Arbor Ridge.

“Based on documentation review, observation, and interview the manager failed to ensure poisonous or toxic materials were maintained 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. Review of Department documentation revealed the facility was licensed for personal care. 2. The Compliance Officer observed an unlocked maintance room locatd on the northwest side of the faciltiy that contained the following: - Several spray cans of Envy Foaming Disinfectant cleaner - Several bottles of Glance RTU Multi-Surface Cleaner - A gallon container of Germicidal Ultra Bleach 3. Review of the facility’s policy and procedures revealed a policy titled, “Cleaning Supplies: Poisonous or toxic materials,” which stated, “2. Locked area separate from food preparation/ storage areas, dining areas, and medications. 3. Not accessible to residents,” 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.”

“Based on documentation review, record review, and interview, the assisted living center failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. § 36-420.04.A., for three of three residents sampled.   Findings include:    1. A.R.S. 36-420.04.A states, "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 R1’s, R2’s, and R3’s medical records revealed no documentation of a standardized form with the prescribed information filled out.     3. In an interview, E3 showed the Compliance Officer a blank “Assisted Living Resident Transfer Checklist”. E3 reported this checklist was filled out once EMS was called. There was no standardized form for R1, R2, and R3 at the time of the inspection with the information prescribed prior to EMS being called.      4. In an exit interview, the findings were reviewed with E1 and E3 and no additional information was provided.”

“Based on documentation review and interview, the manager failed to ensure that a caregiver’s skills and knowledge was verified and documented before the caregiver provided physical health services, according to policy and procedure. The deficient practice posed a risk if the employees were unable to meet a resident's needs.     Findings include:     1. A review of facility documentation revealed no policy and procedure for verifying skills and knowledge of a caregiver or an assistant caregiver.      2. In an interview, E1 reported they have a process to verify skills and knowledge of employees. However, E1 reported E1 does not know if there is a policy. E1 acknowledged a policy was not provided at the time of the inspection.     3. In an exit interview, the findings were reviewed with E1 and E3 and no additional information was provided.”

“Based on record review, documentation review, and interview, the manager failed to implement policies and procedures to protect the health and safety of a resident covering cardiopulmonary resuscitation (CPR), including the method and content of cardiopulmonary resuscitation training, to include a demonstration of the employee's or volunteer's ability to perform cardiopulmonary resuscitation, for three of nine sampled caregivers. 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 E2's personnel record revealed a card from "NationalCPRFoundation" dated August 25, 2022. The card reflected the program was completed online, and there was no documentation to reflect E2's training included a demonstration of E2's ability to perform CPR. 2. A review of E3's personnel record revealed a certificate from "National [illegible text]" dated February 22, 2023. There was no documentation to reflect E2's training included a demonstration of E2's ability to perform CPR. 3. A review of E7's personnel record revealed a certificate from "American Health Care Academy", an online program. The certificate reflected the program was completed online, and there was no documentation to reflect E7's training included a demonstration of E7's ability to perform CPR. 4. In a telephonic interview, the Compliance Officer spoke with a O1, a representative from American Health Care Academy. O1reported an additional certificate would be issued to reflect the demonstration course was completed. According to O1, hands-on certificates are issued separately. 5. A review of the facility work schedule dated September 17, 2023 through September 23, 2023 reflected E3 was scheduled to work as a caregiver from 6:00 AM to 2:00 PM on the following days: -Monday, September 18, 2023; -Tuesday, September 19, 2023; and -Thursday, September 21, 2023. 6. A review of the facility work schedule dated October 22, 2023 through October 28, 2023 reflected E7 was scheduled to work as a caregiver from 6:00 AM to 2:00 PM on the following days: -Sunday, October 22, 2023; -Tuesday, October 24, 2023; -Wednesday, October 25, 2023; -Thursday, October 26, 2023; -Friday, October 27, 2023; and -Saturday, October 28, 2023. 7. In an interview, E1 acknowledged E2's, E3's, and E7's CPR training documentation did not reflect the training included a demonstration of the employee's ability to perform CPR.”

“Based on record review, documentation review, and interview, the manager failed to ensure a personnel record included documentation of compliance with the requirements in A.R.S. \'a7 36-411(A), for one of twelve personnel records sampled. The deficient practice posed a risk if the individual was a danger to a vulnerable population. Finding include: 1. A review of E8's personnel record revealed a fingerprint clearance card with an expiration date of October 4, 2023. 2. A review of the Arizona Department of Public Safety's website revealed E8's fingerprint clearance card was no longer valid, and there was "no results found" from E8's fingerprint clearance card application submitted October 25, 2023. 3. A review of the facility work schedule dated October 22, 2023 through October 28, 2023 reflected E8 was scheduled to work as a caregiver on October 22 and 28, 2023 from 6:00 AM to 10:00 PM. 4. In an interview, E1 confirmed there was no other documentation to reflect E8 had a valid fingerprint clearance card.”

“Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of the resident's orientation to exits from the facility, for five of seven residents sampled. The deficient practice posed a risk if a resident was unaware of the route to be used to evacuate the facility in an emergency. Findings include: 1. A review of R1's, R2's, R3's, R4's, and R6's medical records revealed no documentation of R1's, R2's, R3's, R4's, and R6's orientation to the exits of the facility. 2. In an interview, E1 acknowledged R1's, R2's, R3's, R4's, and R6's medical records did not contain documentation of the residents' orientation to exits from the facility.”