Clearwater Mayo Blvd.

“Based on record review and interview, the manager failed to ensure that the emergency responder face sheet contained the name, address and telephone number of the resident's current pharmacy as required under Arizona Revised Statute (A.R.S.) 36-420.04. A.3.    Findings include:   1. A record review of the facility's prefilled Emergency Medical Services (EMS) Face Sheet for 11 of 11 sampled residents revealed that the form was missing the section containing the name, address, and phone number of the resident's current pharmacy.   2. In an interview, E1 acknowledged that the manager failed to ensure that the EMS face sheet contained the name, address, and phone number of the resident's current pharmacy as required.”

“Based on record review, documentation review, and interview, the manager failed to ensure compliance with A.R.S. § 36-411 for two of eleven sampled employees. The deficient practice posed a risk if E5 or E8 were a danger to a vulnerable population. Findings include: 1. A review of E5 and E8's personnel records revealed, neither employee had a valid Department of Public Safety (DPS) Fingerprint Clearance card. 2. An online check by the Compliance Officer on July 25, 2025 of the Arizona Department of Public Safety (DPS) web portal at https://psp.azdps.gov/services/cardStatusRequest revealed that E5 applied for a Fingerprint card in March 2025. A search the application number returned no results. 3. E8 did not have a fingerprint card nor an application for review. 4. A documentation review of the facility's Policies and Procedures stated, "background and criminal records clearances as required by government regulations" for all employees. 5. In an interview, E1 acknowledged the manager did not ensure compliance with A.R.S. § 36-411 for E5 and E8.”

“Based on record review, documentation review, and interview, the manager failed to ensure that a manager, a caregiver, assistant caregiver, or a volunteer provide documentation of freedom from infectious Tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents.   Findings include:   1. A review of E3’s personnel record revealed no documentation indicating that the employee completed the two-step TB process was available for review. 2. A review of E4, E6, and E7's personnel records revealed a TB screening and risk assessment form was not available for review. 3. A documentation review of the facility's Policies and Procedure titled, "Tuberculosis (TB) Care Staff" stated, "1. All TB tests conducted will be 2-step TB tests. 2. The Employee TB Consent Screening and Documentation form may be used."   4. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for E3, E4, E6, and E7.”

“Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: includes whether the individual requires: continuous medical services, continuous or intermittent nursing services, or restraints; and is dated and signed by a: Physician, Registered nurse practitioner, Registered nurse, or Physician assistant. The deficient practice posed a risk if the facility was unable to meet a resident's needs.   Findings include:   1. A review of R3's medical records revealed, based on the resident's admission dates, the initial or continuation medical authorization form was required. 2. A review of R3's medical records revealed "Physician's Report and Admission Orders-Arizona" form did not have the resident's name listed on it nor the resident's level of care. 3. In an interview, E1 acknowledged the initial physician statement did not document if R3 received supervisory care services, personal care services, or directed care services.”

“Based on record review, documentation review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious Tuberculosis before or within seven calendars after the resident's date of occupancy as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents.   Findings include:   1. A review of R1, R2, R7, and R9’s medical records revealed, documentation of a TB screening and risk assessment form, was not available for review for four of eleven sampled residents. 2. A documentation review of the facility's Policies and Procedure titled, "Tuberculosis (TB) Residents" stated, "The Community will screen residents at the time of admission for information regarding exposure to or symptoms of TB."   3. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for R1, R2, R7, and R9.”

“Based on documentation review, record review, and interview, the manager failed to ensure, before providing assisted living services to a resident, a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults, for one of two sampled personnel members. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a staff schedule for July-September 2024. The schedule revealed E3 worked at the facility on multiple shifts from July-September 2024 as a caregiver. 2. A review of E3's personnel record revealed documentation of first aid training and CPR training. However, the first aid and CPR documentation had expired on August 19, 2024. 3. In an interview, E1 acknowledged E3 had no current documentation of CPR and first aid training.”

“Based on documentation review, record review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. Review of the staff personnel records revealed that E3, who was hired on January 15, 2022, had no documentation of completing fall prevention and fall recovery training as required. 2. During an interview, E1 acknowledged that E3 had not completed the required fall prevention and fall recovery training.”

“Based on record review and interview, the manager failed to ensure that one of five sampled residents who were receiving personal care services had a written service plan reviewed and updated at least once every six months, which posed a health and safety risk. Findings include: 1. Review of R9's medical record revealed that R9's written service plan was updated June 14, 2023 and February 14, 2024. The service plans stated the resident required personal care services. The service plan should have been updated no later than December of 2023. 2. In an interview, E1 acknowledged the sampled resident's service plan did not appear to have been updated as required for this resident receiving personal care services.”

“Based on record review and interview, the manager failed to ensure a resident's written service plan was reviewed and updated at least once every three months, for two of three sampled residents' records reviewed who were receiving directed care services which posted a health and safety risk. Findings include: 1. Review of R2's medical record revealed a written service plan for directed care services dated August 29, 2023 and December 3, 2023. R2's medical record did not contain any other service plans available for review during this time period. 2. Review of R3's medical record revealed a written service plan for directed care services dated July 31, 2023 and November 7, 2023. R3's medical record did not contain any other service plans available for review during this time period. 3. In an interview, E1 and E2 reported during this time period both sampled resident had been receiving directed care services. E1 acknowledged no service plans were found in R2's and R3's medical records to indicate R2's and R3's service plan had been updated at least once every three months as required.”

“Based on record review and interview, the manager failed to ensure two of eleven sampled residents' written service plans reviewed when updated were signed and dated by the resident or resident's representative, the manager, and the nurse or medical practitioner who reviewed the service plans, as required. Finding included: 1. Review of R1's medical record and service plan revealed the resident required directed care and medication administration services. The current service plan that was printed on the day of the compliance inspection had a date of January 1, 2024, however, was never signed by the resident or the representative, the manager, and the nurse or medical practitioner who had reviewed this service plan. 2. Review of R3's medical record and service plan revealed the resident required directed care and medication administration services. The current service plan dated February 10, 2024 was never signed by the nurse or medical practitioner who had reviewed this service plan. 3. In an interview, E1 acknowledged that the sampled residents' service plans had not been signed and dated as required.”

“Based on observation and interview, the manager failed to ensure there was a current drug reference guide that was available for use by personnel members which posed a health and safety risk to the resident if the caregiver was unable to reference a medication a resident was taking. Findings include: 1. During the compliance inspection the compliance officer observed the facility was providing medication administration services. The compliance officer requested and was not provided with a current drug reference guide. 2. In an interview, E1 and E2 acknowledged there was no current facility drug reference guide available.”

“Based on observation and interview, the manager failed to ensure the premises was free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. During a tour of randomly selected residents' units, E1 and the compliance officer observed in R3's unit's main bathroom the wall corners were broken down to the framing where the metal corners were exposed. These jagged broken areas could cause the resident or other individual to suffer physical injury if the resident's skin rubbed against this area and it allows for mold and mildew to develop. 2. In an interview, E1 acknowledged the bathroom walls in R3's unit were not in good repair which could cause a health and safety issue. .”

“Based on observation and interview, the manager failed to ensure a oxygen container was secured, which posed a safety risk. Findings include: 1. During a tour of randomly selected areas of the facility, E1 and the compliance officer observed in R5's unit there was stored one unsecured oxygen container. 2. In an interview, E1 acknowledged the unsecured oxygen container.”

“Based on observation and interview, the manager failed to ensure poisonous or toxic materials that were stored by the facility was stored in a locked area and inaccessible to residents which is a health and safety risk. Findings include: 1. During a facility tour of randomly selected areas of the facility, the compliance officer observed sitting in the residents' hall on first floor was a housekeeping cart with unlocked chemicals of Zep Professional spray, Clorox toilet bowl cleaner, furniture polish, Bright HP202 cleaner, Lime-away cleaner, stainless steel cleaner, and Tropical Mist. No employee was visible during the observations. 2. In an interview, E1 acknowledged the unattended unlocked housekeeping cart containing poisonous or toxic materials.”

“Based on observation, record review, and interview, the manager failed to ensure one sampled dog residing at the facility was licensed consistent with local ordinances. Finding include: 1. During a facility tour, E1 and the compliance officer observed a dog, O1, residing at the facility with R10. 2. The compliance officer requested and was not provided with any documentation that O1 had a current license from Maricopa County Animal Care and Control. 3. In an interview, E1 acknowledged there was no record that O1 had a current license, as required.”