MOSAIC GARDENS MEMORY CARE AT SURPRISE

<p><span style="font-size: 11pt;">Based on record review, documentation review, and interview, the manager failed to ensure that when a service plan was initially developed, and updated, it was signed and dated by the resident or resident's representative (POA) for two of six residents reviewed. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements.</span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;">Findings include:</span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;">1. A review of R1's medical record revealed a service plan dated April 17, 2025. The service plan was not signed by the resident or resident's representative as required.</span></p><p><br></p><p><br></p><p>2.<span style="background-color: rgb(255, 255, 255); font-size: 14.6667px; color: rgb(68, 68, 68);">A review of R2's medical record revealed a service plan dated March 19, 2025. The service plan was not signed by the resident or resident's representative as required.</span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;"> </span></p><p><span style="font-size: 11pt;">3. In an interview, E1 acknowledged the aforementioned service plans were not signed by the resident or resident's representative as require.</span></p><p><br></p>

<p>Based on record review and interview, the manager failed to ensure a written service plan was developed within three days of acceptance for one of one resident who was receiving respite care services, which posed a health and safety risk if the caregivers did not know the services the resident needed to receive.  </p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p>1. Review of R6's record and interview with E1 revealed R6 was accepted to the facility for respite care. The initial written service plan was not completed within three days of acceptance. Based on R6's date of acceptance this was required.</p><p><br></p><p><br></p><p><br></p><p>2. During an interview, E1 acknowledged R6's service plan was not completed within three days of acceptance. </p>

<p>Based on record review and interview, the manager failed to ensure a caregiver provided current documentation of valid cardiopulmonary resuscitation (CPR) training before providing assisted living services. The deficient practice posed a health and safety risk if the employee did not know how to properly perform CPR.  </p><p><br></p><p><br></p><p>Findings include:  </p><p><br></p><p><br></p><p>1. Review of E3's (hired November 2024) personnel record revealed a CPR card that was obtained from www.NationalCPRFoundation.com, which was an online course. E3's CPR online certificate was issued on June 14, 2024. There was no other current documentation of CPR training available for review that would document that E3 had attended an approved CPR training course that included hands-on demonstration of the employee's ability to perform CPR. </p><p><br></p><p><br></p><p>2. The compliance officer contacted a representative from NationalCPRFoundation who stated "Our courses are online only."</p><p><br></p><p><br></p><p>3. During an interview, E1 acknowledged that E3 did not have current documentation of CPR training that included hands-on demonstration of the employee's ability to perform CPR. </p>

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. Review of facility documents revealed a policy and procedure titled "Fall Prevention and Recovery Policy and Training".

2. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of December 22, 2022. The personnel record did not include documentation showing E3 completed fall prevention and fall recovery training.

3. Review of E4's personnel record revealed E4 worked as a caregiver and had a hire date of December 22, 2022. The personnel record did not include documentation showing E4 completed fall prevention and fall recovery training.

4. During an interview, E1 and E2 acknowledged E3 and E4 had not completed a training program for fall prevention and fall recovery.

Based on documentation review and interview, the manager failed to ensure policies and procedures were established, documented, and implemented to protect the health and safety of a resident covering cardiopulmonary resuscitation (CPR) training, including a demonstration of the individual's ability to perform CPR. The deficient practice posed a risk as there were no policies and procedures to reinforce and clarify the health care institution's standards.

Findings include:

1. A policy and procedure was not available covering employee CPR training.

2. During an interview, E1 and E2 acknowledged a policy and procedure was not available covering CPR training.

Based on documentation review and interview, the manager failed to ensure policies and procedures were established, documented, and implemented to protect the health and safety of a resident covering first aid training. The deficient practice posed a risk as there were no policies and procedures to reinforce and clarify the health care institution's standards.

Findings include:

1. A policy and procedure was not available covering employee first aid training.

2. During an interview, E1 and E2 acknowledged a policy and procedure was not available covering first aid training.

Based on record review, documentation review, and interview, the manager failed to ensure the manager provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training before providing assisted living services, for one of five employees reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency.

Findings include:

1. Review of E1's personnel record revealed E1 worked as the facility manager and had a hire date of November 28, 2023. The personnel record revealed a first aid and CPR card with an expiration date of May 18, 2023. There was no other documentation of first aid and CPR training in E1's record.

2. A policy and procedure was not available covering employee first aid and CPR training.

3. During an interview, E1 acknowledged E1's first aid and CPR training expired.

Based on record review and interview, the manager failed to ensure a written service plan included a summary of the resident's medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments, for three of four residents reviewed. The deficient practice posed a risk if medical or health problems were not addresses by the assisted living facility.

Findings include:

1. Review of R2's medical record revealed a written service plan dated May 4, 2023. However, this service plan did not include documentation of a summary of R2's medical or health problems. Review of R2's medical record revealed a document that listed R2's diagnosis as fronto-temperal dementia and major depressive disorder.

2. Review of R3's medical record revealed a written service plan dated February 4, 2023. However, this service plan did not include documentation of a summary of R3's medical or health problems. Review of R3's medical record revealed a document that listed R3's diagnosis as breast cancer, colon cancer, high cholesterol, hypothyroidism, glaucoma, and altered mental status.

3. Review of R4's medical record revealed a written service plan dated May 27, 2023. However, this service plan did not include documentation of a summary of R4's medical or health problems. Review of R4's medical record revealed a document that listed R4's diagnosis as senile degeneration of the brain, atherosclerotic heart disease, and hypertension.

4. During an interview, E1 and E2 acknowledged R2's, R3's, and R4's service plans did not include a summary of the medical or health problems.

Based on record review and interview, the manager failed to ensure a written service plan include the level of service the resident received for four of four residents reviewed. 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.R.S. \'a7 36-401.38 defines "Directed care services" as programs and services, including supervisory and personal care services, that are provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions.

2. Review of R1's medical record revealed a written service plan dated May 22, 2023. However, this service plan did not include the level of service R1 received.

3. Review of R2's medical record revealed a written service plan dated May 4, 2023. However, this service plan did not include the level of service R2 received.

4. Review of R3's medical record revealed a written service plan dated February 4, 2023. However, this service plan did not include the level of service R3 received.

5. Review of R4's medical record revealed a written service plan dated May 27, 2023. However, this service plan did not include the level of service R4 received.

6. During an interview, E1 and E2 acknowledged R1's, R2's, R3's, and R4's service plan did not include the level of service the residents received and reported R1, R2, R3, and R4 received directed care services.

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 four residents 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 medical record revealed a current written service plan dated February 4, 2023. However, a service plan after February 4, 2023 was not available for review.

2. During an interview, E1 and E2 reported R3 received directed care services and acknowledged the service plan was not updated at least once every three months.

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

Findings include:

1. Review of R1's medical record revealed a current written service plan dated May 22, 2023. This service plan stated the following services were needed:
"Staff will perform safety checks on (R1) throughout the day" However, documentation was not available indicating this service was provided June 1st - present.
"reminders and cueing at mealtimes" However, documentation was not available indicating this service was provided June 1st - 3rd, and 6th - present.
"Staff will need to get (R1) dressed and complete all ADLs AM/PM" However, documentation was not available indicating this service was provided June 1st - 3rd, 6th, 8th - 10th, 15th - 17th, and 20th - 24th.
"Staff to complete all grooming tasks for (R1) twice daily. Staff to ensure oral care is completed twice a day. Staff to apply lotion daily...AM/PM" However, documentation was not available indicating this service was provided June 1st - 3rd, 8th - 10th, 15th - 18th, and 20th - 24th.
"Incontinent of bladder and bowel. Caregiver will monitor upon first waking up, going to bed, before and after meals and inbetween meals." However, documentation was not available indicating this service was provided June 1st - 3rd, 7th - 10th, 15th - 18th, and 20th - 24th.

2. Review of R2's medical record revealed a current written service plan dated May 4, 2023. This service plan stated the following services were needed:
"Bathing: Assist (R2) into the shower...daily/and or PRN" However, documentation was not available indicating this service was provided June 1st - 13th, 15th - 19th, and 21st - present.
"Care staff to dress (R2) daily" However, documentation was not available indicating this service was provided June 1st - 3rd, 8th - 10th, 15th - 17th, 19th, and 22nd - 24th.
"Care staff to complete all grooming tasks daily and as needed" However, documentation was not available indicating this service was provided June 1st - 3rd, and 8th - 10th, 15th - 17th, and 22nd - 24th.
"Bowel incontinent, Bladder incontinent, Caregivers to check (R2's) brief before and after meals and as needed" However, documentation was not available indicating this service was provided June 1st - 3rd, 7th - 10th, 15th - 17th, and 20th - present.

3. Review of R3's medical record revealed a current written service plan dated February 4, 2023. This service plan stated the following services were needed:
"Caregiver to assist with dressing/undressing daily" However, documentation was not available indicating this service was provided June 3rd - 6th, and 10th - 13th.
"Caregiver to assist as needed with all grooming tasks - oral care, brushing teeth and hair, washing face twice daily. Caregivers to offer/apply lotion daily" However, documentation was not available indicating this service was provided June 3rd - 6th, and 10th - 13th.
"Caregivers to assist with incontinence care after incontinence episode. Care staff to frequent checks" However, documentation was not available indicating this service was provided June 1st - present.

4. Review of R4's medical record revealed a current written service plan dated May 27, 2023. This service plan stated the following services were needed:
"Grooming - resident will need cuing and set up" However, documentation was not available indicating this service was provided June 3rd - 7th, and 10th - 13th.
"Bathing - standby, set up, reminders or cueing Daily and/or PRN" However, documentation was not available indicating this service was provided June 1st - present.

5. During an interview, E1 acknowledged R1's, R2's, R3's, and R4's medical records did not include documentation of the above listed services and reported the services were provided as indicated in the service plan.

Based on record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, upon acceptance or the onset of the condition and every six months thereafter, stating the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for two of two residents reviewed who were confined to a bed or chair. The deficient practice posed a risk if the facility was unable to meet a resident's needs.

Findings include:

1. Review of R1's medical record revealed a current written service plan dated May 22, 2023. This service plan stated "2 person transfer".

2. Review of R1's medical record revealed no documentation indicating R1's medical practitioner examined R1 upon acceptance or the onset of the condition and every six months thereafter, signed and dated a determination stating R1's needs could be met by the facility, and reviewed the facility's scope of services.

3. Review of R2's medical record revealed written service plans dated February 4, 2023 and May 4, 2023. These service plans stated "1 person assist". Additionally, R2's medical record revealed a document that stated "Resident unsteady gait, unable to stand and pivot on own".

4. Review of R2's medical record revealed no documentation indicating R2's medical practitioner examined R2 upon acceptance or the onset of the condition and every six months thereafter, signed and dated a determination stating R2's needs could be met by the facility, and reviewed the facility's scope of services.

5. During an interview, E1 and E2 reported E1 and E2 were new to the facility and were unaware of R1's and R2's ambulation status. E6 reported E6 was new to the facility, however reported R1 and R2 were unable to ambulate even with assistance. E1 and E2 acknowledged R1's and R2's medical practitioner did not provide a written determination upon acceptance or the onset of the condition and every six months thereafter.

Based on record review and interview, the manager failed to ensure a service plan included cognitive stimulation and activities to maximize functioning; strategies to ensure a resident's personal safety; encouragement to eat meals and snacks; documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident is contraindicated; and coordination of communications with the resident's representative, family members, and, if applicable, other individuals identified in the resident's service plan, for four of four resident reviewed receiving directed care services. The deficient practice posed a health risk to the resident.

Findings include:

1. Review of R1's medical record revealed a written service plan dated May 22, 2023. However, this service plan did not include offering sufficient fluids to maintain hydration; strategies to ensure a resident's personal safety; documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident is contraindicated; and coordination of communications with the resident's representative and/or family members.

2. Review of R2's medical record revealed a written service plan dated May 4, 2023. However, this service plan did not include documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident is contraindicated; and coordination of communications with the resident's representative and/or family members.

3. Review of R3's medical record revealed a written service plan dated February 4, 2023. However, this service plan did not include documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident is contraindicated; and coordination of communications with the resident's representative and/or family members.

4. Review of R4's medical record revealed a written service plan dated May 27, 2023. However, this service plan did not include skin maintenance to prevent bruises, injuries, pressure sores, and infections; offering sufficient fluids to maintain hydration; incontinence care that ensured a resident maintained the highest practicable level of independence when toileting; documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident is contraindicated; and coordination of communications with the resident's representative and/or family members.

5. During an interview, E1 and E2 reported R1, R2, R3, and R4 received directed care services and acknowledged the service plans did not include the requirements.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of four residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication.

Findings include:

1. Review of R1's medical record revealed a current written service plan dated May 22, 2023. This service plan indicated R1 received medication administration.

2. Review of R1's medical record revealed a signed medication order dated May 25, 2023. This medication order stated "DC Bumetanide Start Furosemide 20mg 2 times a day PO".

3. Review of R1's medical record revealed a June 2023 medication administration record (MAR). This MAR stated "Bumetanide 1 mg 2 tablets (1mg) by mouth every day" and indicated two tabs were administered at 7am June 1st - present.

4. During an observation of R1's medications, Bumetanide 0.5mg was observed and two tabs were observed prefilled in the pharmacy provided multi-dose packaging.

5. During an interview, E6 reported the medication was administered per the MAR and E1 and E2 acknowledged R1's medication was not administered in compliance with the available medication order.