symbicort was scheduled to be administered daily at 8:00 AM and 7:00 PM; however, it was administered late on May 11, 2025, at 9:10 AM and on May 7, 2025, at 8:24 PM. Tamsulosin was scheduled to be administered daily at 7:00 PM; however, it was administered late on May 1, 2025, at 8:21 PM and May 7, 2025, at 8:24 PM. Ventolin HFA was scheduled to be administered daily at 8:00 AM, 12:00 PM, 4:00 PM, and 7:00 PM; however, it was administered late on May 11, 2025, at 9:10 AM, May 7, 2025, at 8:24 PM, and May 1, 2025, at 8:21 PM.</p><p><br></p><p><br></p><p><br></p><p>7. In an interview, E1 acknowledged some medications had been administered late and not as ordered for R3 and R4.</p>

Based on document review and interview, after the manager had a reasonable basis, according to A.R.S. \'a7 46-454, to believe abuse, neglect, or exploitation had occurred on the premises, the manager failed to immediately make a report to a peace officer or to the adult protective services central intake unit. The deficient practice posed a potential safety risk for residents and potential rights violation as alleged abuse, neglect, or exploitation was not reported as required.

Findings include:

1. A review of facility incident reports in July 2024 revealed two reports documenting a single incident of alleged abuse between R1 and R2. The reports documented action taken to stop the alleged abuse. Further documentation review revealed the facility documented and reported the incident, pursuant to R9-10-803.J.3, and conducted an investigation, compliant with R9-10-803.J.5 However, documentation indicated the incident was not immediately reported as required per R9-10-803.J.2, and according to A.R.S. \'a7 46-454.

2. In an interview, E1 agreed the incident was not immediately reported as required per R9-10-803.J.2, and according to A.R.S. \'a7 46-454.

This is a repeat citation from a complaint investigation conducted on July 12, 2024.

Based on document review and interview, after the manager had a reasonable basis, according to A.R.S. \'a7 46-454, to believe abuse, neglect, or exploitation had occurred on the premises, the manager failed to immediately make a report to a peace officer or to the adult protective services central intake unit. The deficient practice posed a potential safety risk for residents and potential rights violation as alleged abuse, neglect, or exploitation was not reported as required.

Findings include:

1. A review of facility incident reports in 2024 revealed two reports documenting a single incident of alleged abuse between R1 and R2. The reports documented action taken to stop the alleged abuse. Further documentation review revealed the facility documented and reported the incident, pursuant to R9-10-803.J.3, and conducted an investigation, compliant with R9-10-803.J.5 However, documentation indicated the incident was not immediately reported as required per R9-10-803.J.2, and according to A.R.S. \'a7 46-454.

2. In an interview, E1 agreed the incident was not immediately reported as required per R9-10-803.J.2, and according to A.R.S. \'a7 46-454.

Based on observation and interview, the manager failed to ensure food was protected from potential contamination which posed a health and safety risk.

Findings include:

1. During a tour of the facility's second floor resident Bistro kitchenette, E1 and the compliance officer observed in the reach-in refrigerator there was a large pan of uncovered white dessert appearing food product. The observation was not during mealtime. The uncovered dessert was not protected from the potential of contamination.

2. In an interview, E1 acknowledged the uncovered food which posed a potential for contamination.

Based on observation and interview, the manager failed to ensure that a refrigerator used by the assisted living facility to store food contained a thermometer, accurate to plus or minus 3\'b0 F, placed at the warmest part of the refrigerator.

Findings include:

1. During a facility tour, E1 and the compliance officer observed in the second floor resident bistro's kitchenette reach-in refrigerator there was no thermometer.

2. During an interview, E1 acknowledged this refrigerator did not contain a thermometer.

Based on observation and interview, the manager failed to ensure the premises and equipment were free from a condition or situation that may cause a resident or other individual to suffer physical injury which posed a health and safety risk.

Findings include:

1. During a random tour of the facility's second floor's outdoor balconies, E1 and the compliance officer observed the balcony wood railing has a rough surface with deteriorating paint coverage. A resident or an individual who may put their hand on the railing could obtain an injury. The two rails observed were R4's and R5's units' balcony railings.

2. In an interview, E1 acknowledge the wood railing could cause splinters in a resident's hand when rubbed across the rough boards.

3. During a tour of randomly select areas of the facility, E1 and the compliance officer observed swinging sliding closet/storage doors in R6's unit and the second floor Bistro common area. If a resident or another individual leaned again these swinging closet/storage doors it could cause a resident or other individual to fall and become physically injured.

4. In an interview, E1 acknowledged the swinging closet/storage doors are a hazard that could cause an injury to a resident or individual.

This is a repeat deficiency from the compliance inspections conducted on November 2-3, 2021, and November 8-9, 2022.

Based on observation, documentation review, and interview during a complaint investigation, the manager failed to ensure the facility's policy and procedure was established and documented to ensure the safety of a resident who may wander to protect the health and safety of a resident. The facility is licensed to provide directed care services.

Findings include:

1. During a facility tour of the the facility's secured memory care unit, the compliance officer observed the facility had a secured outdoor area that was alarmed where residents may walk or sit.

2. There was no documentation available for review that the facility had an established and documented policy and procedure to ensure the safety of a resident who may wander that should have been implemented for this incident.

3. In an interview, E1 reported that E1 was unable to locate the facility's wandering policy and procedure.