Elite Quality Home Care.

“Based on record review and interview, the manager failed to ensure that the service plan for a resident receiving directed care services included documentation of the resident's weight or a medical practitioner stating that weighing the resident was contraindicated, for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan dated February 28, 2025, that indicated R1 required directed care services. The service plan did not include documentation of R1's weight or documentation from R1's medical practitioner stating that weighing R1 was contraindicated. 2. In an interview, E1 reported the facility was aware of this deficiency through internal audits and had already taken corrective action to weigh all directed care residents at the time of inspection. E1 acknowledged R1's service plan did not include documentation of R1's weight or documentation from R1's medical practitioner stating that weighing R1 was contraindicated.”

“Based on observation and interview, the manager failed to ensure that the premises and equipment used at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice poses a health and safety risk to residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed an exposed box of wires without a cover located on the side of the house, accessible from the backyard. 2. The Compliance Officer observed multiple shower chairs, bedside commodes, and towels piled precariously in R1's shower. 3. The Compliance Officer also observed exposed wires coming from a hole in a wall in a resident's bedroom. 4. In an interview, E1 reported the facility recently contracted electrical work and reported the aforementioned wires were not functional at the time of inspection. E1 acknowledged the premises and equipment used at the assisted living facility were not free from a condition or situation that may cause a resident or other individual to suffer physical injury.”

“Based on record review, documentation review, and interview, the manager failed to ensure a residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807(G), for two of two residents reviewed accepted by the assisted living facility on or after October 1, 2019. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R1's medical record revealed a residency agreement. This residency agreement did not include the correct provisions allowing a manager to terminate residency of a resident. The residency agreement did not include the following terms for a 14 day termination: -The primary condition for which the individual needs assisted living services is a behavioral health issue; and -The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual. Based on R1's acceptance date, this documentation was required. 2. Review of R2's medical record revealed a residency agreement. This residency agreement did not include the correct provisions allowing a manager to terminate residency of a resident. The residency agreement did not include the following terms for a 14 day termination: -The primary condition for which the individual needs assisted living services is a behavioral health issue; and -The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual. Based on R2's acceptance date, this documentation was required. 3. Rule review of R9-10-807(G) on or after October 1, 2019 and the facility's policy and procedure titled "Termination of Residency Agreements" reviewed and signed by E3 December 1, 2021 stated: "A manager may terminate residency of a resident as follows: 1. Without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in an assisted living facility; 2. With a 14 calendar day written notice of termination of residency: a. For nonpayment of fees, charges or deposits; or b. Under any of the conditions in subsection (C); or 3. With a 30 calendar day written notice of termination of residency, for any other reason." Review of subsection (C) stated: "1. The individual requires continuous: a. Medical services; b. Nursing services unless the assisted living facility complies with A.R.S.36-401(C); or c. Behavioral Health Services; 2. The primary condition for which the individual needs assisted living services is a behavioral health issue; 3. The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual; 4. The assisted living facility does not have the ability to provide the assisted living services needed by the individual; or 5. The individual requires restraints, including the use of bedrails." 4. In an interview, E1 acknowledged R1's and R2's residency agreement did not include the correct policy and procedure for an assisted living facility to terminate residency.”

“Based on record review, observation, and interview, the manager failed to ensure a resident medical record contained a medication order from a medical practitioner for each medication that was administered, for one of two residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed a current written service plan dated May 12, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed no documentation of signed medication orders or verbal medication orders for the following: Digoxin 125mcg (1/2 tab) Trelegy 62.5mcg 3. Review of R1's medical record revealed a September 2023 medication administration record (MAR). This MAR stated the following: "Digoxin 125mcg PO 1/2 tab QD" and indicated one tab was administered at 8pm September 1st - present. "Trelegy 62.5mcg PO 1 QD" and indicated one dose was administered at 8am September 1st - present. 4. During an observation of R1's medications, the following was observed: Digoxin 125mcg was observed and one half tab was observed prefilled in the "Bed" slot of R1's medication organizer. Trelegy 62.5mcg was observed. 5. In an interview, E2 reported the medications were administered per the MAR and acknowledged R1's medical record did not contain a medication order from a medical practitioner for each medication that was administered.”

“Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for two of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R1's medical record revealed a current written service plan dated May 12, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed no documentation of signed medication orders or verbal medication orders for the following: Digoxin 125mcg (1/2 tab) Trelegy 62.5mcg 3. Review of R1's medical record revealed signed medication orders dated July 12, 2023. These medication orders stated the following: "Adult Aspirin EC low strength 81mg tablet delayed release once a day" "Budesonide-Formoterol Fumarate 160-4.5mcg/ACT inhalation aerosol twice a day" "Flomax 0.4mg capsule twice a day" "Levetiracetam 500mg oral tablet disintegrating soluble once a day" "Metoprolol Succinate 50mg oral capsule ER 24 hour sprinkle once a day" 4. Review of R1's medical record revealed a September 2023 medication administration record (MAR). This MAR stated the following: "Digoxin 125mcg PO 1/2 tab QD" and indicated one half tab was administered at 8pm September 1st - present. "Trelegy 62.5mcg PO 1 QD" and indicated one dose was administered at 8am September 1st - present. "Aspirin 81mg PO 1 Q AM" however, stated "On hold". Budesonide-Formoterol Fumarate 160-4.5mcg was not listed on the MAR. "Tamsulosin 0.4mg PO 1 Q 24 hrs" and indicated one tab was administered at 8am September 1st - present. "Levetiracetam 500mg PO 1.5 tab Q AM" and indicated one and a half tabs were administered at 8am September 1st - present. "Levetiracetam 500mg PO 2 tabs Q PM" and indicated two tabs were administered at 8pm September 1st - present. "Metoprolol 50mg PO 1 BID" and indicated one tab was administered at 8am and 8pm September 1st - present. 5. During an observation of R1's medications, the following was observed: Digoxin 125mcg was observed and one half tab was observed prefilled in the "Bed" slot of R1's medication organizer. Trelegy 62.5mcg was observed. Aspirin 81mg was not observed. Budesonide-Formoterol Fumarate 160-4.5mcg was not observed. Tamsulosin 0.4mg was observed and one tab was observed prefilled in the "Morn" slot of R1's medication organizer. Levetiracetam 500mg was observed and one and one half tab was observed prefilled in the "Morn" slot and two tabs were observed prefilled in the "Bed" slot of R1's medication organizer. Metoprolol 50mg was observed and one tab was observed prefilled in the "Morn" and "Bed" slot of R1's medication organizer. 6. In an interview, E2 reported the medications were administered per the MAR and acknowledged R1's medications were not administered in compliance with the available medication orders. 7. Review of R2's medical record revealed a current written service plan dated June 28, 2023. This service plan indicated R2 received medication administration. 8. Review of R2's medical record revealed a signed medication order dated April 24, 2023. This medication order stated "Midodrine 10mg Tab 1 tablet orally TID, hold if SBP [systolic blood pressure] is less than 130". 9. Review of R2's medical record revealed a September 2023 MAR. This MAR stated "Midodrine HCL 10mg PO TID hold is SBP”

“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 a resident. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officer observed Clorox all purpose cleaner and Lysol disinfectant spray unlocked in the bathroom of unoccupied bedroom #3. In addition, Arm & Hammer Oxi Clean laundry detergent was observed unlocked in a hall closet and Sprayway glass cleaner was observed unlocked in a closet in the backyard. 2. During an observation, the caregivers were not accessing the toxic materials at the time of arrival. 3. In an interview, E1 and E2 acknowledged toxic materials were stored unlocked. 4. Technical assistance was provided on this Rule during the complaint investigation conducted September 20, 2021.”