Klara's Adult Care Home, LLC.

“Based on record review and interview, the assisted living home failed to maintain a copy of documentation provided to an emergency responder for two of two residents reviewed. The deficient practice posed a risk if the Department was unable to verify the required documentation was provided during a resident emergency.   Findings include:   1. 36-420.04. requires: Emergency responders; patient information; hospitals; discharge planning; patient screenings; discharge document 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: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 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. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 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. 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. 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. 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.   2. A review of Department documentation revealed the Department received a report that documented the facility contacted emergency medical services (EMS) on March 2, 2026, for R1. The Department received a second report, which documented the facility contacted EMS on December 31, 2025 for R2. During the incidents, R1 and R2 were transported to the hospital for medical services.    3. A review of the facility’s documentation revealed the facility did not have documentation to show the facility provided the emergency responder with a written document that included all of the required documentation for R1 and R2. 4. In an interview, E2 acknowledged the medical records for R1 and R2 did not include evidence that a written document, which included the requirements in A.R.S. 36-420, was provided to EMS upon the residents' transfer to the hospital. 5. In an exit interview, the findings were reviewed with E2 and no additional information was provided.”

“Based on record review, documentation review, and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver documented the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for two of two residents reviewed. The deficient practice posed a health and safety risk.      Findings include:     1. A review of R1's medical record revealed a progress note dated March 2, 2026, that stated, "called 911 went to hospital."   2. A review of Department documentation revealed medical services were called following an accident, emergency, or injury to R2 on December 31, 2025.    3. While on-site for the complaint investigation, the Compliance Officer requested incident report documentation for R1 and R2. However, documentation of the emergency, including 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, and any action taken to prevent the accident, emergency, or injury from occurring in the future was not available for review.    4. In an exit interview, the findings were reviewed with E2 and no additional information was provided.”