Homestead Manor Assisted Living, LLC.

“Based on record review and interview, the manager failed to ensure that a personnel record for each employee included initial training in fall prevention and fall recovery for one of two employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E2's personnel record revealed no documentation of initial training in fall prevention and fall recovery. Based on E2's hire date, this documentation was required. 2. In an exit interview, the findings were reviewed with E4, no additional information was provided.”

“Based on record review and interview, the assisted living home failed to maintain a standardized form for each resident that includes the information prescribed in A.R.S. § 36-420.04.A.1-9 for two out of two residents sampled. The deficient practice posed a risk if the facility was not prepared in case of an emergency. Findings include:  1. A review of R1's medical record revealed there was a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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; The name, address and telephone number of the resident's current pharmacy; 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; 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 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; and A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. 2. A review of R2's medical record revealed there was a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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;  The name, address and telephone number of the resident's current pharmacy; 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 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; and A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. 3. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on documentation review and interview, the health care institution failed to ensure that the facility 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. A review of the facility's documentation revealed that an annual assessment of the health care institution's risk of exposure to infectious tuberculosis was unavailable. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on documentation review and interview, the manager failed to ensure the policies and procedures addressed how a caregiver’s or assistant caregiver’s skills and knowledge were verified and documented. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees. Findings include: 1. A review of the facility's policies and procedures revealed a section titled, "Caregiver Job Description" with the following verbiage, "A caregiver, at the starting date of employment as a caregiver meets all of the following: ...has relevant skills in safe patient handling, emergency responding, and time management." There was no verbiage found in the facility's policies and procedures that determined how the facility would verify staff's skills and knowledge. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on documentation review and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify if qualified staff were present each day to ensure the health and safety of residents. Findings include: 1. A review of facility documentation revealed a document titled "Working Schedule" for April 2026. This schedule showed names and dates, however, no shift hours were documented. 2. In an interview, E4 reported that there were two shifts at the facility, 6am-6pm and 6pm-6am. E4 also reported that sometimes caregivers work overnight and other times they work as needed. 3. In an exit interview, the findings were discussed with E4 and no additional information was provided.”

“Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver who was expected to have more than eight hours per week of direct interaction with residents, provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113 for one of two employees sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..."   2. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. A review of E2's personnel record revealed no documentation of freedom from infectious TB. 4. In an interview, E4 reported E2's date of hire was sometime in March of 2026. 5. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that before providing assisted living services to a resident, a caregiver received orientation that was specific to the duties to be performed by the caregiver for one of two employees sampled. The deficient practice posed a risk if the employee was unable to meet the needs of a resident. Findings Include: 1. A review of E2’s personnel record revealed no documentation of orientation. Based on E2's date of hire, this information was required.  2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on documentation review, record review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) within seven calendar days after the resident's date of occupancy, as stated in R9-10-113 for two of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of R1's medical record revealed no documentation of assessing risks of prior exposure to infectious TB and a determination of whether R1 had signs or symptoms of TB. Based on R1's date of occupancy, this documentation was required. 3. A review of R2's medical record revealed no documentation of assessing risks of prior exposure to infectious TB and a determination of whether R2 had signs or symptoms of TB. Based on R2's date of occupancy, this documentation was required. 4. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“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 two of thwo 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 R1's medical record revealed a service plan dated and signed on March 14, 2026 that stated R1 received personal care services. 2. A review of R1's medical record revealed no documentation that stated whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a medical practitioner or registered nurse. Based on R1's date of occupancy, this documentation was required. 3. A review of R2's medical record revealed a service plan dated and signed on March 14, 2026 that stated R2 received personal care services. 4. A review of R2's medical record revealed no documentation that stated whether R2 required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a medical practitioner of registered nurse. Based on R2's date of occupancy, this documentation was required. 5. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that before or at the time of an individual’s acceptance by an assisted living facility there was a documented residency agreement with the assisted living facility for two of two residents sampled. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of R1 and R2's medical records revealed no documentation of a residency agreement. 2. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in a resident’s medical record for two out of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1’s medical record revealed a service plan, which included the following: Showering, two times a week; Comb hair, daily; Shampooing, two times a week; Check pressure areas daily; and Check feet daily. 2. A review of R1’s activities of daily living sheet for the month of March 2026 revealed the following: Showering documented as completed only once a week, no documentation of a shower from March 8-14. No documentation of hair combing from March 1-31. No documentation of shampooing from March 1-31. No documentation of checking pressure areas from March 1-31. No documentation of checking feet from March 1-31. 3. A review of R2’s medical record revealed a service plan, which included the following: Bed bath, twice a week; Nail care, check nails daily; Hair combing, daily; Incontinence checks every 3-4 hours; and Turn every 2-3 hours in bed. 4. A review of R2’s activities of daily living sheet for the month of March 2026 revealed the following: Bed baths documented as completed only once a week from March 1-31 No documentation of nail care from March 11-31; No documentation of hair combing from March 1-31; Incontinence checks only documented as completed at 7am and 5pm everyday from March 1-31; and No documentation of turning resident from March 1-31. 5. In an exit interview, the findings were reviewed with E4 who reported that these services were provided but were not documented, and no additional information was provided.”

“Based on documentation review, observation, and interview, the manager failed to ensure that 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 that monitored 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. A review of the facility license revealed the facility was licensed at the directed care level. 2. During an environmental inspection of the facility with E4, the Compliance Officer observed the door that led to the backyard did not contain an alert. This door was not being monitored. 3. In an exit interview, the findings were reviewed with E4 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure medication was administered to a resident in compliance with a medication order for one of two residents 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 R2’s medical record revealed R2’s current service plan dated March 14, 2026. The service plan revealed R2 required medication administration. 2. A review of R2's medical record revealed a signed medication order from a medical practitioner was unavailable for the following medications: Linzess, 72mcg 1 cap by mouth every day; Glipizide, 5mg 1 tab by mouth every day; and Oxybutynin, 15mg, 1 tab by mouth every day. 3. A review of R2’s medical record revealed a Medication Administration Record (MAR) for the month of March 2026. This MAR revealed the following: Linzess was administered every day at 5pm; Glipizide was administered every day at 5pm; and Oxybutynin was administered every day at 5pm. 4. A review of R2’s medical record revealed a signed medication order from a medication practitioner dated July 23, 2025. This medication order prescribed the following medications: Carvedilol, 12.5mg, 1 tab po every 12 hours, hold for SBP less than 110 or HR less than 60; Insulin Glargine Solution, 100 units, inject 20 units subcutaneously at bedtime for diabetes; and Lisinopril oral tab 40mg once a day for HTN, hold if SBP is less than 110 or hr less than 60. 5. A review of R2’s medical record revealed a MAR for the month of March 2026. This MAR revealed the following: Carvedilol, 12.5mg, was administered twice every day at 8am and at 5pm; Insulin Glargine Solution, 100 units, 15 units every day at 7pm; and Lisinopril 40mg was administered every day at 8am. 6. A review of R2's medical record revealed a document titled "B/P Monitoring Record," which showed R2's vitals taken every day for the month of March 2026. According to this document, R2's systolic blood pressure was less than 110 or heart rate was less than 60 on March 4, 5, 6, 14, 16, 17, 21, 25, 26, 29, 30, and 31, indicating Carvedilol and Lisinopril should have been held. 7. In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure that 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 residents who were not prescribed the accessible medication. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed the following unlocked medications: Thera Anti-Fungal body powder in the bathroom of R1 and R2; Medline remedy A&D Ointment in the bathroom of R1 and R2; and Dyna Shield skin protectant Zinc Oxide ointment in the bathroom of R1 and R2. 2. A review of R1 and R2's medical records revealed R1 and R2 received medication administration and neither resident self administered medications. 3. In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on documentation and interview, the manager failed to ensure that a disaster plan included how a resident’s medical record will be available to individuals providing services to the resident during a disaster, a plan to ensure each resident’s medication will be available to administer to the resident during a disaster, and a plan for obtaining food and water for individuals present in the assisted living facility or the assisted living facility’s relocation site during a disaster. The deficient practice posed a risk as there was no plan to ensure the health and safety of residents in an emergency. Findings include: 1. A review of the facility’s documentation/policies and procedures revealed a disaster plan for the facility; however, the plan did not include:  how a resident’s medical record will be available to individuals providing services to the resident during a disaster; a plan to ensure each resident’s medication will be available to administer to the resident during a disaster; and a plan for obtaining food and water for individuals present in the assisted living facility or the assisted living facility’s relocation site during a disaster. 2.  In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on interview and documentation review, the manager failed to ensure that a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. In an interview, E4 reported there were two shifts: 6am-6pm (morning) and 6pm-6am (night). 2. A review of the facility's disaster drills revealed the following: January 14, 2026, on the morning shift, November 26, 2025, on the morning shift, July 12, 2025, on the morning shift, and April 18, 2025, on the morning shift. 3. In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure that a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours after the resident’s acceptance by the assisted living facility, for one of two residents sampled. The deficient practice posed a health and safety risk if the resident needed to exit the facility in an emergency.   Findings Include: 1. A review of R1 and R2’s personnel records revealed no documentation of R1 and R2's orientation to the exits from the assisted living facility and the route to be used when evacuating. 2. In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure that hot water temperatures were maintained between 95º F and 120º F in areas of an assisted living facility used by 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 with E4, the Compliance Officer used a department-issued thermometer to test the hot water temperature. The hot water temperature was measured at 150º F on the thermometer. 2. In an exit interview, the findings were reviewed with E4, 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 stored in a locked area and 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 the following toxic materials unlocked throughout the facility: Dishwasher pods in an unlocked kitchen cabinet under sink; Febreeze air freshener in common areas; and Colorox disinfecting wipes in common areas. 2. In an exit interview, the findings were reviewed with E4, and no additional information was provided.”

“Based on documentation review, observation, 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 E1 and E2 were not qualified to provide the required services unsupervised.   Findings include:   1. Arizona Revised Statutes (A.R.S.) § 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 Officers observed E1 and E2 working alone at the facility and providing direct services to residents. After the Compliance Officer arrived, E2 called E4 and informed E4 that the Compliance Office was there for an inspection. E4 arrived at the facility approximately 2 hours later.   3. A review of E1's and E2’s personnel records revealed E1 and E2 were hired as an assistant caregiver. There was no documentation in E1's and E2’s personnel records to indicate E1 and E2 completed an approved caregiver training program.   4. In an interview, E3 and E4 acknowledged E1 and E2 were assistant caregivers and E1 and E2 provided services to residents without being under the direct supervision of a caregiver or manager.”

“Based on observation and interview, the manager failed to ensure at least the manager or a caregiver was present at an assisted living home when a resident was present in the assisted living home. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs.   Findings include:   1. During the environmental inspection of the facility, the Compliance Officer observed E1 and E2 working alone at the facility. E1 and E2 reported E1 and E2 were hired as assisted caregivers E2 called E4 and informed E4 that the Compliance Office was there for an inspection. E4 arrived at the facility approximately 2 hours later.   2. In an interview, E3 and E4 acknowledged no manager or caregiver at the facility when residents were present.”

“Based on documentation review, record review, and interview, the manager failed to maintain a personnel record for each employee which included the items required by this rule, for one of four employees sampled. The deficient practice posed a risk as required information could not be verified for an employee.   Finding include:   1. During the environmental inspection of the facility, the Compliance Officer observed E1 and E2 working alone at the facility. E1 and E2 reported E1 and E2 were hired as assisted caregivers   2. A review of personnel records revealed no personnel records for E1 and E2.   3. In an interview, E3 and E4 acknowledged no personnel records were available for E1 and E2 before the end of the inspection.”