BETTER LIVING HOME, LLC

<p>Based on documentation review and interview, the health care institution failed to ensure that the health care institution established, documented, and implemented tuberculosis (TB) infection control activities that included annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. A review of the facility's documentation records revealed no facility risk assessment for infectious tuberculosis was documented and available during the inspection.</p><p><br></p><p><br></p><p>2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.</p><p><br></p><p><br></p><p>3. Technical assistance was provided on this Rule during the inspection conducted on April 20, 2023.</p>

<p>Based on record review, documentation review, and interview, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered and the effect of the opioid administered for one of nine residents sampled.</p><p><br></p><p><br></p><p>Findings include: </p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255); color: rgb(68, 68, 68);">1. A review of R2's medical record revealed a service plan indicating R2 received personal care services and medication administration.</span></p><p><br></p><p><br></p><p>2. A review of R2’s medical record revealed a narcotic administration record dated October 2025. This record revealed <span style="background-color: rgb(255, 255, 255); color: rgb(68, 68, 68);"> “Oxycodone HCL 10 MG Tablet, take 1 tablet po every 6 hours as needed for pain” and indicated Oxycodone was administered as ordered every day between October 3, 2025 and October 14, 2025. </span>Documentation was not available showing the need for the opioid, the response to the opioid, and the effect of the opioid administered.</p><p><br></p><p><br></p><p>3. A review of facility documentation revealed a policy last revised June 19, 2024, titled "Opioid Medications." The policy stated "...An assessment of a resident's pain will be identified prior to administering an opioid medication using the "0 to 10" scale where "0" is no pain at all and "10" is the worst pain the resident can imagine. Once the pain medication is given, the individual providing the medication, or another individual authorized to administer medications will monitor the resident's response to the opioid medication to include how effective the opioid medication was to resolve the pain. This will be accomplished by reassessing the pain level approximately 30 minutes but no more than one hour after the medication is delivered. ili. Each time the above pain level assessments are taken they will be recorded in the resident's medical record on the MAR, a PRN-MAR or an Opioid MAR. iv. The effectiveness of the opioid medication will be determined and document on the Opioid PRN MAR.”</p><p><br></p><p><br></p><p>4. In an interview, E1 reported R2 did not have an end-of-life condition or an active malignancy and was not receiving hospice services.</p><p><br></p><p><br></p><p>5. In an exit interview, the findings were reviewed with E1 and no additional information was provided. </p>

<p>Based on record review and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident’s date of occupancy and as specified in R9-10-113, for two of two residents sampled. The deficient practice posed a TB exposure risk to residents.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. A review of R1 and R2's medical records revealed no documentation of evidence of freedom from infectious TB. Based on the residents' date of acceptance, this documentation was required.</p><p><br></p><p><br></p><p>2. In an exit interview, the findings were reviewed with E2 and no additional information was provided.</p>

<p>Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in a resident’s medical record, for two out of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. A review of R1’s activities of daily living sheet revealed the following missing documentation of services required to be provided to R1 in accordance with the services stated in the service plan:</p><p><br></p><ul><li>No documentation of checks every 3-4 hours at night.</li></ul><p><br></p><p><br></p><p>2. A review of R2’s activities of daily living sheet revealed the following missing documentation of services required to be provided to R2 in accordance with the services stated in their service plan:</p><p><br></p><ul><li>No documentation of showers and shampoo between October 13-20, 2025.</li><li>No documentation of dressing resident Oct 16-20, 2025.</li><li>No documentation of checks every 3-4 hours at night.</li></ul><p><br></p><p><br></p><p>3. In an interview, E1 reported the services were provided but just not documented.</p><p><br></p><p><br></p><p>4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.</p>

<p>Based on observation and interview, the manager failed to ensure that residents' medical records were protected from loss, damage, or unauthorized use. The deficient practice posed a risk of protected, sensitive resident health information being disclosed without the resident's consent or knowledge. </p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. During an environmental inspection of the facility, the Compliance Officer observed medical records sitting out on a table with the resident's name and private health information inside.</p><p><br></p><p><br></p><p>2. In an exit interview, the findings were reviewed with E1 and no additional information was provided. </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. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. A review of R1’s medical record revealed signed medication orders dated July 24, 2025. These medication orders stated the following:</p><p><br></p><ul><li>"Acetaminophen 500mg, po 2 tabs three times daily for pain."</li></ul><p><br></p><p><br></p><p>2. A review of R1’s October 2025 medication administration record (MAR) revealed the following:</p><p><br></p><ul><li>Acetaminophen 500mg, 2 tabs two times daily and indicated Acetaminophen was administered two times a day during the month of October 2025.</li></ul><p><br></p><p><br></p><p>3. A review of R2’s medical record revealed a signed medication order dated September 25, 2025. This order stated the followig:</p><p><br></p><ul><li>“Lyrica oral cap 50mg po, 1 cap po three times a day, every day for nerve pain anti convulsant.”</li></ul><p><br></p><p><br></p><p>4. A review of R2’s October 2025 MAR revealed no documentation of Lyrica or administration of the medication during the month of October 2025.</p><p> </p><p><br></p><p>5. During an observation of R2's medications, Lyrica was not observed.</p><p><br></p><p><br></p><p>6. There was no documentation of discontinuation of the medication available in R2's medical record.</p><p><br></p><p><br></p><p>7. In an exit interview, the findings were reviewed with E3 and no additional information was provided. </p>

<p>Based on observation and interview, the manager failed to ensure that 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 were not prescribed the accessible medication.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. During an environmental inspection of the facility, the Compliance Officer observed the following unlocked medications inside a bag sitting in the bedroom of R3:</p><ul><li>Bactrim, 1 tab po twice daily for 7 days;</li><li>Cephalexin 500 mg, 1 capsule po 4 times daily for 7 days; and</li><li>Esomeprazole Magnesium 20 mg capsules.</li></ul><p><br></p><p><br></p><p>2. In an interview, E1 reported that the unlocked medication belonged to a caregiver, E2, and was not supposed to be left in the room.</p><p><br></p><p><br></p><p>3. In an exit interview, the findings were reviewed with E1 and no additional information was provided. </p><p><br></p><p><br></p><p>4. This is a repeat deficiency from the inspection conducted on April 20, 2023. </p>

<p>Based on documentation and interview, the manager failed to ensure that a disaster plan included a plan to ensure each resident’s medication would be available to administer to the resident during a disaster. The deficient practice posed a risk as there was no plan to ensure the health and safety of residents in an emergency.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. A review of the facility’s documentation revealed a disaster plan for the facility; however, the plan did not include a plan to ensure each resident’s medication would be available to administer to the resident during a disaster.</p><p><br></p><p><br></p><p>2.  In an exit interview, the findings were reviewed with E1 and no additional information was provided. </p>

<p>Based on observation and interview, the manager failed to ensure that the premises were cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection. The deficient practice posed a risk to the physical health and safety of a resident.</p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. During an environmental inspection of the facility, the Compliance Officer CO observed spoiled and sticky food particles at the bottom of a drawer inside the kitchen refrigerator. A green/gray fuzzy substance was observed on a cucumber, and lemons and limes that were coated in the sticky food particles sitting inside the drawer.</p><p><br></p><p><br></p><p>2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. </p><p><br></p><p><br></p><p>3. This is a repeat deficiency from the inspection conducted on April 20, 2023. </p>

Based on documentation review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery which posed a health and safety risk to residents, for four of six sampled personnel records reviewed.

Findings include:

1. Review of the facility's documents revealed no documented evidence the fall prevention and fall recovery training program had been implemented for all staff.

2. Reviewed of the six sampled caregiver personnel records revealed there was no documentation that E3, E4, E5, and E6 had completed the required training.

3. In an interview, E1 acknowledged the facility did not have documentation that these sampled staff had completed the required fall prevention and fall recovery training, as required.

Based on observation, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, which required employees to have a valid fingerprint clearance care and for owners to make documented, good faith efforts to verify the current status of a person's fingerprint clearance card; for one of six sampled personnel records, which posted a safety risk.

Findings include:

1. Review of the sampled personnel records revealed E3 was hired on January 5, 2023 as an assistant caregiver. E3's record contained a copy of a fingerprint clearance card that was issues January 13, 2018, which was prior to the date of hire. There was no documentation that E3's fingerprint clearance card was verified at the time of hire. E3 was observed working on the day of the compliance inspection.

2. In an interview, E1 acknowledged there was no documentation that E3's fingerprint clearance card was verified. E1 reported that E3 was a "volunteer" assistant caregiver.

3. The compliance officer verified on the DPS website that E3 did have a valid fingerprint clearance card.

Based on observation, documentation review, record review, and interview, the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver, for one of one assistant caregivers observed. The deficient practice posed a risk as the individual was not qualified to provide the required services.

Findings include:

1. The facility is licensed at the directed care level.

2. Review of A.R.S. \'a7 36-401.A.42. revealed "Supervision" means direct overseeing and inspection of the act of accomplishing a function or activity.

3. Review of E3's record revealed no documentation of completing a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers. In addition, E3's record did not include documentation showing an administrator's license, a nursing license, or employment as a caregiver prior to November 1, 1998. Therefore, E3 was not qualified to be left alone with the residents based on the lack of caregiver training.

4. At the time of the compliance inspection, the compliance officer observed E3 arriving to the facility after the inspection had begun. Throughout the inspection E3 was observed pushing R2's wheelchair in the residents' common dining and TV room area and assisting residents with snacks while at the same time there was no caregiver in direct supervision of E3. E2 was in another area of the facility. Later the manager arrived to the facility.

5. Review of E3's personnel record stated that E3 was hired on January 5, 2023 as an assistant caregiver. There was no documentation in E3's record of E3's job duties and new employee/volunteer orientation.

6. In an interview, E1 reported that E3 was a "volunteer" assistant caregiver. E1 acknowledged there was no documentation of E3's job duties and no documentation of E3 receiving new employee/volunteer orientation.

Based on documentation review, record review, and interview, the manager failed to ensure an assistant caregiver's skills and knowledge were verified and documented before providing physical health services and according to policies and procedures which posed a health and safety risk; four of eight caregiver and assistant caregiver personnel records were reviewed.

Findings include

1. At the time of the compliance inspection, the compliance officer observed E3 arriving to the facility after the inspection had begun. Throughout the inspection E3 was observed pushing R2's wheelchair in the residents' common dining and TV room area and assisting residents with snacks while at the same time there was no caregiver in direct supervision of E3. E2 was in another area of the facility. Later the manager arrived to the facility.

2. Review of E3's personnel record stated that E3 was hired on January 5, 2023 as an assistant caregiver. There was no documentation in E3's record that E3's skills and knowledge were verified and documented before providing physical health services.

3. In an interview, E1 reported that E3 was a "volunteer" assistant caregiver. E1 acknowledged there was no documentation that E3's skills and knowledge were verified and documented before providing physical health services.

Based on record review and interview, the manager failed to ensure that within 90 calendar days before or on the day the individual was accepted by an assisted living facility there was completed the required documented determination. The documentation should have included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; this was based on the date of acceptance, for two of three sampled residents' records reviewed which posed a health and safety risk.

Findings include:

1. Review of R4's and R5's medical records revealed no documentation of a pre-admission determination on or prior to their dates of acceptance. Based on the residents' dates of acceptance this documentation was required.

2. During an interview, E1 acknowledged there was no available evidence the pre-admission determination was completed as required for these two residents.

Based on record review and interview, the manager failed to ensure that a resident had a written service plan that included the level of service the resident was expected to receive, which posed a health and safety risk for one of five residents' records reviewed

Findings include:

1. Review of R5's current service plan dated April 14, 2023 stated the resident required "supervisory" care services. This service plan stated the resident required medication administration services.

2. In an interview, E1 reported R5 required "personal" care services. E1 acknowledged the service plan stated the resident required "supervisory" care services and resident required medication administration services.

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 vaccinations for influenza (flu) and pneumonia according to A.R.S. \'a7 36-406(1)(d), which required the facility to make the vaccinations for flu and pneumonia available to the resident on site on a yearly basis; for one of one sampled resident's record 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 date of acceptance in R2's medical record, the compliance officer requested and was not provided documentation to indicate R2 had received the flu and pneumonia vaccines in 2022. There was no other documentation available in R2's medical record to indicate the vaccines were offered, given, refused, or contraindicated in 2022.

2. In an interview, E1 acknowledged there was no documentation available that the flu and pneumonia vaccines had been made available to R2 in 2022.

Based on record review and interview, the manager failed to ensure that for one of the one sampled resident who was unable to ambulate even with assistance, the resident's primary care provider (PCP) or other medical practitioner had examined the resident, at the time of acceptance or within 30 days before acceptance or at onset, and at least once every six months throughout the duration of the resident's condition to determine if the resident's needs could be met. This determination should have been based upon a current resident examination and the assisted living facility's scope of services, which posed a health and safety risk. The facility was licensed to provided directed care services.

Findings include:

1. In an interview, E2 reported R2 was unable to ambulate even with assistance for the past year.

2. Review of R2's medical record contained no documented determination from R2's PCP or medical practitioner at the time of acceptance or onset nor anytime since that stated R2's needs could be met by the facility. This documented determination should have been completed at the time of acceptance or onset and at least every six months throughout the duration of the resident's condition, stating R2's needs were being met by the facility based upon a current resident examination and the facility's scope of services.

3. During an interview, E1 acknowledged the determination for R2 was not completed as required.

Based on record review and interview, the manager failed to ensure a service plan included strategies to ensure a resident's personal safety, for two of two residents' records reviewed who was receiving directed care services. The deficient practice posed a health and safety risk to the resident if the caregivers did not know how to ensure the resident's safety.

Findings include:

1. Review of R2's current service plan dated February 6, 2023 and R4's current service plan dated March 9, 2023 stated the residents each required direct care services. Neither service plan included strategies to ensure the residents' personal safety.

2. In an interview, E1 acknowledged R2's and R4's current service plans did not include strategies for the residents' personal safety.

Based on observation and interview, the manager failed to ensure a medication stored by the facility was stored in a locked room, closet, cabinet, or self-contained unit; which posed a health and safety risk.

Findings include:

1. During a facility tour, E2 and the compliance officer observed in the facility's unlocked kitchen refrigerator door there was stored Rocklatan 2.5 ml eye drops. The order dated March 17, 2023 stated R1 required these drops every day at the hour of sleep.

2. In an interview, E1 and E2 acknowledged the unlocked medication.

Based on observation, documentation reviewed, and interview, the manager failed to ensure an employee disaster drill was conducted on each shift and documented which posed a safety risk.

Findings include:

1. During an interview, E2 reported the facility had two shifts: First shift from 7:00 AM to 7:00 PM, the second shift from 7:00 PM to 7:00 AM. The conspicuously posted work schedule confirmed the facility's work schedule.

2. Based on the documentation provided by E1, the only employee disaster drill on the first shift was conducted in the past 12 months on March 10, 2023. On the second shift employee disaster drills were conducted on June 11, 2022, September 11, 2022, and December 11, 2022.

3. In an interview, E1 acknowledged the facility had two shifts and employee disaster drills were not conducted at least every three months on each 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 which posed a health and safety risk.

Findings include:

1. During a facility tour, E2 and the compliance officer observed in R1's, R2's, R3's, and R4's bedrooms their ceiling fans blades had a buildup of thick grayish product which gave the appearance the ceiling fans blades were not kept clean.

2. In an interview, E2 acknowledged the residents' bedroom ceiling fans were not kept clean.