Maryland Gardens Assisted Living.

“Based on record review and interview, before or within five working days after a resident's acceptance by an assisted living facility, the manager failed to obtain on the residency agreement, the signature of the resident, the resident's representative, the resident's legal guardian, or another individual who has been designated by the individual under A.R.S § 36-3221 to make health care decisions on the individual's behalf for one of three residents sampled.   Findings include: 1. A review of R1's medical record revealed a residency agreement; however, the residency agreement was not signed by R1 or R1's representative. Based on R1's acceptance date , this documentation was required. 2. In an interview, E1 acknowledged that R1 residency agreement did not include the signature of the resident or the resident's representative.”

“Based on observation and interview, the manager failed to ensure there was a current toxicology reference guide that was available for use by personnel members.  Findings include: 1. The Compliance Officer requested the current toxicology reference guide. However, the toxicology reference guide was not provided to the department for review.  2. In an interview, E1 acknowledged that the facility did not have a toxicology reference guide available for use by personnel members”

“Based on documentation review and interview, the manager failed to ensure documentation of the monthly testing of the facility's smoke detectors was maintained for at least 12 months after the date of the test. The deficient practice posed a risk to the health and safety of residents if the fire alarm system was not working properly. Findings include: 1. During a review of facility documentation the surveyor requested documentation indicating smoke detectors at the facility were tested each month. No documentation was provided. 2. In an interview, E1 acknowledged there was no documentation indicating the facility's smoke detectors were tested monthly.”

“Based on observation, record review, interview, and documentation review, the manager failed to ensure policies and procedures were established, documented, and implemented to protect the health and safety of a resident that covered methods by which the assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide. The deficient practice prevented the facility's staff from ensuring the health and safety of the resident, as R1 was missing from the facility, and was not found. Findings include: 1. In observation, R1 was not observed at the facility during the investigation. 2. In record review, R1's medical record included documentation R1 was not able to be located at the facility following the lunch meal on November 15, 2024. R1 was last observed sitting on a bench in the outdoor common area located near the lunch room. 3. During an interview, the Compliance Officer requested to review the facility's policies and procedures which covered methods by which the facility was aware of the general or specific whereabouts of the residents. E1 reported the facility did not have a documented policy; however, reported the caregivers monitored the whereabouts of the residents of the facility. E1 reported the caregivers observed R1 sitting on a bench in the outdoor common area at 12:35pm on November 15, 2024. At approximately 1:05-1:10 pm the caregiver was not able to locate R1, and reported R1's absence to E5. E1 reported R1 was not located and R1's whereabouts were unknown. 4. In documentation review, the facility did not have policies and procedures that covered methods by which the facility was aware of the general or specific whereabouts of a resident.”

“Based on observation, documentation review, and interview, the manager failed to ensure the facility's premises were cleaned and disinfected, to prevent, minimize, and control illness or infection. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed R2's residential unit #12 had a strong urine odor and the floors were "sticky." The residential unit #5 also had "sticky" floors. The Compliance Officer observed an area on the other side of a locked gate (located by resident units) that was littered with garbage and refuse to include, but not limited to the following: trash cans uncovered and filled with trash, a storage cabinet on the ground, multiple bed frames, five gallon paint buckets, paper and plastic cups, wood pieces, clothing items, etc. The area smelled of urine. 2. During an interview, E1 reported the residents who occupied the residential units had issues with urinating, and a resident urinated in the area where the garbage and refuse was stored. 3. In documentation review, a facility policy, titled, 'Environmental Standards," dated August 1, 2023, documented, "... The premises and equipment used at the ... facility are ... cleaned and if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness and infection... However, the facility's policy did not include the procedures the facility would implemented to ensure a clean and disinfected environment. 4. During an interview, E1 acknowledged the residential units and the area located by the residential units, were not maintained in a clean manner.”

“Based on observation, documentation review, and interview, the manager failed to ensure that garbage and refuse were stored in covered containers. The deficient practice posed a health risk to residents. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed an area on the other side of a locked gate (located by resident units) that was littered with garbage and refuse to include, but not limited to the following: trash cans uncovered and filled with trash, a storage cabinet on the ground, multiple bed frames, five gallon paint buckets, paper and plastic cups, wood pieces, clothing items, etc. 2. In documentation review, a facility policy, titled, 'Environmental Standards," dated August 1, 2023, documented, "... Garbage and refuse are... stored in covered containers lined with plastic bags, and ... removed from the premises at least once a week..." 3. During an interview, E1 reported the residents threw trash in the area. E1 acknowledged the facility was required to store garbage and refuse in covered containers.”

“Based on observation, documentation review, and interview, the manager failed to ensure soiled linen and soiled clothing stored by the facility was stored in closed containers. The deficient practice posed a risk. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed the laundry room and outside area had soiled linen stored in uncovered containers. Lids were observed to be stored against a wall; however, were not being used. The laundry containers had soiled linens piled high above the container. 2. In documentation review, a facility policy, titled, 'Environmental Standards," dated August 1, 2023, documented, "... soiled linen and soiled clothing stored by the assisted living facility are maintained separate from clean linen and clothing and stored in closed containers..." 3. During an interview, E1 acknowledged the soiled linen and clothing stored by the facility was not stored in a closed container.”

“Based on observation, and interview, the manager failed to ensure a resident's sleeping area was not used as a common area. Findings include: 1. During the environmental inspection with E1, the Compliance Officer observed the residential units numbered 1, 2, 7, 9, and 12 had a common area and separate bedrooms, which were occupied by residents. These units had a bed in the common area, and units 1, 7 and 12 were observed to have residents sleeping in the beds in the common area. 2. During an interview, R2 was observed in a bed in the common area of unit 12, and reported [R2] resided there for approximately four months. R3 was observed in a bed in the common are of unit 7 and reported [R3] had resided there for approximately three months. 3. During an interview, E1 reported the residents resided in the common areas of the units because the facility was completing renovations of the residential units. E1 acknowledged a resident's sleeping area was used as a common area.”

“Based on observation and interview, for five residential units observed, the manager failed to ensure that each sleeping area had clean linen, including a mattress pad. Findings include: 1. During an environmental inspection with E1, the Compliance Officer observed the beds in units 2, 5, 10, 11, and 12, did not have mattress pads. The beds were observed to have one fitted sheet and a blanket. 2. During an interview, E1 reported the residents' beds were furnished by the facility, and acknowledged the residents' sleeping areas did not have mattress pads, and were required to have clean linen, including a mattress pad, sheets large enough to tuck under the mattress, pillows, pillow cases, a bedspread, waterproof mattress covers as needed, and blankets to ensure warmth and comfort for the resident, per R9-10-820.D.7.b.”

“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 one of three residents sampled accepted by the assisted living facility on or after October 1, 2013. 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 no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged documentation was not available that showed R1 provided documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.”

“Based on record review and interview, the manager failed to ensure 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 which included the requirements in R9-10-807(D)(1-10) for one of three 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 R2's medical record revealed no documented residency agreement dated before or at the time of R2's acceptance into the facility. 2. In an interview, E1 acknowledged there was no documented residency agreement dated before or at the time of R2's acceptance into the facility at the time of the inspection. E1 reported R2's family were handed the residency agreement and did not return the agreement to the facility.”

“Based on record review and interview, the manager failed to ensure at the time of admission, a resident or resident's representative received a written copy of the requirements in subsection (B), for one of three residents sampled. The deficient practice posed a risk as individuals were not informed of the resident requirements. Findings include: 1. A review of R2's medical record revealed no documentation showing the resident or resident's representative received a copy of the requirements in subsection (B). Based on R2's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged the documentation showing the resident or resident's representative received a copy of the resident rights was not available during the time of the inspection.”

“Based on documentation review, record review, and interview, the manager failed to ensure a resident's orientation to the assisted living facility's evacuation plan and the route to be used was documented. 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 R2's medical record revealed no documentation of orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility. Based on R2's date of acceptance, this documentation was required. 2. In an interview, E1 acknowledged R2's medical record did not include documentation R2 received orientation to exits from the assisted living facility and the route to be used when evacuating the assisted living facility.”

“Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a health and safety risk to residents with access to the poisonous or toxic materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed "Bright Solution Klearview Glass and Multi-surface Cleaner" and "Apple Jack Non-acid Bathroom Cleaner" stored in an accessible cabinet under the common area sink. The cabinet did not have a locking device installed. 2. In an interview, E1 acknowledged the aforementioned poisonous or toxic materials were not stored in a locked location and inaccessible to residents.”