CLEARWATER AGRITOPIA

<p><span style="color: black; font-size: 12px;">Based on documentation review, record review, and interview, the assisted living center failed to maintain a copy of documentation provided to an emergency responder. The deficient practice posed a risk if the Department was unable to verify the required documentation was provided during a resident emergency.</span></p><p><span style="font-size: 12px;"> </span></p><p><span style="color: black; font-size: 12px;">Findings include:</span></p><p><span style="font-size: 12px;"> </span></p><p><span style="color: black; font-size: 12px;">1. </span><span style="color: rgb(68, 68, 68);">A.R.S. § 36-420.04.D.</span><span style="color: black; font-size: 12px;"> requires: Emergency responders; patient information; hospitals; discharge planning; patient screenings; discharge document A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. 7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. 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. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. 9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives.</span></p><p><br></p><p><span style="font-size: 12px;">2. In documentation review, the Department received a report which documented the facility contacted emergency medical services (EMS) on May 4, 2025 for R2. The Department received a second report which documented the facility contacted EMS on </span><span style="font-size: 12px; background-color: rgb(255, 255, 255);">January 29, 2025 for R3. During the incidents, R2 and R3 were transported to the hospital for medical services.</span></p><p><br></p><p><span style="font-size: 12px; background-color: rgb(255, 255, 255);">3. </span><span style="font-size: 12px; color: black;">In documentation review and record review, the facility did not have documentation to show the facility provided the emergency responder with a written document that included all of the required documentation for R2 and R3.</span></p><p><br></p><p><span style="color: black; font-size: 12px;">4. During an interview, E2 reported each resident had the standardized form in their record to be provided to an emergency responder, as required. E2 acknowledged the medical records for R2 and R3 did not include evidence a written document, which included the requirements in A.R.S. 36-420.04, was provided to EMS upon the residents' transfer to the hospital. </span></p><p><br></p><p><span style="font-size: 12px;">5. In an exit interview, the findings were reviewed with E2 and no additional information was provided.</span></p>

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 vaccination for influenza (flu) according to A.R.S. \'a7 36-406(1)(d), which required the facility to make the vaccination available to the resident on site on a yearly basis; for two of seven sampled residents records 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 dates of acceptance and review of R2's and R4's medical records, the compliance officer requested and was not provided documentation to indicate R2 and R4 had received the flu vaccine. There was no other documentation available in R2's and R4's medical records to indicate the vaccine was offered, given, refused, or contraindicated within the past 12 months.

2. In an interview, E1 and E2 acknowledged there was no documentation available that the flu vaccine had been made available to R2 and R4 during the past 12 months.

Based on observation, record review, and interview, the manager failed to ensure that a service plan for a resident who is receiving personal care services included the treatment of bruises, injuries, pressure sores, and infections, which posed a health and safety risk; for two of two sampled residents.

Findings include:

1. Review of R2's current service plan dated February 15, 2024 did not document the lateral leg wounds and the treatment of these wounds that were being treated by an outside service.

2. Review of R3's current service plan dated January 25, 2024 did not document the lateral heel wounds and the treatment of these wounds that were being treated by an outside service.

3. In an interview, E1 and E2 acknowledged the residents' wounds. However, these sampled residents' service plans did not document the wounds and the treatment of these wounds.

Based on record review and interview, the manager failed to ensure that for one two sampled resident who were unable to ambulate even with assistance, the resident's primary care provider (PCP) or other medical practitioner signed a determination stating that the resident's needs were being met. This determination was to be completed at least once every six months throughout the duration of the resident's condition to determine if the resident's needs could be met which was based upon a current resident examination and the assisted living facility's scope of services which posed a health and safety risk. The facility is licensed to provided directed care services.

Findings include:

1. In an interview, E2 reported that R6 has been unable to ambulate even with assistance for at least the past twelve months.

2. Review of R6's medical record found a documented determination completed that was dated November 22, 2023. However, there was no documented determination completed by R3's medical practitioner prior to November 2023. The determination should have been based on a current examination of the resident, the facility's scope of services, and a statement that the resident's needs could be met by the facility.

3. In an interview, E2 acknowledged there was no documentation of the required determinations available for review prior to November 2023 which could pose a health risk to the resident.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below which posed a health and safety risk.

Findings include:

1. During a facility tour, E1 and the compliance officer observed the facility's kitchen reach-in refrigerator, that contained food, had a thermometer that registered 48\'b0 F at the warmest area of the refrigerator. The refrigerator was not in use during the observation.

2. During an interview, E1 acknowledged the facility's refrigerator was not maintained at 41\'b0 F or below.

Based on observation and interview, the manager failed to ensure that frozen foods were stored at a temperature of 0\'b0 F or below.

1. During a facility tour, E1 and the compliance officer observed in the facility's kitchen walk-in freezer, that contained food, the temperature on the facility's thermometer registered +10 degrees F. The freezer was not in use at the time of the observation.

2. During an interview, E1 acknowledged the facility's kitchen walk-in freezer temperature was not maintained at 0\'b0 F or below.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted at least once every three months on each shift and documented which posed a safety risk.

Findings include:

1. During an interview, E1 and E2 reported the facility had three shifts: First shift from 6:00 AM to 2:00 PM, the second shift from 2:00 PM to 10:00 PM, and the third shift from 10:00 PM to 6:00 AM.

2. Review of the first shift employee disaster drills documentation for the past 12 months revealed drills were conducted on: May 28, 2023, July 26, 2023, and November 1, 2023.

3. In an interview, E1 acknowledged the facility's employee disaster drills were not conducted at least once every three months on the first 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.

Findings include:

1. During a tour of randomly selected residents' units, E1 and the compliance officer observed in R1's unit there were numerous dog potty pads laying on the floor throughout the unit. A number of them appeared to have pet urine and feces on the pads. It was difficult to know where to walk. The few areas of the floor that were not covered with dog potty pads one could see urine like stains on the carpet. The unit had a strong urine and unclean odor. E1 and the compliance officer observed a small dog in the unit with the resident.

2. In an interview, E1 acknowledged that R1's unit did not did not appear clean which could pose a health risk to the resident.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials that were stored by the facility were in a locked area and inaccessible to residents.

Findings include:

1. During a facility tour of the memory care unit, E1 and the compliance officer observed an unlocked storage room in the common hall where residents could walk that contained paint cans, unlabeled spray bottles with a clear solution in them, Resolve Stain Remover, and insect spray. The unlocked storage room in memory care unit near the entrance of the unit there was stored cans of paint.

2 . In the Signature Unit there was an unlocked storage room near the kitchenette that contained sanitizer spray.

3. In an interview, E1 acknowledged the unlocked poisonous or toxic materials being stored by the facility.

Based on observation and interview, the manager failed to ensure that combustible or flammable liquids and hazardous materials stored by the assisted living facility were stored in a locked area inaccessible to residents.

Findings include:

1. During a tour of the facility, E1 and the compliance officer observed a storage room attached to the facility next to the facility's kitchen and the residents' dinning area where six propane tanks were stored.

2. In an interview, E1 acknowledged the hazard of having propane tanks stored in the facility.

Based on record review and interview the manager failed to ensure two sampled dog residing at the facility were licensed consistent with the local ordinances.

Finding include:

1. The compliance officer requested and was not provided with any licensing documentation for the two sample dogs residing at the facility. There was no documentation that O1 and O3 were licensed with the Maricopa County Animal Care and Control, as required.

3. In an interview, E1 acknowledged there was no record that O1's and O3 had been licensed as required.