Aimee's Arizona Angels.

“Based on record review and interview, the health care institution's chief administrative officer failed to ensure training and education related to recognizing the signs and symptoms of tuberculosis (TB) was provided annually to individuals employed by the health care institution, for three of four personnel records reviewed. The deficient practice posed a potential illness risk to residents.  Findings include: 1. A review of E1's personnel record did not include documentation of completed training on recognizing the signs and symptoms of TB. Based on E1's date of hire, this documentation was required. 2. A review of E2's personnel record did not include documentation of completed training on recognizing the signs and symptoms of TB. Based on E2's date of hire, this documentation was required. 3. A review of E4's personnel record did not include documentation of completed training on recognizing the signs and symptoms of TB. Based on E4's date of hire, this documentation was required. 4. In an interview, E1 acknowledged that training and education related to recognizing the signs and symptoms of TB were not provided.”

“Based on observation and interview, the manager failed to ensure the premises 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 posed potential dangers to residents.   Findings include:   1. The Compliance Officer observed one ambulatory resident.   2. During the environmental inspection, the Compliance Officer observed the following in the backyard: -A shed in the backyard was unlocked and opened. The Compliance Officer was able to reach inside the shed and had access to the various gardening tools stored within.   -A large rolled-up area rug leaning against the wall on the back porch and large pieces of furniture and debris were scattered throughout the yard in various places.     3. During the environmental inspection, in R3's bedroom, the Compliance Officer observed that the bed was bent in the middle and was being held up by a box underneath the bed. 4. In an interview, E1 acknowledged that the premises 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 observation and interview, the manager failed to ensure that 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, the Compliance Officer observed one bag of "Grow Plants potting mix" and one gallon bottle of "Western States Vitamin B-1 Chelating Agent" in an unlocked plastic storage bench in the backyard. The cabinet and bench did not have a locking device.    2. In an interview, E1 acknowledged that the poisonous or toxic materials were accessible to residents and stored unlocked.”

“Based on a documentation review, observation, and interview, for a facility authorized to provide directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area which allowed a resident to be at least 30 feet away from the facility and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A documentation review of Department records revealed the facility was licensed to provide directed care services. 2. During an environmental inspection of the facility, the Compliance Officer's observed an exit door to the backyard had a door alarm, however, the alarm was turned off. 3. In an interview, E1 acknowledged there was a means of exiting the facility to an outside area allowing a resident to be at least 30 feet away from the facility which did not control or alert employees of the egress of a resident from the facility.”

“Based on a documentation review, record review and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for five of five residents sampled who received medication administration services. The deficient practice posed a risk as the Department was provided false or misleading information. Findings include: 1. A review of R1's medical record revealed a service plan, updated January 12, 2024, for supervisory care services including medication administration. A review of R1's medical record revealed a September 2024 medication administration record MAR. The MAR did not include documentation of the following medication administered on September 18, 2024: -"Allopurinol-100mg 4 tabs PO QD 08:00" - "Amlodipine 10mg 1 tab PO QD 08:00" -"Furosemide 40mg 1 tab PO QD 08:00" -"Lisinopril 40mg 1 tab PO QD 08:00" -" Potassium 10meq 2 tabs PO QD 08:00" -"Tiotropium 2.5mcg 2 Puffs QD 08:00", and "Zoloft 100mg 1 tab PO QD." 2. A review of R2's medical record revealed a service plan, updated December 31, 2023, for directed level of care services including medication administration. A review of R2's medical record revealed a September 2024 medication administration record MAR. The MAR did not include documentation of the following medication administered on September 18, 2024: -"Acidophilus 1 tab PO QD 08:00" -"Isosorbide Mononitiate 30mg 1 tab PO QD 08:00" -"Sertialine 100mg .5 tab PO QD 08:00" -"Spironolactone 25mg 1 tab PO QD 08:00" -"Torsemide 10mg 1 tab PO QD 08:00" -"Ondansetron 4mg 1 tab PO BID 08:00, 16:00" and -"Carvedilol 6.25mg PO BID 08:00, 8pm." The 8pm medication revealed initial's from the facility staff with the medication administered. 3. A review of R3's medical record revealed a service plan, updated August 13, 2024, for directed level of care services including medication administration. A review of R3's medical record revealed a September 2024 medication administration record MAR. The MAR did not include documentation of the following medication administered on September 18, 2024: -"Aspirin 81mg 1 tab PO QD 07:30" -"Cetirizine 10mg 1 tab PO QD 07:30" -"Duloxetine 30mg 1 CAP PO QD 07:30" -"Feirous Sulfate 325mg 1 tab PO QD 07:30" -"Glipizide 5mg 1 tab PO QD 07:30" -"Oxybutynin 5mg 1 tab PO QD 07:30" and -"Methenamine Hippurate 1gm 1 tab PO BID 07:30, 20:00." The 20:00 medication revealed initial's by facility staff indicating the medication was administered. 4. A review of R4's medical record revealed a September 2024 medication administration record MAR. The MAR did not include documentation of the following medication administered on September 18, 2024: -"Amlodipine 5mg 1 tab PO QD 08:00" and -"Citalopram 20mg 1 tab PO QD 08:00." 5. A review of R5's medical record revealed an initial service plan, dated August 17, 2024, for personal level of care services including medication administration. A review of R5's medical record revealed a September 2024 medication administration record MAR. The MAR did not include documentation of the following medication administered on September 18, 2024: -"Duloxetine 60mg 1 tab PO QD 09:00" -"Ascorbic Acid 500mg 1 cap PO QD BID 09:00, 20.00" -"Levothroxine 50mcg 1 tab Po QD 09:00" -"Methocarbamol 100mg 1 tab PO QID 06:00, 12:00, 17:00, 22:00" -"Zinc Sulfate 220mg 1 cap Po QD 09:00" -"Multivitamin 1 tab PO QD 09:00" and, -"Senna 8.6mg 2 tabs PO BID 09:00, 20:00." -"Ascorbic Acid 500mg 1 cap" had facility staff initialed as taken for 20:00 hour. A review of R5's medical record revealed a series of progress notes which confirmed R5 went to the hospital on August 30, 2024, and was not in the facility for several days thereafter. The review revealed a "Patient Discharge Instructions" document which confirmed R5 was released from the hospital in the early afternoon on September 3, 2024. However, the aforementioned MAR for September 2024 revealed the following: - No documentation of R5 having received several scheduled medications at 9:00 AM on September 4, 2024, due to R5 being "OOF," meaning "Out of Facility," even though R5 had returned to the facility the day before; and - Documentation of R5 having received linezolid at 9:00 AM on September 3, 2024, even though R5 had not yet returned to the facility. 6. In an interview, E1 reported R5 was sent to the hospital on August 30, 2024, and returned to the facility in the early afternoon on September 3, 2024. 7. During an interview, E1 acknowledged R1,R2,R3,R4,and R5's MAR did not include documentation from facility staff on the MAR on September 18, 2024. E1 reported R5 received R5's scheduled medications on September 4, 2024, and facility staff made a mistake in incorrectly documenting the administrations on September 3-4, 2024.”

“Based on documentation review, observation, record review, and interview, a person established, conducted, and maintained a health care institution without a current and valid license issued by the Department. The deficient practice posed a risk as the unlicensed operation or maintenance of a health care institution is prohibited and is declared a nuisance inimical to the public health and safety, per Arizona Revised Statutes (A.R.S.) \'a7 36-430. Findings include: 1. A.R.S. \'a7 36-407(C) states: "The licensee may not transfer or assign the license. A license is valid only for the premises occupied by the institution at the time of its issuance." 2. During the environmental inspection of the facility conducted on September 5, 2023, the Compliance Officer observed four residents and two caregivers. The Compliance Officer also observed a locked medication cart. 3. A medical record review revealed resident binders, residency agreements, medication administration records, and documentation of assisted living services provided to residents. 4. In an interview, E1 reported O1 sold the business to E1 on June 1, 2023. E1 reported O1 sold the business, but not the LLC. E1 reported the facility provided assisted living services to four residents at the time of the inspection. El reported having at least four residents since June 1, 2023. E1 reported E1 had not yet submitted an application for licensure, but was in the process of doing so. E1 reported O1 did not continue to operate the health care institution as O1 should have while E1 was applying for licensure. 5. A review of Department documentation revealed this address was licensed as an assisted living home named and owned by Angels on Duty Assisted Living LLC. The review revealed no notice notifying the Department the facility had been sold. 6. In a telephonic interview, O1 reported O1 sold E1 the business on June 1, 2023. O1 reported not knowing O1 needed to notify the Department of the sale despite prior conversations with the Compliance Officer on this topic regarding other facilities O1 had been involved in. 7. In an email received at 10:54 AM on September 5, 2023, O1 stated: "To Whom It May Concern, [O1] sold Arizona Angels Assisted Living [was Arizona Angels, is now Angels on Duty Assisted Living LLC] to [E1] on June 1, 2023." 8. A documentation review revealed a document titled "PURCHASE AGREEMENT" dated May 31, 2023. The agreement stated: "Angels on Duty Assisted Living agrees with [E1] to purchase Angels on Duty Assisted Living Las Flores that is currently owned by [O1]. The Terms of the agreement are that [E1] will pay [O1] Owner of Angels on Duty Assisted Living Las Flores a total of [amount] for Angels on Duty Assisted Living." The agreement was signed by O1 and E1. 9. A review of R1's, R2's, R3's, and R4's medical records revealed residency agreements. The agreements revealed R1, R2, R3, and R4 were residents of the home since before the date of the sale. 10. A review of Department documentation revealed an initial application for AL12778 was received on September 21, 2023. 11. During an initial inspection conducted on May 2, 2024, the Compliance Officer observed five residents. 12. A medical record review revealed medical records for five residents. The review revealed the home was providing unlicensed care after June 1, 2023, when Angels on Duty Assisted Living LLC was sold. 13. A review of Department documentation revealed the license for this facility (AL12778) was effective on July 11, 2024.”