Circles of Life Residential Care.

“Based on documentation review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training, for one of four personnel sampled. The deficient practice posed a health and safety risk for residents.    Findings include:    1. A review of E2’s personnel record revealed documentation of E2’s completed training for fall prevention and fall recovery dated April 5, 2024. However, no further documentation of additional training was available for review.  2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.”

“Based on documentation review and interview, the health care institution failed to implement tuberculosis (TB) infection control activities, including providing training and education related to recognizing the signs and symptoms of TB to individuals employed by the health care institution, for one of four personnel records reviewed. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance. Findings include: 1. A review of E2's personnel record (hired November 18, 2018) did not include documentation of training and education related to recognizing the signs and symptoms of TB. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.”

“Based on observation, documentation review, and interview, the manager failed to ensure a designated caregiver was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility's premises. The deficient practice posed a risk as no individual was designated to act on behalf of the governing authority in the on-site management of the assisted living facility. Findings include: 1. Upon arrival, the Compliance Officer observed E3 was the only employee on the premises. E2 arrived at the facility later in the survey. 2. A review of the facility's documentation revealed there was no documentation to reflect E3 was designated in writing, accountable for the assisted living facility when the manager was not present. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided. This is a repeat deficiency from the compliance inspection conducted on July 24, 2024.”

“Based on documentation review, record review, and interview, the manager failed to ensure that a manager provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training that included a demonstration of the individual's ability to perform CPR before providing assisted living services to one of four employees sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of the facility's policy and procedure revealed a policy titled "Job Descriptions, Duties, & Responsibilities." The policy stated "... 1. To be hired as a Facility Manager... 2. To be hired as a Caregiver... 5. All of the above staff must have an employee file that is maintained on the premises for each employee or volunteer containing... Current training in adult CPR and adult first aid that meets the requirements of this assisted living facility's policy and procedures..." 2. A review of E1’s personnel record revealed a first aid and CPR card with an expiration date of August 31, 2025. There was no other documentation of CPR training in E1's record. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure a written service plan was available for two of three residents sampled. The deficient practice posed a health and safety risk if the caregivers did not know the services the resident needed to receive.   Findings include: 1. A review of R1's medical record revealed no documentation of a service plan. Based on R1's date of acceptance, a service plan was required.   2. A review of R3's medical record revealed no documentation of a service plan. Based on R3's date of acceptance, a service plan was required. 3. In an exit interview, the findings were reviewed with E2 and no additional information was provided.”

“Based on documentation review, observation, and interview, the manager failed to ensure the means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility. The deficient practice posed a risk if staff were unaware of the egress of a resident from the facility. Findings include:  1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the environmental inspection of the facility, the Compliance Officer observed the door leading to the back yard had an alert. However, the alert was turned off at the time of observation.  3. In an exit interview, the findings were reviewed with E2 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 separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the environmental tour of the facility, the Compliance Officer observed a kitchen refrigerator where an unlocked medication storage bag contained the following medications: -Morphine Sulfate Oral Solution 100 mg per 5 mL; -Lorazepam Con 2 mg/mL; and -Insulin pens. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a bottle of Windex, a bottle of All Purpose Cleaner with Bleach, Toilet Bowl Cleaner, and a bottle of glass cleaner in an unlocked cabinet under the sink in the bathroom. An unlocked cabinet under the kitchen sink had a container of Clorox, and an unlocked metal storage cart contained two bottles of Raid Insect Killer. 2. In an exit interview, the findings were reviewed with E2, and no additional information was provided.”

“Based on observation, record review, and interview, the manager failed to ensure a qualified caregiver, who had been designated in writing, was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility premises. The deficient practice posed a risk as no individual was designated to act on behalf of the governing authority in the onsite management of the assisted living facility. Findings include: 1. Upon arrival, the Compliance Officer observed E3 was the only personnel member present and working at the facility. The Compliance Officer asked E3 if E3 was the manager's designee. E3 stated, "No, I am just the caregiver." E3 called E1 to come to the facility to facilitate the inspection. The Compliance Officer requested the facility's policies and procedures or other documentation to review while waiting for E1 to arrive. E3 again called E1 and E1 directed E3 to give the Compliance Officer access to the tablet which contained electronic resident information. However, the Internet connection was not operating properly, and the Compliance Officer was unable to review information. 2. E3 asked the Compliance Officer to wait for E1 to facilitate the inspection. E1 arrived approximately one hour later and facilitated the inspection from that point. 3. In an interview, E1 acknowledged the manager failed to ensure a qualified caregiver, designated in writing, was present on the premises and accountable for the assisted living facility when the manager was not present.”

“Based on documentation review and interview, the manager failed to provide documentation required by this Article within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. The Compliance Officer arrived on-site at approximately 1:15 PM. E3 asked the Compliance Officer to wait for E1 to arrive to facilitate the inspection. 2. E1 arrived at approximately 2:30 PM and reported the facility stored all documentation electronically and E1 would email the Compliance Officer the requested documentation. The Compliance Officer requested the following documentation at 2:40 PM with a two hour deadline of 4:40 PM. -The facility's policies and procedures; -R1's, R2's, and R3's complete resident medical records including any incident reports; -All personnel records; -Staff schedules for the last 3 months; and -Manager designee documentation. 3. The Compliance Officer received the following electronic documention within the 2 hour time frame: -The facility's policies and procedures; -R1's, R2's, and R3's partial medical records; and -E3's and E4's personnel records. 4. In an interview, E1 acknowledged the requested documentation was not provided within the required time frame.”

“Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan and documented the services provided in the resident's medical record, for three of three residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. A review of R1's medical record revealed a document titled, "Service Plan," dated July 28, 2023, which listed the following services R1 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Independent; Twice daily and as needed; -Nail Care: Independent; Nails checked daily and trimmed as needed; -Hair Care: Independent; Daily and as needed; -Dressing: Requires assistance; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires assistance; Daily as needed; -Transferring: Requires assistance; Daily and as needed; and -Transportation to Appointments: Requires assistance; As needed. 2. A review of R2's medical record revealed a document titled, "Service Plan," dated December 13, 2023, which listed the following services R2 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Requires supervision; Twice daily and as needed; -Nail Care: Requires supervision; Nails checked daily and trimmed as needed; -Hair Care: Requires supervision; Daily and as needed; -Dressing: Requires assistance; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires total care; Daily as needed -Transferring: Requires assistance; Daily and as needed; and -Transportation to Appointments: Requires total care; As needed 3. A review of R3's medical record revealed a document titled, "Service Plan," dated March 11, 2024, which listed the following services R3 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Requires supervision; Twice daily and as needed; -Nail Care: Requires supervision; Nails checked daily and trimmed as needed; -Hair Care: Requires supervision; Daily and as needed; -Dressing: Requires supervision; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires total care; Daily as needed; -Transferring: Independent; Daily and as needed; and -Transportation to Appointments: Requires assistance; As needed. 4. A review of R1's, R2's, and R3's medical records revealed no documentation to reflect R1, R2, and R3 were provided with the assisted living services in R1's, R2's, and R3's service plans. 5. In an interview, E1 acknowledged the Compliance Officer did not receive documentation that R1, R2, and R3 were provided with the assisted living services in R1's, R2's, and R3's service plans. E1 reported the services were provided and documented; however, the documentation was not provided for review.”

“Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for one of one resident sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a medication administration record (MAR) dated March 2024. The MAR indicated R1 received several medications, including the following: -Diazepam 5 milligrams (mg), one tablet at 7:00 AM and 7:00 PM; -Docusate 100 mg, one tablet at 7:00 PM; -Trazodone 100 mg, one tablet at 7:00 PM; and -Valproic acid 250 mg/5ml orally at 7:00 AM, 2:00 PM, and 7:00 PM. 2. A review of R1's medical record revealed no signed medication orders for the aforementioned medications. 3. In an interview, E1 acknowledged the aforementioned medications were not administered in compliance with a medication order as no signed orders were provided for review.”

“Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for one of one resident sampled receiving medication administration. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a medication administration record (MAR), dated March 2024. The MAR included the following scheduled medications: -Diazepam 5 milligrams (mg), one tablet at 7:00 AM and 7:00 PM; -Docusate 100 mg, one tablet at 7:00 PM; -Levothyroxine .075 mg, one tablet at 6:00 AM; -Olanzapine 5 mg, mg, one tablet at 7:00 AM and 7:00 PM; -Trazodone 100 mg, one tablet at 7:00 PM; and -Valproic acid 250 mg/5ml orally at 7:00 AM, 2:00 PM, and 7:00 PM. 2. Further review of R1's MAR revealed the aforementioned medications were not documented as administered on the following days at the required times: -March 11, 2024-March 14, 2024. 3. In an interview, E1 acknowledged the aforementioned medications were not documented in R1's medical record as administered. However, E1 reported E1 believed R1 received the medications as prescribed.”

“Based on documentation review, record review, and interview, the manager failed to ensure when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, a caregiver or assistant caregiver documented the date and time of the accident, emergency, or injury; a description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver or assistant caregiver; and any action taken to prevent the accident, emergency, or injury from occurring in the future. The deficient practice posed a risk as critical information needed in an investigation regarding a resident's urgent medical needs were not obtained as required. Findings include: 1. A review of Department documentation revealed R1 was transported via emergency medical services to Chandler Regional Medical Center on September 29, 2023. 2. In an on-site complaint investigation, the Compliance Officer requested R1's medical record for review, including any incident reports. 3. A review of R1's electronically submitted medical record revealed no incident reports were received as requested. 4. In an interview, E1 acknowledged the facility called 911 for R1 on September 29, 2023. E1 reported the facility did create an incident report documenting the emergency room visit. However, E1 reported not remembering the Compliance Officer requested incident reports and therefore, they were not provided.”