BROOKDALE NORTH SCOTTSDALE

<p>Based on documentation review and interview, the assisted living center that contacted an emergency responder on behalf of a resident failed to provide the emergency responder with a written document that included all requirements in Arizona Revised Statutes (<span style="background-color: rgb(255, 255, 255); color: rgb(68, 68, 68);">A.R.S.) § 36-420.04.A.</span></p><p><br></p><p><br></p><p>Findings include: </p><p><br></p><p><br></p><p>1. A.R.S. § 36-420.04.A states, "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:</p><p>1. The reason or reasons the emergency responder was requested on behalf of the resident.</p><p>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.</p><p>3. The name, address and telephone number of the resident's current pharmacy.</p><p>4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive.</p><p>5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative.</p><p>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.</p><p>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.</p><p>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.</p><p>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."</p><p><br></p><p><br></p><p><br></p><p>2. <span style="color: rgb(68, 68, 68); background-color: rgb(255, 255, 255);">A review of the facility’s emergency responder documentation from January 28, 2025, did not include the reason or reasons the emergency responder was requested on behalf of R2. </span></p><p><br></p><p><br></p><p><br></p><p>3. A review of the facility’s emergency responder documentation from December 17, 2024, did not include the following required elements for R4: </p><ul><li>The reason or reasons the emergency responder was requested on behalf of the resident; and </li><li>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. </li></ul><p><br></p><p><br></p><p><br></p><p>4. <span style="color: rgb(68, 68, 68); background-color: rgb(255, 255, 255);">A review of the facility’s emergency responder documentation from January 25, 2025, did not include the reason or reasons the emergency responder was requested on behalf of R5. </span></p><p><br></p><p><br></p><p><br></p><p>5. A review of the facility’s emergency response binder revealed a prefilled document with all required documents available for all residents in the case of an emergency. </p><p><br></p><p><br></p><p><br></p><p>6. In an interview, E2 reported all staff have access to the required documents per A.R.S § 36-420.04(A)(1-9). E1 acknowledged that the facility failed to provide emergency responders with all required documents for R2, R4, and R5. </p>

Based on documentation review and interview, the manager failed to submit a documented report to the governing authority that included an identification of each concern about the delivery of services related to resident care, and any change made or action taken as a result of the identification of a concern about the delivery of services related to resident care. The deficient practice posed a risk as a quality management program documents the necessary information required to effectively manage services provided.

Findings include:

1. A review of the facility's policies and procedures manual revealed a policy titled "Quality Management Plan". The policy stated "The quality management plan should include an evaluation of the quality management program at least once every 12 months. Documentation in a report of those resident services requiring improvement and the proposed actions will be submitted to the governing authority."

2. The Compliance Officer requested to review the facility's quality management reports submitted to the governing authority. However, the reports submitted to the governing authority were not provided for review.

3. In an interview, E1 acknowledged the quality management program and the annual reports had not been implemented.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of nine residents reviewed. The deficient practice posed a risk if the facility was unable to meet a resident's needs.

Findings include:

1. A review of R7's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R7's acceptance date, this documentation was required.

2. In an interview, E1 acknowledged R7 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

This is a repeat deficiency from the on-site compliance inspection conducted on August 7, 2023.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area, and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident.

Findings include:

1. Review of Department documentation revealed the facility was authorized to provide directed care services.

2. During the tour of the "Memory Care" section of the facility with E2, the Compliance Officer observed a door with an alarm leading to a courtyard, however, this courtyard did not allow residents to be at least 30 feet away from the facility. The Compliance Officer observed two other doors leading to an outdoor space that did allow residents to be at least 30 feet from the facility, however, both of these doors required codes to open.

3. In an interview, E2 reported that in an emergency, the two doors are supposed to unlock. E2 and E5 reported not knowing the code to open the door in an emergency.

4. In an interview, E1 acknowledged there was not a means of exiting the facility that allowed a resident to be at least 30 feet away from the facility and that controlled or alerted employees of the egress of the resident.

Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of nine residents receiving medication administration sampled. 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 June 20, 2024. This service plan indicated R1 received medication administration.

2. Review of R1's medical record revealed no documentation of signed written or verbal medication orders for Tramadol HCL 50mg and Cephalexin 250mg.

3. Review of R1's August 2024 medication administration record (MAR) indicated the following:
-TraMadol HCL 1.5 Oral tablet 50mg was administered once a day August 1st-13th
-Cephalexin Oral Capsule 250mg was administered twice a day August 1st-6th

4. In an interview, E1 reported the medications were administered per the MAR and acknowledged the medications were not administered in compliance with an available medication order.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members.

Findings include:

1. The Compliance Officer observed the facility's drug reference guide was the "Nursing 2022 Drug Handbook".

2. Review of the publisher's website revealed the "Nursing 2025-2026 Drug Handbook" was the most recent edition.

3. In an interview, E1 acknowledged that a current drug reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members.

Findings include:

1. The toxicology guide available for use by personnel members was the "Poisoning & Drug Overdose" Seventh edition, published by McGraw Hill Lange.

2. Review of the publishers website revealed that "Poisoning & Drug Overdose" Eighth edition was the current version.

3. In an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

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 and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. Review of facility documentation revealed policies regarding fall prevention and head injuries, however a policy regarding a training program for all staff regarding fall prevention and fall recovery was not provided for review.

2. Review of E2's, E3's, E4's, and E5's personnel records revealed no documentation showing completion of fall prevention and fall recovery training.

3. In an interview, E1 acknowledged E2's, E3's, E4's, and E5's personnel records did not contain documentation that showed the health care institution had administered a training program for all staff regarding fall prevention and fall recovery.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411 (A) & (C), for three of four personnel records sampled. The deficient practice posed a risk if the personnel were a danger to a vulnerable population and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A.R.S. \'a7 36-411.A. states: "A. Except as provided in subsections F, G, H and I of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work..."

2. A.R.S. \'a7 36-411.C. states: "Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person's fingerprint clearance card."

3. A review of E2's personnel record revealed E2 was hired as a caregiver in 2024. The personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E2's fitness to work in a residential care institution.

4. A review of E3's personnel record revealed E3 was hired as a caregiver in 2017. The personnel record revealed no documentation of a fingerprint clearance card. Additionally, E3's personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E3's fitness to work in a residential care institution.

5. A review of E5's personnel record revealed E5 was hired as a caregiver in 2023. The personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E5's fitness to work in a residential care institution.

6. In an interview, E1 acknowledged documentation was not available that showed E2's, E3's, and E5's work references were obtained upon hire at the facility. E1 acknowledged E3's personnel record provided to the Compliance Officer at the time of inspection did not contain a fingerprint clearance card for review

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before the caregiver or assistant caregiver provided physical health services, for four of four caregivers sampled. The deficient practice posed a risk if a caregiver was unable to meet a resident's needs and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A review of the facility's staffing schedule for April 28, 2024 - May 4, 2024, revealed E2 was scheduled to work on the following days and times:
-May 1, 2pm-10pm;
-May 2, 2pm-10pm;
-May 3, 2pm-6am;
-May 4, 2pm-10pm.

2. A review of E2's personnel record revealed E2 was hired as a caregiver in 2024.

3. A review of E2's personnel record revealed documentation of E2's verified skills and knowledge was not available for review.

4. A review of the facility's staffing schedule for April 28, 2024 - May 4, 2024, revealed E3 was scheduled to work on the following days and times:
-April 29, 2pm-10pm;
-May 3, 2pm-10pm;
-May 4, 2pm-10pm.

5. A review of E3's personnel record revealed E3 was hired as a caregiver in 2017.

6. A review of E3's personnel record revealed documentation of E3's verified skills and knowledge was not available for review.

7. A review of the facility's staffing schedule for April 28, 2024 - May 4, 2024, revealed E4 was scheduled to work on the following days and times:
-April 28, 10pm-6am;
-April 29, 10pm-6am;
-May 3, 10pm-6am;
-May 4, 10pm-6am.

8. A review of E4's personnel record revealed E4 was hired as a caregiver in 2023.

9. A review of E4's personnel record revealed documentation of E4's verified skills and knowledge was not available for review.

10. A review of the facility's staffing schedule for April 28, 2024 - May 4, 2024, revealed E5 was scheduled to work on the following days and times:
-April 28, 6am-2pm and 10pm-6am;
-April 29, 2pm-10pm;
-April 30 2pm-6am;
-May 1, 10pm-6am;
-May 2, 10pm-6am;
-May 4, 6am-2pm and 10pm-6am.

11. A review of E5's personnel record revealed E5 was hired as a caregiver in 2023.

12. A review of E5's personnel record revealed documentation of E5's verified skills and knowledge was not available for review.

13. In an interview, E1 reported the skills and knowledge had been verified, however, no documentation was provided to the Compliance Officer at the time of inspection. E1 acknowledged documentation that E2's, E3's, E4's, and E5's skills and knowledge were verified before providing physical health services was not available for review.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for two of four residents sampled receiving personal 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 and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. Review of R1's medical record revealed a current written service plan for personal care services dated February 15, 2023. However, a service plan after February 15, 2023 was not available for review.

2. Review of R2's medical record revealed a current written service plan for personal care services dated October 10, 2023. However, a service plan after October 10, 2023 was not available for review.

3. In an interview, E6 reported that E6 thought more recent service plans had been made, but that resident medical records had recently been thinned, and E6 was unable to provide the service plans for review. E1 and E6 acknowledged R1 and R2 received personal care services and service plans updated at least once every six months were not available for review at the time of inspection.

Based on record review and interview, the manager failed to ensure a resident's medical record contained the resident's signed residency agreement and any amendments, for five of five residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A review of R1's, R2's, R3's, R4's and R5's medical records revealed a documented residency agreement with the assisted living facility to include the requirements in R9-10-807(D)(1-10) was not available for review.

2. In an interview, E1 reported that residency agreements were stored in the business office, and that E1 did not have access to them. E1 acknowledged R1's, R2's, R3's, R4's and R5's medical records did not contain a signed residency agreement during the inspection.

Based on record review and interview, the manager failed to ensure a resident's medical record contained the resident's service plan and updates, for one of five residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A review of R4's medical record revealed a current written service plan dated February 9, 2024, however, no previous service plans were available for review.

2. In an interview, E6 reported that resident medical records had recently been thinned, and E6 was unable to locate the service plans for review. E1 and E6 acknowledged that R4's medical record did not contain the resident's original services plans and updates.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of assisted living services provided to the resident, for five of five residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A review of R1's medical record revealed a service plan (dated February 2023) for personal care services. The service plan stated R1 was to receive assistance in activities of daily living. However, documentation of assisted living services provided were not available for review.

2. A review of R2's medical record revealed a service plan (dated October 2023) for personal care services. The service plan stated R2 was to receive assistance in activities of daily living. However, documentation of assisted living services provided were not available for review.

3. A review of R3's medical record revealed a service plan (dated November 2023) for personal care services. The service plan stated R3 was to receive assistance in activities of daily living. However, documentation of assisted living services provided were not available for review.

4. A review of R4's medical record revealed a service plan (dated February 2024) for personal care services. The service plan stated R4 was to receive assistance in activities of daily living. However, documentation of assisted living services provided were not available for review.

5. A review of R5's medical record revealed a service plan (dated February 2024) for directed care services. The service plan stated R5 was to receive assistance in activities of daily living. However, documentation of assisted living services provided were not available for review.

6. In an interview, E1 and E6 acknowledged that the medical records for R1, R2, R3, R4, and R5 provided to the Department during the inspection did not contain documentation of assisted living services provided to the residents.

Based on record review and interview, the manager failed to ensure the resident's medical record included documentation of medication administration, for five of five residents sampled who received medication administration. The deficient practice posed a risk as medication administered could not be verified against a medication order and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. A review of R1's medical record revealed a service plan (dated February 2023) for personal care services. The service plan revealed R1 received medication administration.

2. A review of R1's medical record revealed medication orders.

3. A review of the medical record for R1 provided to the Department for review revealed a medication administration record (MAR) for R1 for September 2023 - January 2024. However, documentation of medication administered to R1 after January 2024 was not available for review.

4. A review of R2's medical record revealed a service plan (dated October 2023) for personal care services. The service plan revealed R2 received medication administration.

5. A review of R2's medical record revealed medication orders.

6. A review of the medical record for R2 provided to the Department for review revealed a MAR for R2 for September 2023 - January 2024. However, documentation of medication administered to R2 after January 2024 was not available for review.

7. A review of R3's medical record revealed a service plan (dated November 2023) for personal care services. The service plan revealed R3 received medication administration.

8. A review of R3's medical record revealed medication orders.

9. A review of the medical record for R3 provided to the Department for review revealed a MAR for R3 for September 2023 - January 2024. However, documentation of medication administered to R3 after January 2024 was not available for review.

10. A review of R4's medical record revealed a service plan (dated February 2024) for personal care services. The service plan revealed R4 received medication administration.

11. A review of R4's medical record revealed medication orders.

12. A review of the medical record for R4 provided to the Department for review revealed a MAR for R4 for September 2023 - January 2024. However, documentation of medication administered to R4 after January 2024 was not available for review.

13. A review of R5's medical record revealed a service plan (dated February 2024) for directed care services. The service plan revealed R5 received medication administration.

14. A review of R5's medical record revealed medication orders.

15. A review of the medical record for R5 provided to the Department for review revealed a MAR for R1 for September 2023 - January 2024. However, documentation of medication administered to R5 after January 2024 was not available for review.

16. In an interview, E6 reported misunderstanding the document and record request, however, the requested MARs were not provided for review after the Compliance Officer clarified the request. E1 and E6 acknowledged that documentation of medication administration was not provided for R1, R2, R3, R4, and R5 after January 2024.

Based on record review and interview, the manager failed to ensure a resident medical record contained documentation showing the influenza and pneumonia vaccinations were offered every 12 months to four of five residents sampled. The deficient practice posed a health and safety risk of residents not having the knowledge of the availability of the vaccination and the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection.

Findings include:

1. Review of R1's, R2's, R3's, and R5's medical records revealed no documentation showing the influenza and pneumonia vaccinations were offered or received. Based on R1's, R2's, R3's, and R5's acceptance dates, this documentation was required.

2. During an interview, E1 acknowledged R1's, R2's, R3's, and R5's medical records did not include current documentation showing the influenza and pneumonia vaccinations were offered or received.

Based on documentation review, record review and interview, the health care institution failed to provide appropriate first aid to a non-injured resident who had fallen, appeared to be uninjured, and was unable to reasonably recover independently. The deficient practice posed a risk as the facility called 911 instead of providing first aid to a non-injured resident by assisting them off the floor after a fall.

Findings include:

1. A review of facility policies and procedures revealed a policy titled "Falls Management Policy," which stated, "...4. A post fall evaluation is completed after a resident fall, individualized interventions are considered, and the evaluation is a part of the resident record. 5. When a fall occurs: a. In Assisted Living: i. Assist the resident and provide first aid..."

2. A review of R1's medical record revealed a service plan for personal care services dated March 22, 2023. The service plan contained a section titled "Escort & Mobility" which stated, "Provide physical assistance to and from dining room and/or community activities as needed; Physical impairment is one of the reasons for the escort assistance; be alert to heightened risk for falling; Resident has fallen in the last twelve months; Resident has fallen without apparent harm/injury (Severity Code 1)."

3. Further review of R1's medical record revealed an internal incident report dated July 20, 2023 which stated, "Incident Information: Date of Incident: 7/20/2023, Approx. Time of Incident 04:30 PM...Location of Incident: Resident Bathroom, In Shower / Tub, Nature of Incident: Fall, Witnessed, Type of Injury/Impairment: No Apparent Injury, Body Part(s) injured: Not Applicable...Severity Code: 1-No Apparent Harm / Injury, Additional Facts Not Referenced Above: Care associate stated the resident not fall [sic] - [R1's] legs gave out - [E12] lowered [R1] to the ground." The incident report did not indicate 911 was called to assist the resident.

4. In an interview, O1 reported Phoenix Fire Department paramedics responded to a 911 call from the facility on July 20, 2023. O1 reported the responding paramedics found R1 seated in the bathroom awake, alert, and uninjured. O1 reported the paramedics were asked to assess and assist R1 back into R1's wheelchair. O1 reported R1 did not want further evaluation or transportation to a hospital. O1 reported the paramedics on-site were told by facility staff the facility had a "no lift policy" and the caregivers were advised to call 911.

5. In an interview, E2 reported facility staff called 911 because R1 had never had an incident like this before. E1 reported facility staff were unable to lift R1 because R1 could not assist and was "dead weight." E2 reported R1 was not injured so facility staff did not need to do first aid. However, E2 acknowledged the health care institution failed to assist a non injured resident who had fallen, appeared to be uninjured and was unable to reasonably recover independently.

6. In an interview, E1 reported there were six facility staff on site at the time of the incident, however staff were advised not to lift R1 to avoid injuring themselves or R1. E1 acknowledged the health care institution failed to provide first aid to a non-injured resident who had fallen, appeared to be uninjured and was unable to reasonably recover independently.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's caregiver certification, for one of seven individuals hired as a caregiver.

Findings include:

1. A review of facility documentation revealed staffing schedules for June and July 2023. The staffing schedules revealed E6 was scheduled to work in the facility's memory care unit on the following dates:
-June 11-15, 2023 (overnight shift);
-June 18-22, 2023 (overnight shift);
-June 25-29, 2023 (overnight shift);
-July 3-6, 2023 (overnight shift);
-July 9-13, 2023 (overnight shift);
-July 23-28, 2023 (overnight shift);
-July 30-31, 2023 (overnight shift); and
-August 1-3, 2023 (overnight shift).

2. A review of E6's personnel record revealed a job description titled "Caregiver." The job description stated "Certifications, Licenses, and other Special Requirements In accordance with state law, may need to possess current state certification and follow regulations to maintain certification currency." The job description was dated and signed by E6.

3. Further review of E6's personnel record revealed documentation of completion of a caregiver training program approved by the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board) was not available for review.

4. In an interview, E1 reported E1 believed E6 was a certified caregiver. E1 reported E1 was unable to find documentation of E6's caregiver certificate, but believed E11 probably had a copy of the certificate in E11's office. E1 reported E11 was out of office on the day of the inspection, and E1 was unable to access additional documents for E6. E1 acknowledged E6's personnel record did not include documentation of completion of a caregiver training program approved by the NCIA Board.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant, for one of four residents sampled.

Findings include:

1. A review of R1's medical record revealed no documentation dated within 90 calendar days before R1 was accepted by the assisted living facility to indicate whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant.

2. In an interview, E2 reported all residents are required to have a "Physician/Healthcare Provider Plan of Care" document completed and signed by a physician, registered nurse practitioner, registered nurse or physician assistant. E2 reported this document contains the details required by Arizona Administrative Code (A.A.C.) R9-10-807(B)(1)(a)-(b). E2 reported E2 believed this document must have been completed before R1 was admitted to the facility, but acknowledged documentation containing the required details was not available for review.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative, the manager, or the nurse or medical practitioner who reviewed the service plan, when initially developed and when updated, for six of ten residents sampled.

Finding included:

1. A review of R3's medical record revealed a written service plan for supervisory care services dated February 14, 2023. However, the service plan was not signed or dated by the resident or resident's representative.

2. A review of R4's and R6's medical records revealed service plans for personal care services which were updated on March 22, 2023. However, R4's and R6's service plan updates were not signed or dated by the residents or residents' representatives.

3. A review of R8's and R9's medical records revealed service plans for directed care services dated January 24, 2023 which were signed and dated by the residents' representatives, the manager, and the nurse who reviewed the service plans. R8's and R9's electronic medical records revealed R8's and R9's service plans had been reviewed and updated every three months since the January 24, 2023 update, however the updated service plans were not signed and dated by the residents or residents' representative, the manager, or the nurse who reviewed them.

4. A review of R10's medical record revealed an updated service plan for directed care services dated January 13, 2023. However the service plan update was not signed or dated by the manager, or the nurse who reviewed the service plan.

5. In a joint interview, E1 and E2 acknowledged the service plans for R3, R4, R6, R8, R9, and R10 were not signed and dated as required.

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months.

Findings include:

1. A review of facility documentation revealed documentation to indicate evacuation drills for employees and residents were conducted at least once every six months was not available for review.

2. In an interview, E3 reported E3 was in charge of conducting evacuation drills and had not conducted any evacuation drills since E3 started working at the facility. E3 reported E3 was unsure when or if any evacuation drills had been conducted prior to E3's hiring at the facility. E3 reported E3 had an evacuation drill scheduled for October 2023, but now planned to conduct the drill sooner. E3 acknowledged evacuation drills for employees and residents were not conducted at least once every six months.

This is a repeat citation from the previous on-site compliance inspection conducted on October 17, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver, for two of two assistant caregivers sampled.

Findings include:

1. Arizona Revised Statutes (A.R.S.) \'a7 36-401(A)(42) states "Supervision" means: "direct overseeing and inspection of the act of accomplishing a function or activity."

2. A review of E5's and E6's personnel records revealed E5 and E6 were hired as assistant caregivers.

3. A review of the facility staffing schedule revealed E5 and E6 were the only staff scheduled to work the overnight shift at the facility from 10:00 PM to 6:00 AM on March 13, 2023.

4. In an interview, E1 reported E1 had only recently started working at the facility and was not familiar with all of the staff roles yet. E1 reported E1 would review and adjust the schedule. E1 acknowledged E5 and E6 worked the aforementioned shift as scheduled and interacted with residents without the supervision of a manager or caregiver.

Based on record review, documentation review, and interview, the manager failed to ensure at least one manager or caregiver was present at an assisted living center when a resident was on the premises.

Findings include:

1. A review of E5's and E6's personnel records revealed E5 and E6 were hired as assistant caregivers.

2. A review of the facility staffing schedule revealed E5 and E6 were the only staff scheduled to work the overnight shift at the facility from 10:00 PM to 6:00 AM on March 13, 2023.

3. In an interview, E1 reported E1 had only recently started working at the facility and was not familiar with all of the staff roles yet. E1 reported E1 would review and adjust the schedule. E1 acknowledged there was not at least one manager or caregiver present at the assisted living center when a resident was on the premises on the aforementioned shift.