Paradise Home in Phoenix.

“Based on documentation review and interview, the assisted living center failed to provide the required documentation to an emergency responder when an emergency responder had been contacted. Findings include: 1. A review of facility documentation revealed a "Incident report form" dated August 24, 2024. The documentation included all information required except the reason the emergency responder was requested on behalf of the resident, pharmacy information, basic medical history, and point of contact for the facility. 2. In an interview, E3 acknowledged documentation to an emergency responder when an emergency responder had been contacted had not included the reason the emergency responder was requested on behalf of the resident, pharmacy information, basic medical history, and point of contact for the facility.”

“Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under Arizona Revised Statutes (A.R.S.) \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06. The deficient practice posed a risk if the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. A review of Department documentation revealed the previous manager for the facility resigned from the facility effective February 1, 2024. 2. During the environmental inspection of the facility, the Compliance Officer observed a managers license posted on the wall for E1. 3. In an interview, E3 reported E1 had been the facility manager since July 5, 2024. They had another manager from a period of March 1, 2024 to June 1 2024, and had gaps with no manager from February 1, 2024 to March 1, 2024 and from June 1, 2024 to July 5, 2024. E3 was not aware the Department had not been notified of these changes. 4. In an interview, E3 acknowledged the governing authority failed to designate, in writing, a manager who had either a certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. \'a7 36-446.06.”

“Based on documentation review, observation, record review and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before providing physical health services and according to policies and procedures, for two of three caregivers sampled. The deficient practice posed a risk if an employee did not possess required skills and knowledge to ensure the health and safety of residents. Findings include: 1. A review of facility documentation revealed a policy titled "Employees and Orientation and On-going Training Policy and Procedures." The policy stated "New staff will be given an orientation form/skills/knowledge verification form and it will be completed...before providing services to residents." 2. A review of E3's personnel record revealed a skills and knowledge verification form. However, the document had not included the employee name, completion date, or initials of the employee completing the skills and knowledge verifications. 4. A review of E4's personnel record revealed no documentation to indicate E4's skills and knowledge were verified before E4 provided services and according to policies and procedures. 5. In an interview, E3 acknowledged E3's and E4's skills and knowledge were not verified and documented before E3 and E4 provided physical health services, and according to policies and procedures.”

“Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, was only assigned to provide the assisted living services the caregiver or assistant caregiver had the documented skills and knowledge to perform, and documented the services provided in the resident's medical record, for one of five sampled residents. The deficient practice posed a risk if a resident did not receive required services from a qualified employee to meet their needs, and services could not be verified as provided against a service plan. Findings include: 1. A review of R5's medical record revealed Activities of Daily Living (ADL) sheets while R5 was residing in the home was not available for review at the time of inspection. 2. In an interview, E3 acknowledged R5's ADL sheets was not avalailable for review at the time of inspection.”

“Based on documentation review, observation and interview, the manager failed to ensure a resident was not subjected to restraint. The deficient practice posed a potential for physical injury and psychological distress. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(201) states: "Restraint" means "any physical or chemical method of restricting a patient's freedom of movement, physical activity, or access to the patient's own body." 2. During an environmental inspection of the facility, the Compliance Officer observed R6 had a rail on each side of their bed and was currently holding onto the one on his right side. 3. During an environmental inspection of the facility, the Compliance officer observed R2 had a rail on the side of their bed opposite of the wall. 4. In an interview, E3 reported both residents were bedbound and the rails were to help keep the residents from falling out of bed and were requested by hospice. E3 reported if R6 did not have the rails R6 would become very upset. 5. In an interview, E3 acknowledged R2 and R6 were subjected to restraints.”

“Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of freedom from infectious tuberculosis (TB), for five of five residents sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-113(B)(2)(a-b) states: "B. A health care institution's chief administrative officer shall: 2. As part of the annual assessment of the health care institution's risk of exposure to infectious tuberculosis according to subsection (A)(2)(d), ensure that documentation is obtained for each individual required to be screened for infectious tuberculosis that: a. Indicates the individual's freedom from symptoms of infectious tuberculosis; and b. Is signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101." 2. A review of R1's, R2's, R3's, R4's and R5's medical records revealed documentation of freedom from TB. However, documentation of TB screening was not available for review at the time of inspection. 3. In an interview, E3 acknowledged failure to ensure a resident's medical record contained documentation of freedom from infectious tuberculosis.”

“Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order and documented in the resident's medical record, for one of five residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration. Findings include: 1. In an interview, E3 reported all residents received medication administration services. 2. A review of R3's medical record revealed a signed medication order list for the following medications: -Capecitabine 500 MG take three tablets by mouth every 12 hours; and -Glargine-YFGN insulin pen inject 4 units every night at bedtime. However, these medications were not documented as administered at the following dates: -Capecitabine from August 20, 2024 to August 24, 2024; and -Glargine-YFGN from August 20, 2024 to August 24, 2024. 3. In an interview, E3 reported not administering medication because E3 was waiting on salibas to deliver. E3 had attempted alternative routes to obtain medication but was unable to obtain them. 4. In an interview, E3 acknowledged medication was not provided in compliance with an order.”

“Based on documentation review and interview, the manager failed to ensure the disaster plan required in subsection (A)(1) was reviewed at least once every 12 months. The deficient practice posed a risk if facility staff were unable to implement the disaster plan. Findings include: 1. A review of facility documentation revealed documentation of a disaster plan review conducted every 12 months was not available for review at the time of inspection. 2. In an interview, E3 acknowledged the manager failed to ensure the disaster plan required in subsection (A)(1) was reviewed at least once every 12 months.”

“Based on documentation review and interview, the manager failed to ensure an employee disaster drill 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. A review of facility documentation revealed a disaster drill conducted on March 1, 2023. However, documentation of a disaster drill conducted after March 1, 2023 was not available for review at time of inspection. 2. In an interview, E3 acknowledged disasters drills were not conducted every three months on each shift and documented.”

“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. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. During an environmental inspection of the facility the Compliance Officer observed broken window in R2's and R4's bedroom. The inside pane of the window was broken, with edges hidden behind a curtain. The outside window glass was still intact. 2. During an environmental inspection of the facility the Compliance Officer observed the backyard gate latch kept closed with a twisted piece of metal. The Compliance Officer could not easily remove the piece of metal to open the gate. 3. In an interview, E3 acknowledged the premises was not free from a condition or situation that may cause a resident or other individual to suffer physical injury. This is a repeat deficiency from the inspection conducted on April 27, 2023.”

“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. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed an cabinet underneath the sink. The locks on the cabinet had been disengaged and contained the following items: -A can of "Method antibac all purpose cleaner"; -A bottle of Febreeze "Unstopables" fabric spray; and -A bottle of Kroger Glass Cleaner with an unidentified clear liquid in the container. 2. In an interview, E3 acknowledged the sink where toxic materials were kept was not locked and inaccessible to residents. This is a repeat deficiency from the inspection conducted on April 27, 2023.”

“Based on observation and interview, the manager failed to ensure equipment used at the assisted living facility was maintained in working order. Findings include: 1. During an environmental inspection of the facility the Compliance Officer the garage lights were not functioning, and the garage was dark. The Compliance Officer asked E4 to turn on the lights. However, E4 opened the garage door to allow sunlight into the garage. The Compliance Officer observed a light source with bulbs on the ceiling of the garage. 2. In an interview, E4 reported needing to open the garage to let light into the garage, and the lights were not functional. 3. In an interview, E3 acknowledged the lights in the garage were not in working order. This is a repeat deficiency from the inspection conducted on April 27, 2023.”