CAMELLIA ASSISTED LIVING HOME LLC

Assisted Living Home | Assisted Living

Facility Information

Address 8340 North 86th Lane, Peoria, AZ 85345
Phone 6023094292
License AL13100H (Active)
License Owner CAMELLIA ASSISTED LIVING HOME LLC
Administrator SHERYL LARA CRUZ
Capacity 10
License Effective 7/26/2025 - 7/25/2026
Services:
3
Total Inspections
2
Total Deficiencies
0
Complaint Inspections

Inspection History

INSP-0160947

Complete
Date: 10/2/2025
Type: Compliance (Annual)
Worksheet: Assisted Living Home
SOD Sent: 2025-10-22

Summary:

The following deficiencies were found during the on-site compliance inspection conducted on October 2, 2025:

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:
R9-10-817.B.3.c. Medication Services<br> B. If an assisted living facility provides medication administration, a manager shall ensure that: <br>3. A medication administered to a resident: <br>c. Is documented in the resident’s medical record.
Evidence/Findings:
<p>Based on record review and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of two residents sampled.</p><p><br></p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p><br></p><p>1 . A review of R1's medical record revealed signed medication orders for the following medications:</p><p>-Metoprolol Tartrate 50 MG, 1 tablet 2 times daily;</p><p>-Potassium Chloride ER 10 MEQ once a day; and</p><p>-Trazadone 50 MG once daily.</p><p>However, the following medications were not documented as administered on the following days:</p><p>-Metoprolol Tartrate (8 AM) from September 27, 2025 to September 30, 2025; (8 PM) from September 26, 2025 to September 30, 2025;</p><p>-Potassium Chloride from <span style="background-color: rgb(255, 255, 255);">September 27, 2025 to September 30, 2025; and</span></p><p>-Trazodone from September 26, 2025 to September 30, 2025.</p><p><br></p><p><br></p><p><br></p><p>2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.</p>
Temporary Solution:
Sheryl Lara Cruz, the Administrator, acknowledged the failure of the facility to ensure documentation as stated in R9-10-817.B.3.c. Medication Services.
Permanent Solution:
The administrator is aware of the policies and procedures on Medication Services regarding medication administration to a resident should be documented in the resident’s medical record. Immediately, after the survey the Administrator gathered all the staff and provided the Medication and Administration In-Service Training to reiterate the importance of documenting medication administration. Staff are acknowledged and have a better understanding.
Person Responsible:
Sheryl Lara Cruz, Administrator

Deficiency #2

Rule/Regulation Violated:
R9-10-820.A.14.a-c. Environmental Standards<br> A. A manager shall ensure that: <br>14. If pets or animals are allowed in the assisted living facility, pets or animals are: <br>a. Controlled to prevent endangering the residents and to maintain sanitation; <br>b. Licensed consistent with local ordinances; and <br>c. For a dog or cat, vaccinated against rabies;
Evidence/Findings:
<p>Based on documentation review and interview, the manager failed to ensure pets at the facility were licensed consistent with local ordinances. </p><p><br></p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p><br></p><p>1 . A review of facility documentation revealed documentation of rabies vaccinations for O1 and O2. However, documentation of licensing from Maricopa county was not available for review at the time of inspection. </p><p><br></p><p><br></p><p><br></p><p>2 . In an exit interview, the findings were discussed with E1 and no additional information was provided. </p>
Temporary Solution:
Sheryl Lara Cruz, the Administrator, acknowledged the failure of the facility to ensure documentation as stated in R9-10-820.A.14.a-c. Environmental Standards.
Permanent Solution:
The administrator is aware of the policies and procedures on Environmental Standard ensuring pets at the facility were licensed consistent with local ordinances, vaccinated and controlled to prevent endangering the residents and to maintain sanitation. Immediately, during the survey the Administrator created and registered both pets to the Maricopa County Pets licensing and filed the document receipt at the facility. will continue to monitor and ensure that licensed will be renewed annually.
Person Responsible:
Sheryl Lara Cruz, Administrator

INSP-0065789

Complete
Date: 9/20/2024
Type: Other
Worksheet: Assisted Living Home
SOD Sent: 2024-09-23

Summary:

No deficiencies were found during the on-site abbreviated initial follow-up inspection conducted on September 20, 2024.

✓ No deficiencies cited during this inspection.

INSP-0065788

Complete
Date: 7/22/2024 - 7/24/2024
Type: Compliance (Initial)
Worksheet: Assisted Living Home
SOD Sent: 2024-07-26

Summary:

No deficiencies were found during the on-site initial inspection conducted on July 22, 2024, and the off-site documentation review completed on July 24, 2024.

✓ No deficiencies cited during this inspection.