Daniela's Assisted Living.

“Based on documentation review, observation, and interview, the manager failed to ensure 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 monitored or alerted employees 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. Arriving at the facility, the Compliance Officer observed the front door wide open. Once the Compliance Officer walked to the door, a caregiver was seen walking to the kitchen counter. When the caregiver noticed the Compliance Officer, they signaled for them to come in. 3. The Compliance Officer mentioned that the door was left open. E2 closed the door, but the keys were left hanging on the door. The Compliance Officer pointed it out, and E2 took the keys. 4. The Compliance Officer observed that the door had a functional alarm. 5. The Compliance Officers observed ambulatory residents. 6. In an interview, E2 reported that they were moving something from the backyard to the front yard, and that was why the door was left wide open.”

“Based on documentation review, observation, and interview, the manager failed to ensure that the premises were cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection. Findings include: 1. A review of the facilities policies and procedures revealed a document titled "Cleaning and Disinfection", which stated: "Common household detergents or disinfectants will be used following the manufacturer's recommendations for use of cleaners and disinfectants. Proper hand hygiene is required as per Hand Washing and Gloving policies and procedures set forth in this manual" "Surfaces in proximity to the resident and those that are touched frequently are cleaned and if applicable disinfected daily. These include surfaces such as tables, counter tops, chairs, stools and table tops, door knobs, toilet seats, commodes, beds, lifting equipment etc." 2. When the Compliance Officer walked into the kitchen, they observed a resident playing with dominoes. 3. During an environmental inspection of the kitchen and dining room area, the Compliance Officer opened a drawer and observed several bugs crawling inside a cabinet. There were also dead bug remains in other drawers and cabinets. Those drawers and cabinets contained kitchen supplies and activity supplies for residents, such as dominoes. 4. In an exit interview, E2 acknowledged that cabinets and drawers were not being cleaned daily and disinfected according to policies and procedures.”

“Based on observation, documentation review, and interview, the manager failed to ensure that a pest control program that complied with Arizona Administrative Code (A.A.C.) R3-8-201(C)(4) was implemented and documented.  Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed several bugs crawling inside a cabinet. There were also dead remains in other drawers and cabinets. Those drawers and cabinets contain kitchen supplies and activity supplies for residents. 2. In an interview, E4 reported that they don't use those drawers and cabinets. During the exit interview, E2 acknowledged that the pest control program was not implemented.”

“Based on record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411(C), for two of four sampled employees. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states: "A...as a condition of employment in a residential care institution...employees and owners of residential care institutions...shall have valid fingerprint clearance cards...C. 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..." 2. A review of E2's and E3's personnel record revealed no documentation of compliance with the requirements in A.R.S. \'a7 36-411(C) to include documented, good faith attempts to contact prior employers. 3. In an interview, E1 acknowledged E2's and E3's personnel records did not contain documentation of compliance with the requirements in A.R.S. \'a7 36-411(C).”

“Based on documentation review, record review, and interview, the manager failed to report suspected abuse of a resident according to Arizona Revised Statutes (A.R.S.) \'a7 46-454. The deficient practice posed a risk to the health and safety of residents. Findings include: 1. A.R.S. \'a7 46-454(A) states "A. A health professional, emergency medical technician, home health provider, hospital intern or resident, speech, physical or occupational therapist, long-term care provider, social worker, peace officer, medical examiner, guardian, conservator, fire protection personnel, developmental disabilities provider, employee of the department of economic security or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. The guardian or conservator of a vulnerable adult shall immediately report or cause reports to be made of such reasonable basis to the superior court and the adult protective services central intake unit. All of the above reports shall be made immediately by telephone or online." 2. Arizona Administrative Code (A.A.C.) R9-10-101(111) states "[i]mmediate" means "without delay." 3. A review of facility documentation reveal an incident report dated May 13, 2024. The incident report revealed R1 was allegally hit on the head by R3. The incident report did not indicate whether Adult Protective Services (APS) was notified of the incident. 4. In an interview, E1 acknowledged a report was not submitted to APS and/or law enforcement regarding the incident.”

“Based on observation, 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. The deficient practice posed a risk as E2 was not qualified to provide the required services unsupervised. Findings include: 1. Arizona Revised Statutes (A.R.S.) \'a7 36-401(A)(49) states "[s]upervision" means "directly overseeing and inspecting the act of accomplishing a function or activity." 2. During the environmental inspection of the facility, the Compliance Officer observed E2 and E3 working at the facility. E2 was providing direct services to residents without the direct supervision of E3. After the Compliance Officer arrived, E3 called E1 and informed E1 that the Compliance Officer was there for an inspection. E1 arrived to the facility at approximately 10:30 AM. 3. A review of facility policies and procedures revealed a policy titled "Employees and Volunteers Qualifications." The policy stated: "The hiring individual or manager shall hire at least one certified caregiver per shift and assistant caregivers and volunteers to provide duties as instructed in order to cover the scheduled and unscheduled needs of the residents. The hiring individual or manager will ensure, check and document that each caregiver, or assistant caregiver providing physical health services or behavioral health services have the required skills and knowledge before providing any services to the residents. Furthermore, we seek those who are capable of patience, creativity, willingness to learn new techniques/program strategies and who are willing to provide to the residents as related to their person-centered needs, promoting independence, self-determination, and choice as outlined in the Service Plan. Job description, responsibilities and duties: Assistant caregivers...2. Services will be provided to the resident only after receiving the specific training and documentation and under the supervision and direction of another caregiver or manager." 4. A review of E2's personnel record revealed E2 was hired as an assistant caregiver. There was no documentation in E2's personnel record to indicate E2 completed an approved caregiver training program. 5. In an interview, E1 acknowledged E2 was an assistant caregiver and provided services to residents without being under the direct supervision of a caregiver or manager.”

“Based on observation, documentation review, and interview, the manager failed to ensure medication 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 the physical health and safety of residents with access to the unsecured medication. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed two bottles of "Amlodipine 10 mg (milligrams)", one bottle of "Metoprolol ", two bottles of "Magnilife Leg and Back Pain Relief", and a bottle of "Bayer Aspirin 81 mg" in the bathroom inside the caregiver room in the facility. The medications were not stored in a self-contained unit used only for medication storage and the caregiver room was not locked at the time of the observation. 2. A review of facility policies and procedures revealed a policy titled "Medications Including Opioids and Narcotics." The policy stated: "Due to the current opioid crisis, this facility has setup procedures intended to reduce the inappropriate use of these controlled substances, improve safety, and reduce harm while preserving the vital roles of clinicians and residents in the management of acute and chronic pain. Opioids are powerful pain relievers a doctor can order to manage acute and chronic pain. Opioid medication, if not taken correctly, can cause an overdose and even death. The facility Manager will ensure the following procedures are followed by Caregivers and or designated individuals and other qualified personnel. Training in this regard is documented in Orientation and Verification of Skills and Knowledge...Part II- Receiving, Storing, Inventorying, Tracking, Dispensing Medication Including Opioids and Narcotics....4. Medication stored by the facility must be secured in a locked storage area, closet, cabinet, or self-contained unit used only for medication storage." 3. In an interview, E1 acknowledged the aforementioned medications were not stored in a locked area used only for medication storage.”