BROOKDALE ARROWHEAD RANCH

<p>Based on record review, <span style="background-color: rgb(255, 255, 255); color: rgb(68, 68, 68);">documentation review, </span>and interview, the manager failed to ensure that a personnel record for a caregiver included current documentation of first aid (FA) and cardiopulmonary resuscitation (CPR) training for one of six caregivers reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency.</p><p> </p><p><br></p><p>Findings include:</p><p> </p><p><br></p><p>1. A review of E6's personnel record revealed a FA and CPR certification with an expiration date of June 6, 2024.</p><p><br></p><p><br></p><p>2. A documentation review of the employee schedule dated June 27- August 2, 2025, revealed E6 worked the following dates: July 27, July 28, July 29, July 30, July 31, 2025.</p><p> </p><p><br></p><p>3. In an interview, E1 checked and verified that the employee did not have a current CPR/FA certification.</p><p> </p><p><br></p><p>4. In an exit interview, the findings were reviewed with E1, and no additional information was provided. </p><p> </p>

<p><span style="font-size: 14px; color: rgb(0, 0, 0);">Based on record review, documentation review, and interview, the manager of an assisted living center who contacted an emergency responder on behalf of a resident failed to provide a written document with all required information to the emergency responder for three of three residents sampled. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident.</span></p><p><br></p><p><br></p><p><br></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);">Findings include:</span></p><p><br></p><p><br></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);">1. A review of R1's, R2's, and R3's medical records revealed a fall-related incident that occurred and required the residents to receive medical services. R1’s incident was noted on January 16, 2025; R2’s on May 3, 2025; and R3’s on May 7, 2025.</span></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);"> </span></p><p><br></p><p><br></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);">2. A review of facility documentation revealed a standardized form for R1, R2, and R3. However, the standardized form provided to the emergency responder did not include the reason or reasons the emergency responder was requested on behalf of R1, R2, and R3.</span></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);"> </span></p><p><br></p><p><br></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);">3. In an interview, E1 acknowledged that the written documents provided to emergency responders for the incidents involving R1 on January 16, 2025, R2 on May 3, 2025, and R3 on May 7, 2025, did not include the reason or reasons the emergency responders were requested on behalf of each resident.</span></p><p><br></p><p><br></p><p><br></p><p><span style="font-size: 14px; color: rgb(0, 0, 0);">Technical assistance was provided on this statute during the complaint inspection conducted on November 12, 2024. </span></p>

<p><span style="font-size: 14px;">Based on record review and interview, the manager failed to ensure that when a resident had an incident that resulted in the resident needing medical services, a caregiver documented any action taken to prevent the incident from occurring in the future, for three of three residents sampled who had fall-related injuries that resulted in the residents needing medical services. The deficient practice posed a health and safety risk.</span></p><p><br></p><p><br></p><p><span style="font-size: 14px;">Findings include:</span></p><p><br></p><p><br></p><p><span style="font-size: 14px;">1. A review of R1's medical record revealed a progress note dated January 16, 2025. This progress note stated, "Resident fall occurred on 01/16/2025 7:00 PM. resident's room, next to the bed Fall was near the bed… resident was not able to answer due to the language barrier. There were physical signs of head injury. bruise to the L eye called ED. POA, provider, 911…” However, the documentation did not include any action taken to prevent the incident from occurring in the future.</span></p><p><br></p><p><br></p><p><br></p><p><span style="font-size: 14px;">2. A review of R2's medical record revealed a progress note dated May 03, 2025. This progress note stated, "staff found resident on the floor next to room 63. Resident has a bug lump on the left side of the forehead. Resident fall occurred on 05/03/2025 1:00 AM. Hallway next to room 63 Fall was near no furniture. No one witnessed the resident fall. There were physical signs of head injury. Abrasion to left side of forehead 911 called… There were signs of bruising as result of the fall. Left side of forehead…” However, the documentation did not include any action taken to prevent the incident from occurring in the future.</span></p><p><br></p><p><br></p><p><br></p><p><span style="font-size: 14px;">3. A review of R3's medical record revealed a progress note dated May 07, 2025. This progress note stated, “Resident was using [R3] walker and started to bend [R3] knees and started to fall. [R3] hit [R3] butt first then smacked the back of [R3] head on the floor. The resident laid there and did not move nor respond to the staff. [R3] stared to get clammy and BP was low. Resident hit [R3] head pretty hard and we weren't able to fill for any lumps. POA notified. HWD and RCC notified. PCP notified. resident sent out to thunderbird hospital at 1:37 on 5/7/25.” However, the documentation did not include any action taken to prevent the incident from occurring in the future.</span></p><p><br></p><p><br></p><p><br></p><p><span style="font-size: 14px;">4. In an interview, E1 reported R1, R2, and R3 were sent out to the hospital for fall-related injuries and acknowledged R1, R2, and R3's medical records did not include documentation of any action taken to prevent the incidents from occurring in the future.</span></p><p><br></p>

<p>Based on documentation review, record review, observation, and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as resident rights were violated.</p><p><br></p><p> </p><p>Findings include:</p><p><br></p><p> </p><p>1. A review of facility documentation revealed a document titled "Incident Investigation." This document stated, “On 4/23/25 around 7:00 PM, ... As [Care Partner] was entering the apartment, [Care Partner] saw [R1] lying on [R1's] back on [R2’s] bed and [R2] between [R1’s] legs, appearing to be having sexual intercourse. Unsure of what [Care Partner] was seeing, [Care Partner] turned on the light and surprised [R2], as [R2] turned away to hide [R2’s genitals]. Right away, [Care Partner] attempted to remove [R1] from [R2’s] bed ... Based on eyewitness reports, the interaction seemed to be consensual. Neither resident appeared to be in any distress or pain. [Care Partner], while still on the bed, assessed [R1]. No signs of redness to the [genital] area, bruising on [R1’s] legs, or emotional distress.”</p><p><br></p><p><br></p><p>2. A review of R1’s service plan revealed that R1 received directed care services. The service plan stated that R1 was "Incapable of recognizing danger, summoning assistance, expressing needs or making basic care decisions" and R1 "wanders around the community and into other residents’ room and will lay in their bed. [R1] is redirected out of the room to common areas or to [R1’s] room."</p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255); color: rgb(68, 68, 68);">3. A review of R2’s service plan revealed that R2 received directed care services. The service plan stated that R2 was "Incapable of recognizing danger, summoning assistance, expressing needs or making basic care decisions".</span></p><p><br></p><p><br></p><p>4. In an interview, E1 acknowledged that the incident involving R1 and R2 occurred and reported that R1 and R2 should be allowed to participate in sexual activity.</p><p><br></p><p><br></p><p>This is a repeat deficiency from the complaint inspection conducted on November 12, 2024.</p>

Based on record review and interview, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of eight residents reviewed, which posed a high potential health and safety risk to residents and staff of TB exposure.

Findings include:

1. Review of R5 ' s and R6 ' s medical records revealed a negative TB skin test. However there was no additional documentation of freedom from infectious TB available for review. Based on R5 ' s and R6 ' s acceptance date, this documentation was required.

2. In an interview, E1 acknowledged R5 and R6 did not provide current documentation of freedom from infectious TB before acceptance.

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

Findings include:

1. Review of R1's, R2's, R3's, R4's, R5's, R6's, R7's, and R8's medical records revealed current service plans. However there was no mention of the frequency of the night checks being done for the residents.

2. Review of R8 ' s medical records revealed a current service plan dated December 21, 2024. Which stated, "[R8] is confined to a bed or a chair because of an inability to ambulate even with assistance," A further look at R8 ' s service plan showed no documentation of repositioning the resident.

3. A review of R8 ' s electronic medical records revealed in the tasks menu of the services being provided there is an instruction section that states "Reposition and peri care at time of toileting."

4. In an interview, E1 reported the facility did reposition R8 every two hours at night and every three hours during the day. E1 also acknowledged R1 ' s, R2 ' s, R3 ' s, R4 ' s, R5's, R6's, R7 ' s and R8 ' s written service plan did not include the frequency of assisted living services being provided to the residents.

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

Findings include:

1. A review of the facility's policies and procedures revealed a policy titled "Night Check Policy," the policy stated "Policy Overview - Resident care staff should make night checks of the residents. A resident or his/her legally responsible party may choose not to have the associates perform night checks. The choice not to receive night checks should be documented in a Negotiated Risk Agreement, where permitted by state regulation, and on the resident's Service Plan. Policy Detail - 1. Associates should perform night checks approximately every four (4) to six (6) hours or as determined by the residents' need."

2. A review of R1's medical record revealed a current written service plan for personal care services dated May 12, 2024. The service plan did not have a documented Negotiated Risk Agreement on the resident's service plan as specified in the policy.

3. A review of R1's medical record revealed an activities of daily living (ADL) sheet for October and November 2024. The ADL sheet for October and November 2024 revealed no documentation that the night checks were provided as required in the policy for the following dates and shifts:
- October 2nd - 8th;
- October 18th and 19th;
- October 31st;
- November 1st and 2nd;
- November 5th;
- November 8th and 9th;
- November 11th and 12th; and
- November 14th and 15th.

4. In an interview, E2 reported that R1's service plan did not indicate that the family opted out of receiving night checks.

5. In an interview, E1 and E2 acknowledged R1's medical record did not include documentation of the night checks per the policy.

This is an uncorrected deficiency from the complaint inspection conducted on November 12, 2024.

Based on observation, record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of five residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan and the Department was provided false or misleading documentation.

Findings include:

1. The Compliance Officer arrived at the facility around 9:00 AM.

2. During the environmental tour, the Compliance Officer observed R5 in R5's room. The room was not cleaned and a severe cockroach infestation was observed in the room. Live and deceased cockroaches were observed in multiple locations, including on the resident's bed surface, between the mattress and fitted sheet, along the floor surfaces, and on the walls.

3. In an interview, E1 reported E1 was not aware of the severe cockroach infestation in R5's room (Room 5).

4. In an interview, the Compliance Officer questioned E1, E2 and E4 if the resident's room had been cleaned by the morning caregiver, if so, why was it not reported to the manager that the room had a severe cockroach infestation.

5. In an interview, R5 reported that no one had cleaned R5's room today (November 12th). In addition, R5 reported that R5 had noticed the cockroaches for the past two weeks and had mentioned it to E6 and the front desk.

6. In an interview, E1 and E2 reported that R5 was a late sleeper and no one had cleaned the room yet that day (November 12th). In addition, E1 and E2 reported that usually once the residents were awake, morning caregivers would go into the residents room to perform basic cleaning tasks and make the bed.

7. A review of R5's medical record revealed an activities of daily living (ADL) sheet for November 12, 2024 that indicated all of R5's services were provided on the Day shift that day by E3.

8. In an interview, E3 reported that R5's room was not cleaned and E3 did not initial the ADL sheet. E3 reported to be unaware who would have signed the ADL sheet using E3's initials on November 12, 2024.

9. A review of R5's medical record revealed a service plan for personal care services dated August 2024. The service plan stated the following services were needed:
- Provide set-up of shower supplies and ensure safety devices are in place - Twice weekly.
- Laundry assistance - Weekly on Tuesday.
- Housekeeping assistance - Weekly on Monday between 1 PM and 2 PM.
- Bathroom Assistance: To change protective undergarments as needed - Daily.
- Physical assistance: With changing protective undergarments
- Monitoring for skin irritation and breakdown - As needed.
- Incontinence care: Maintain inventory of supplies and ensure availability of pull-ups - Ongoing.
- Escort assistance: To and from the dining room and community activities - As needed.
- Skin Care: Encourage fluids to maintain hydration and skin health - Daily and Monitor skin integrity for risks like shearing or bruising - During showers and quarterly.

10. A review of R5's ADL sheet for October and November 2024 revealed no documentation that the services were provided for the following dates and shifts;
- October 1st Days, Evenings, and Nights.
- October 2nd Days and Nights
- October 3rd, 4th, and 5th Evening and Nights
- October 6th Days
- October 10th and 12th Nights
- October 13th and 14th Evenings
- October 15th Days
- October 17th Nights
- October 18th Days and Nights
- October 19th Nights
- October 24th Evenings
- October 26th Nights
- October 27th Days
- October 28th Evenings
- October 29th, 30th, and 31th Nights
- November 1st Days and Nights
- November 2nd Nights
- November 3rd Days and Evening
- November 5th and 6th Nights
- November 7th and 8th Evening and Nights
- November 9th Nights
- November 10th Days
- November 11th Evening and Nights

11. In an interview, E1 and E2 acknowledged the ADL sheet on November 12, 2024 documented the services were provided to R5 on the Day shift by E3, however, the services were not provided and the Department was provided false or misleading documentation. In addition, E1 and E2 acknowledged R5's medical record did not include documentation of the services indicated in the service plan for the above listed dates, however, reported the services were provided as indicated in the service plan.

Based on observation and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as a resident's rights were violated.

Findings include:

1. The Compliance Officer arrived at the facility around 9:00 AM.

2. During the environmental tour, the Compliance Officer observed R5 in R5's room. The room was not cleaned and a severe cockroach infestation was observed in the room. Live and deceased cockroaches were observed in multiple locations, including on the resident's bed surface, between the mattress and fitted sheet, along the floor surfaces, and on the walls.

3. In an interview, R5 reported that R5 had noticed the cockroaches for the past two weeks in the room (Room 5) and had mentioned it to E6 and the front desk.

4. In an interview, E1 and E2 acknowledged that R5 was not treated with dignity, respect, and consideration.

Based on observation, interview and documentation review, the manager failed to ensure a pest control program was implemented and effective. The deficient practice posed a potential risk to infection control by exposing residents to unsanitary conditions.

Findings include:

1. During the environmental tour, the Compliance Officer observed R5 in R5's room. The room was not cleaned and a severe cockroach infestation was observed in the room. Live and deceased cockroaches were observed in multiple locations, including on the resident's bed surface, between the mattress and fitted sheet, along the floor surfaces, and on the walls.

2. In an interview, R5 reported that R5 had noticed the cockroaches for the past two weeks in the room (Room 5) and had mentioned it to E6 and the front desk.

3. In an interview, E1 and E6 reported that the facility maintained a 'Pest Control Log' for documenting pest activity. This log was monitored by the contracted pest control service provider, who conducts scheduled weekly treatments and responds to additional service requests as needed.

4. A review of facility documentation revealed a "Eco Lab Log," the log reported the following;
11/08 - Bugs - Room 5
11/10 - Roaches - Room 23
11/10 - Roaches - Front desk
11/11 - Roaches - Room 5
11/11 - Roaches - Room 4

5. In an interview, E1 stated E1 was unaware of the cockroach infestation in R5's room (Room 5). E1 acknowledged pest control services has not been out to the facility for treatment and the program had not been effective since there was a severe cockroach infestation.

6. Technical assistance was provided on this Rule during the complaint inspection conducted on October 18, 2024.