LIVING WATERS ASSISTED LIVING LLC

Based on interview and documentation review, the licensee failed to notify the department within thirty days after any change regarding a controlling person, and the licensee failed to provide the information and affirmation required pursuant to subsection A, paragraph 1, subdivision (d) of A.R.S. \'a7 36-422.

Findings include:

A.R.S. \'a7 36-422(H) An applicant or licensee must notify the department within thirty days after any change regarding a controlling person and provide the information and affirmation required pursuant to subsection A, paragraph 1, subdivision (d) of this section.

1. In an interview, O1 reported O1 and O2 owned AL11982.

2. A review of the Arizona Corporation Commission website revealed O1 was a member of Living Waters Assisted Living LLC and O2 was the statutory agent. O1 was appointed a member on April 1, 2023. O2 was appointed statutory agent on April 1, 2023. A review of the "Articles of Amendment" dated April 1, 2023, revealed O3 was removed from the LLC and O1 and O2 were added to the LLC.

3. A review of Department documentation revealed the previous owners, or O1 and O2 failed to notify the Department of the April 1, 2023 changes to the LLC.

4. In an interview, O1 reported being unaware of the requirements.

Based on documentation review, observation, and interview, the governing authority failed to notify the Department according to Arizona Revised Statutes (A.R.S.) \'a7 36-425(I) when there was a change in the manager and identify the name and qualifications of the new manager.

Findings include:

1. A review of Department documentation revealed O3 was the manager for AL11982 as of April 2023.

2. The Compliance Officer observed E1's manager's license posted on the premises of AL11982.

3. In an interview, O1 reported E1 became the new manager in May 2023.

4. A review of Department documentation revealed evidence to indicate the governing authority notified the Department when there was a change from O3 to E1, and provided E1's qualifications, was not available.

5. In an interview, O1 acknowledged the facility did not notify the Department of a change in the facility's manager.

Based on documentation review and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk if there was no record to ensure shifts and tasks were covered.

Findings include:

1. The Compliance Officer requested to review current documentation of the caregivers and assistant caregivers working each day, including the hours worked by each.

2. In an interview, E2 reported E1 had taken the staffing schedule for September 2023 and the documentation was not available for review.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of four residents sampled. The deficient practice posed a TB exposure risk to residents.

Findings include:

1. A review of R2's (admitted in 2023) medical record revealed a chest x-ray dated in May 2023. The chest x-ray stated "Reason for Exam: Edema." Additionally, a hand-written note on the document stated "No TB" signed by a medical practitioner. However, evidence R2 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC) was not available for review; and the chest x-ray was not an infectious TB screening test.

2. A review of R3's (admitted in 2023) medical record revealed evidence of freedom from infectious TB was not available for review.

3. In an interview, O1 and E2 acknowledged R2 and R3 did not provide current documentation of freedom from infectious TB in compliance with R9-10-113.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount and frequency of assisted living services being provided to the resident, for one of four residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident.

Findings include:

1. A review of R2's medical record revealed a service plan for directed care services (dated in July 2023). The service plan stated "Bathing... Sponge bath... Peri care... Hygiene/Grooming... Elimination... Incontinent... bowel... bladder... uses disposable undergarments..." However, the service plan did not include the amount and frequency of the assisted living services being provided to R2.

2. A review of R2's medical record revealed an activities of daily living (ADL) sheet for September 2023. The ADL sheet stated "Oral Care... AM...Eve... Shaving (PRN)... Dressing... AM... Eve... Nail Care (PRN)... Full bath/Bed bath on Monday and Thursday..." The aforementioned services were documented as provided on September 1, 2023 - September 12, 2023.

3. In an interview, O1 and E2 acknowledged the amount and frequency of assisted living services being provided to R2 was not included on R2's service plan.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for three of four residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan.

Findings include:

1. A review of R1's medical record revealed a current written service plan for personal care services dated in June 2023. The service plan revealed R1 was incontinent of bowel and bladder. Additionally, the service plan stated, "Summary of level of assistance needed... toileting...moderate..." However, documentation was not available to indicating the service was provided September 1 - 12, 2023.

2. In an interview, E2 reported R1 used disposable undergarments. E2 reported caregivers occasionally assist R1 with the undergarments.

3. A review of R2's medical record revealed a current written service plan for directed care services dated in July 2023. The service plan revealed R2 was incontinent of bowel and bladder and used disposable undergarments. Additionally, the service plan stated, "Summary of level of assistance needed... toileting... maximum..." However, documentation was not available indicating the service was provided September 1 - 12, 2023.

4. In an interview, E2 reported R2 is bed-ridden. E2 reported caregivers assisted R2 with incontinence needs.

5. A review of R3's medical record revealed a current written service plan for personal care services dated in August 2023. The service plan revealed R3 was incontinent of bowel and bladder. Additionally, the service plan stated, "Summary of level of assistance needed... toileting...maximum..." However, documentation was not available indicating the service was provided September 1 - 12, 2023.

6. In an interview, O1 and E2 acknowledged R1's, R2's, and R3's medical records did not include documentation of the above listed services and reported the services were provided as indicated in the service plan.

This is a repeat deficiency from the compliance inspection conducted on September 15, 2022.

Based on record review, observation, and interview, the manager failed to ensure a resident's medical record contained a medication order from a medical practitioner for each medication administered to the resident, for one of four residents sampled who received medication administration.

Findings include:

1. A review of R1's medical record revealed a signed medication order for Oxybutynin Chloride tab 5 mg, one tab, twice a day at 8:00 AM and 8:00 PM.

2. A review of R1's medical record revealed a medication administration record (MAR) for September 2023. The MAR stated, "Oxybutynin 5 mg tablet, take on tablet by mouth once a day." The MAR revealed the aforementioned medication was administered from September 1 - 12, 2023 at 8:00 AM.

3. The Compliance Officer observed Oxybutynin 5 mg tablet prefilled in the "AM" slot of R1's medication organizer.

4. In an interview, O1 and E2 reported the medication order had recently changed. However, O1 and E2 acknowledged R1's medical record did not contain a medication order from a medical practitioner for Oxybutynin Chloride tab 5 mg, once a day.

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 one of four residents sampled who received medication administration.

Findings include:

1. A review of R1's medical record revealed a signed medication order for Oxybutynin Chloride tab 5 mg, one tab, twice a day at 8:00 AM and 8:00 PM.

2. A review of R1's medical record revealed a medication administration record (MAR) for September 2023. The MAR stated, "Oxybutynin 5 mg tablet, take on tablet by mouth once a day." The MAR revealed the aforementioned medication was administered from September 1 - 12, 2023 at 8:00 AM.

3. The Compliance Officer observed Oxybutynin 5 mg tablet prefilled in the "AM" slot of R1's medication organizer.

4. In an interview, O1 and E2 reported the medication order had recently changed. O1 and E2 acknowledged R1's medication was not administered in compliance with a medication order, and were unable to provide the new medication order for review.

Based on record review and interview, the manager failed to ensure when a resident had an emergency resulting in the resident needing medical services, a caregiver documented the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of one residents reviewed who had an emergency resulting in the resident needing medical services.

Findings include:

1. A review of R1's medical record revealed an incident report dated April 8, 2023. The report stated, "[R1] was in bed and attempted to get up in the middle of the night [sic] slid off [R1's] bed and onto the floor. Injury Sustained: At time of fall, no injury. Edit: 24 hours pain started. Action Taken: Helped [R1] into bed after assessing fall. Stated [R1] was okay. Monitor for 24-72 hours. 24-48 hours after fall, experiencing pain. Called primary." However, the document did not include any action taken to prevent the accident, emergency, or injury from occurring in the future.

2. In an interview, R1 reported to recall injuring R1's hip in 2023 at the facility.

3. In an interview, E2 reported R1 had pain in R1's hip shortly after the incident. E2 reported management called R1's primary doctor to send a mobile x-ray. E2 reported shortly after, R1's family arrived at the facility. R1 reported to the family an issue with R1's heart. An ambulance was called to transport R1 to the hospital.

4. A review of R1's medical record revealed documentation of the aforementioned incident was not available to include the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of one residents reviewed who had an emergency resulting in the resident needing medical services.

5. In an interview, E2 reported the x-ray revealed R1 had a hairline fracture and it would heal on its own.

6. In an interview, O1 and E2 acknowledged R1's medical record did not include documentation of the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent both incidents from occurring in the future.