AMIRA CARE, LLC

INSP-0147269

Complete

Date: 8/5/2025

Type: Complaint;Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2025-08-21

Summary:

The following deficiencies were found during the on-site compliance inspection and investigation of complaint 00138507 and 00104282 conducted on August 5, 2025:

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

R9-10-110.E. Modification of a Health Care Institution E. A licensee shall not implement a modification described in subsection (C) until an approval or amended license is issued by the Department.

Evidence/Findings:

Based on documentation review, observation, and interview, the licensee implemented a modification of the facility, without an approval or amended license issued by the Department. The deficient practice posed a risk as the Department was unable to assess and approve the modification, as the facility did not submit an updated floor plan. Findings include: 1. Review of Department documentation revealed a floor plan for AL13204. The document indicated AL13204 had eight bedrooms and the primary bedroom was one bedroom. Department documentation revealed no documentation the licensee submitted a request for approval for a modification to the physical plant, including the addition of one bedroom. 2. The Compliance Officers observed the primary bedroom was modified by splitting it into two separate bedrooms. 3. In an interview, E1 reported E1 did not notify the department of the modification of the primary bedroom. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Temporary Solution:

An architect was contacted to start the process of approval of the new plan.

Permanent Solution:

New plans are drawn and an application to the City of Goodyear is in process. The manager will submit the approved plans to Health Department as soon as they are approved.

Person Responsible:

Daniel Valean, Manager

Deficiency #2

Rule/Regulation Violated:

R9-10-113.A.1-2. Tuberculosis Screening A. If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that: 1. Are consistent with recommendations in Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019, published by the U.S. Department of Health and Human Services, Atlanta, GA 30333, available at https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm, incorporated by reference, on file with the Department, and including no future editions or amendments; and 2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1); b. If an individual may have a latent tuberculosis infection, as defined in A.A.C. R9-6-1201: i. Referring the individual for assessment or treatment; and ii. Annually obtaining documentation of the individual's freedom from symptoms of infectious tuberculosis, signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101; c. Annually providing training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by or providing volunteer services for the health care institution; d. Annually assessing the health care institution's risk of exposure to infectious tuberculosis; e. Reporting, as specified in A.A.C. R9-6-202, an individual who is suspected of exposure to infectious tuberculosis; and f. If an exposure to infectious tuberculosis occurs in the health care institution, coordinating and sharing information with the local health agency, as defined in A.A.C. R9-6-101, for identifying, locating, and investigating contacts, as defined in A.A.C. R9-6-101.

Evidence/Findings:

Based on record review and interview, the health care institution failed to ensure that the facility documented tuberculosis infection control activities that included annually providing training and education related to recognizing the signs and symptoms of tuberculosis for two of two employees reviewed. The deficient practice posed a potential illness risk to residents. Findings Include: 1. A review of E1's and E2’s personnel records revealed no documentation of tuberculosis training. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Temporary Solution:

The manager checked all the employee records for any discrepancies in the compliance with the employment rules.

Permanent Solution:

The manager understands that each employee needs to follow the annual process of recognizing the signs and symptoms of Tuberculosis and that a new employee has to provide a proof of training in recognizing the signs and symptoms of Tuberculosis. Currently all the employees are compliant.

Person Responsible:

Daniel Valean, Manager

Deficiency #3

Rule/Regulation Violated:

R9-10-808.C.1.g. Service Plans C. A manager shall ensure that: 1. A caregiver or an assistant caregiver: g. Documents the services provided in the resident’s medical record; and

Evidence/Findings:

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 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 service plan that indicated R1 received “Hair Care/ Shaving BID” and “Nail care Q W”. 2. Review of R1’s medical record revealed R1’s activities of daily living (ADL) for the month of July 2025 that did not include documentation of hair care, shaving, and nail care being completed. 3. Review of R7’s medical record revealed a service plan that indicated R7 received “Hair Care/ Shaving BID”. 4. Review of R7’s medical record revealed R7’s ADL for the month of July 2025 that did not include documentation of hair and shaving being completed. 5. Review of R8’s medical record revealed a service plan that indicated R8 received “Hair Care/ Shaving BID” and “Resident is checked every 3-4 hours at night and as needed during the day time”. 6. Review of R8’s medical record revealed R8’s ADL for the month of July 2025 that did not include documentation of hair, shaving, and night checks being completed. 7. In an interview, E1 reported R1, R7, and R8 received their activities of daily living; however the services provided were not documented. 8. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Temporary Solution:

The manager made the corrections in the ADL set up for all the residents and added Hair Care and Night Check records, modified the feeding schedule for one of the residents, and the Nail Care, according with their Service Plans.
Note: One of the residents surveyed was discharged on 8/5/2025.

Permanent Solution:

The electronic system monitoring the ADLs was updated to provide set up and records in regards of the Hair Care, Night Checks and Nail Care services.

Person Responsible:

Daniel Valean, Manager

Deficiency #4

Rule/Regulation Violated:

R9-10-817.F.1. Medication Services F. When medication is stored by an assisted living facility, a manager shall ensure that: 1. Medication is stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure that medication stored by the assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officers observed the following medications in common areas around the facility: <ul><li>Tetracyte first aid and antibiotic topical ointment;</li></ul> <ul><li>Watergel triple antibiotic ointment;</li></ul> <ul><li>Mupirocin prescription ointment;</li></ul> <ul><li>Bacitracin ointment;</li></ul> <ul><li>Medline antifungal ointment;</li></ul> <ul><li>Periguard ointment;</li></ul> <ul><li>Dynarex diaper rash ointment;</li></ul> <ul><li>Chamosyn ointment with manuka honey; and</li></ul> <ul><li>Aspercreme pain reliever ointment.</li></ul> 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided

Temporary Solution:

The manager, together with the three caregivers, stored all the medications in the medication cabinet, under lock.

Permanent Solution:

The manager designated one of the caregivers to check on a daily basis that all the medications are under lock in the medication cabinet.

Person Responsible:

Daniel Valean, Manager

Deficiency #5

Rule/Regulation Violated:

R9-10-820.A.11. Environmental Standards A. A manager shall ensure that: 11. Poisonous or toxic materials stored by the assisted living facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings Include: 1. During an environmental inspection of the facility with E2, the Compliance Officers observed the following: <ul><li>flammable air freshener out in the hallway and bathrooms; and</li></ul> <ul><li>antifreeze/coolant in the unlocked garage.</li></ul> 2. During an environmental inspection of the facility with E2, the Compliance Officers also observed the following chemicals in an unlocked cabinet under the kitchen sink: <ul><li>LA's Totally Awesome All Purpose cleaner spray;</li></ul> <ul><li>Granite and Stone disinfectant spray;</li></ul> <ul><li>Comet cleaning powder; and </li></ul> <ul><li>Easy Off heavy duty degreaser spray.</li></ul> 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Temporary Solution:

The toxic and poisonous materials were removed from the immediate access of the residents and stored under lock.

Permanent Solution:

The manager designated one of the caregivers to check the house, on a daily basis, for any toxic or poisonous chemicals located in the immediate reach of the residents. The storage cabinet under sink will be checked to be locked and materials like air fresheners will be also stored under lock.

Person Responsible:

Daniel Valean, Manager

Deficiency #6

Rule/Regulation Violated:

R9-10-821.D.4.b.i-ii. Physical Plant Standards D. A manager shall ensure that: 4. A resident’s sleeping area: b. Is not used as a passageway to a common area, another sleeping area, or common bathroom unless the resident’s sleeping area: i. Was used as a passageway to a common area, another sleeping area, or common bathroom before October 1, 2013; and ii. Written consent is obtained from the resident or the resident’s representative;

Evidence/Findings:

Based on observation, interview, and documentation review, the manager failed to ensure a resident's sleeping area was not used as a passageway to a common area or another sleeping area. The deficient practice posed a potential privacy rights violation to the resident. Findings include: 1. The Compliance Officers observed caregivers sleeping in the primary bathroom. The caregivers could only access the bathroom by entering R7's bedroom. 2. In an interview, E1 reported the caregivers’ room was in the primary bedroom's bathroom. 3. Review of Department records revealed the facility was originally licensed on September 20, 2024, therefore, an exception from the Department before October 1, 2013 would not apply.

Temporary Solution:

The manager contacted an architect to redraw the site plan and get approval from the City of Goodyear. The caregivers were moved to a different room.

Permanent Solution:

The entrance door to the resident's room is moved a few feet towards the resident's room, to have the bathroom door outside of the resident's room.

Person Responsible:

Daniel Valean, Manager

Deficiency #7

Rule/Regulation Violated:

R9-10-803.C.1.b. Administration C. A manager shall ensure that policies and procedures are: 1. Established, documented, and implemented to protect the health and safety of a resident that: b. Cover orientation and in-service education for employees and volunteers;

Evidence/Findings:

Based on documentation review, record review, and interview, the manager failed to ensure that policies and procedures were implemented that covered in-service education for two of two employee records reviewed. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of the facility's policy and procedure titled “Orientation and in-service training” revealed a policy statement that stated, “12 hours of continuing education completed in the previous 12 months will be required upon start of employment services.” 2. A review of E1's personnel record revealed a hire date of August 5, 2024. E1's personnel record did not include any previous continuing education completed prior to the start date for E1. 3. A review of E2’s personnel record revealed a hire date of September 25, 2024. E2's personnel record included documentation of two hours of continuing education in fall prevention and recovery completed prior to the start date for E2. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Temporary Solution:

The Policy and Procedure Manual was updated at the chapter "Ongoing training guidelines".

Permanent Solution:

The Policy and Procedure Manual was updated at the chapter "Ongoing training guidelines".

Person Responsible:

Daniel Valean, Manager

Facility Information

Inspection History

INSP-0147269

Summary:

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #3

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #4

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #5

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #6

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #7

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

INSP-0103890

Summary: