Haven of Camp Verde Alf, LLC.

“Based on record review and interview, the manager failed to develop and administer a training program for all staff regarding fall prevention and fall recovery, including initial and continued competency training. Findings include: 1 . A review of facility documentation revealed documentation of a training program regarding fall prevention and fall recovery, including initial and continued competency training, was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of four residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1 . A review of R1's and R2's medical records revealed negative TB signs and symptoms screenings and risk assessments. However, documentation of a negative TB test was not available for review at the time of inspection. Based on the residents' dates of acceptance, this documentation was required. 2 . In an exit interview, the findings were discussed with E1, and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submitted documentation that was dated within 90 calendar days before the individual was accepted by an assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for three of four residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1 . A review of R2's, R3's and R4's medical records revealed documentation that was dated within 90 calendar days before the individual was accepted by the assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1, and no additional information was provided. This is a repeat deficiency from the compliance inspection conducted on June 12-13, 2023.”

“Based on record review and interview, the manager failed to ensure a written notice of termination of residency included the date of notice, the reason for termination, the policy for refunding fees, charges, or deposits, the deposition of a resident's fees, charges, and deposits, and contact information for the state Long-Term Care Ombudsman, for one of four residents sampled. Findings include: 1 . A review of R1's medical record revealed that documentation of a notice of termination of residency was not available for review at the time of inspection. 2 . In an interview, the findings were discussed with E1, and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that a resident's medical record contained documentation of the resident's orientation to exits from the assisted living facility, for three of four residents sampled. Findings include: 1 . A review of R1's, R3's, and R4's medical records revealed that documentation of an orientation completed was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1, and no additional information was provided. This is a repeat deficiency from the compliance inspection conducted on June 12-13, 2023.”

“Based on observation and interview, the manager failed to ensure there was a means of exiting the facility for a resident that allowed the resident to exit to a location at least 30 feet away from the facility that is secure. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed a door from the back of the building leading to the backyard with a magnetic lock. However, the lock was not functioning at the time of inspection. The gate leading out of the backyard was also not locked; therefore, the outside area was not secure. 2 . In an exit interview, the findings were reported to E1 and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure medication stored by the assisted living facility was stored in a locked self-contained unit. 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, the Compliance Officer observed a medication room door that was open. Inside the room was an unlocked refrigerator with boxes of insulin. Further inspection of the facility revealed an unlocked staff room door. Inside the room was an unlocked refrigerator with boxes of Arformoterol Tartrate Inhalation Solution. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility 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, the Compliance Officer observed an unlocked cabinet under the sink in the pantry room next to the dining room. The Compliance Officer was able to access a bottle of "Miracle-Gro." 2 . During an environmental inspection of the facility, the Compliance Officer observed an unlocked shower room from the main hallway. On a shelf in the shower room was a bottle of "Clorox" disinfectant cleaner. 3 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on observation, record review and interview, the governing authority failed to designate a certified manager. Findings include: 1. During an interview, E1 stated that E1 was the facility administrator, but was not a certified manager. E1 further stated that there had not been a certified manager overseeing the facility since O1 left. 2. Record review revealed that O1's last day as the facility manager was June 30, 2024. 3. During an interview, E1 acknowledged that no certified manager had been designated.”

“Based on documentation review and interview, the manager failed to ensure that a plan is established, documented, and implemented for an ongoing quality management program that, includes a method to make changes or take actions as a result of the identification of a concern about the delivery of services related to resident care. Findings include: 1. Review of the monthly facility quality management reports revealed that the reports did not implement a method to make changes or take actions as a result of the identification of a concern about the delivery of services related to resident care. 2. During an interview, E1 acknowledged the required documentation was not included in the facility quality management reports.”

“Based on record review and interview, the manager failed to ensure that two of three sample resident records contained documentation of notification to the resident of the availability of vaccinations for influenza. Findings include: 1. The record belonging to R1 contained documentation indicating that the resident was last notified of the availability of the influenza vaccination on October 18, 2022. No additional documentation indicating when the resident had been offered, refused, or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 2. The record belonging to R2 contained documentation indicating that the resident was last notified of the availability of the influenza vaccination on October 18, 2022. No additional documentation indicating when the resident had been offered, refused, or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged that the record did not contain the required documentation.”

“Based on record review and interview for two of two sample personal care resident records, the manager failed to obtain documentation reflecting that the resident or resident's representative requested that the resident remain in the facility. Findings include: 1. During an interview, E1 indicated that R2 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted. 2. The resident's record did not contain a request from the resident or their representative to remain in the facility. Based on the resident's date of acceptance this documentation was required. 3. During an interview, E1 indicated that R3 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted. 4. The resident's record did not contain a request from the resident or their representative to remain in the facility. Based on the resident's date of acceptance this documentation was required. 5. During an interview, E1 acknowledged that the required documentation was not in the resident's records.”

“Based on documentation review and interview, the manager failed to ensure that documentation of each evacuation drill included an identification of residents needing assistance for evacuation Findings include: 1. Review of 12 months of facility evacuation drill documentation revealed that the documentation failed to identify the residents needing assistance for evacuation. 2. During an interview, E1 stated, "We do have non-ambulatory and directed care residents here who would need assistance." 3. During an interview, E1 acknowledged the required documentation was not available for review.”

“Based on documentation review and interview, the manager failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that included annually assessing the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1. Review of facility documentation failed to reveal an annual assessment of the health care institution's risk of exposure to infectious tuberculosis. 2. During an interview, E1 acknowledged that the required documentation was not available for review.”