Classic Assisted Living LLC.

“Based on documentation, record review, and interview, for two of two residents reviewed, the facility failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04. The deficient practice posed a risk as the required patient information was not prepared for an emergency.   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 (HIPAA) 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. In record review, the medical records for R1 and R2 did not include a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04, noted above.   3. During an interview, E1 reported having the standardized forms for all residents; however, the forms were not completed. E1 acknowledged the medical records for R1 and R2 did not include a standardized form for each resident that included the information prescribed in A.R.S. 36-420.04.”

“Based on observation, documentation review, record review, and interview, for one of four employees reviewed, the manager failed to have a personnel record for an employee, as required by this Article. The deficient practice posed a risk to resident health and safety if the facility did not obtain documentation showing an employee met the requirements to provide services for the residents, and if the facility provided false or misleading information to the Department.   Findings include:  1. Upon arrival at the facility, the Compliance Officer observed E4 exit a back door from the kitchen and run across the yard while ducking beneath the window. E4 was observed unlocking a gate, which exited to the street, and taking the garbage cans to the sidewalk. 2. During an interview, E4 identified self, and reported ... worked at the facility for three years, from 7 am - 7 pm, with Thursday and Saturday as days off work. 3. During an interview, E2 and E3 were present in the kitchen when E4 exited the facility, and were unsure who E4 was, and said E4 might be a Hospice nurse (O1) who worked with a resident. E2 reported garbage collection day was the day prior, and that E4 was bringing the garbage cans back into the backyard. 4. In record review, the Compliance Officer requested to review E4's personnel record. No personnel record was provided. 5. In an interview, E1 reported not knowing who E4 was, and also said E4 might have been O1. 6. In an interview, R3 (alert and oriented) reported E2 and E4 provided services for R3. R3 observed E4 taking the garbage cans to the curb. 7. During an interview, the Compliance Officer contacted O1, who reported not being present at the facility on the day of the inspection. 8. During an interview, E1 again reported not knowing who E4 was and acknowledged that a personnel record was required for all caregivers who worked at the facility.”

“Based on record review and interview, for one of two residents reviewed, who received directed care services, the manager failed to ensure a resident's written service plan was reviewed and updated at least once every three months. The deficient practice posed a risk if a resident's service plan was not updated to reinforce and clarify services, and a caregiver was not aware of the services to be provided for a resident.   Findings include:   1. In record review, R1's medical record (received directed care services) included a service plan dated December 24, 2024. The record did not include an updated service plan every three months, as required.    2. During an interview, E1 acknowledged R1's service plan was not updated every three months, as required.”

“Based on observation and interview, the manager failed to ensure medication was stored in a locked manner. The deficient practice posed a safety risk to residents if medications were accessible. Findings include: 1. During an environmental inspection, the Compliance Officer (CO) observed a key in a kitchen cabinet. The unlocked cabinet contained resident medications in prefilled medisets. The CO did not observe staff were administering medication to residents. 2. During an interview, E1 and E2 observed the key was left in the medication cabinet, and acknowledged the facility was required to store medication in a locked manner. 3. This is a repeat deficiency from the inspection conducted on November 14, 2023.”

“Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months. The deficient practice posed a health and safety risk to residents and employees if the disaster plan was not up-to-date to meet the needs of the residents during a disaster.   Findings include:   1. In documentation review, the facility's disaster plan was last reviewed on January 10, 2024, and was not reviewed at least once every 12 months.   2. During an interview, E1 acknowledged the facility's disaster plan was not reviewed at least once every 12 months.”

“Based on observation and interview, for two common bathrooms, the manager failed to ensure the bathroom contained paper towels in a dispenser or a mechanical air hand dryer. The deficient practice posed a potential risk to infection control. Findings include: 1. During an environmental inspection, two common bathrooms did not have a dispenser for paper towels or a mechanical air hand dryer. A used paper towel roll was observed on its side on a shelf. 2. During an interview, E1 acknowledged the facility was required to have paper towels in a dispenser or a mechanical air hand dryer in a common bathroom.”

“Based on record review, and interview, for three of three residents who had a health care power of attorney (POA), the manager failed to ensure a resident's medical record contained a copy of the (POA) documentation. The deficient practice posed a risk if the facility did not obtain and adhere to a resident's documentation of representation. Findings include: 1. In record review, R1's, R2's, and R3's medical records indicated R1, R2, and R3, had POAs, who signed the residents' acceptance documentation and service plans. The medical records for R1, R2, and R3 did not include a copy of the residents' POA documents. Based on the residents' acceptance dates, this documentation was required to be in the residents' records. 2. During an interview, E1 and E4 reported R1, R2, and R3, had a POA, and acknowledged the residents' medical records did not include a copy of the residents' POA documentation.”

“Based on observation, record review, and interview, for one of three residents reviewed, who was unable to walk, even with assistance, and received personal care services, the manager failed to ensure the resident's primary care provider (PCP) or other medical practitioner (MP) examined the resident at the onset of the condition and at least every six months throughout the duration of the resident's condition, reviewed the facility's scope of services, and signed and dated a determination stating the resident's needs were being met by the facility. The deficient practice posed a health risk to a resident if a resident's condition was not reviewed by a PCP or MP, to approve a resident's stay at the facility. Findings include: 1. In observation, the surveyor observed R1 at the facility during the inspection. 2. In record review, R1's medical record included documentation of a signed determination, dated January 20, 2022. R1's record did not include a signed and dated determination since January 20, 2022, as required. 3. During an interview, E1 reported R1 was unable to walk, even with assistance, since admission, and continued to be unable to walk. E1 acknowledged R1's record did not include a signed and dated determination stating the residents' needs could be met by the facility.”

“Based on observation and interview, for the facility which provided directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area which controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a health and safety risk to residents as an unlocked door provided access to the outside, without alerting employees. Findings include: 1. In observation, the compliance officer observed seven residents at the facility. During an environmental inspection, the compliance officer observed an unlocked sliding door, which exited to the backyard patio. The door did not control or alert employees of the egress of a resident from the facility. 2. During an interview, E1 acknowledged the door, which allowed exit to the backyard, did not have an alarm, and did not alert employees of the egress of a resident. 3. Technical assistance was provided during the compliance inspection conducted on September 22, 2022.”

“Based on observation and interview, the manager failed to ensure medication stored by the facility was stored in a separate locked area, used only for medication storage. The deficient practice posed a risk if medications were not stored separately with medications only. Findings include: 1. During an environmental inspection, the surveyor observed a refrigerator in a locked closet, in a hallway by resident rooms. The refrigerator contained food and drink, and had three packages of suppositories stored on a shelf on the refrigerator door. 2. During an interview, E1 reported the refrigerator was in a locked closet, and the suppositories belonged to residents. E1 acknowledged resident medications were required to be stored in a separate locked area used only for medication storage.”

“Based on observation, record review, documentation review, and interview, for one of three residents reviewed, who received controlled substances, the manager failed to ensure policies and procedures were implemented for inventorying controlled substances. The deficient practice posed a risk if controlled substances were not inventoried and accounted for. Findings include: 1. In observation, the facility had Lorazepam medication (a Schedule IV Controlled Substance), for R1, stored by the facility. The medication container indicated 30 pills were dispensed on March 21, 2023. The compliance officer observed 46 pills in the medication container. 2. In record review, R1's medical record included a physician's order for the Lorazepam medication; 0.5mg take one tablet by mouth every four hours, as needed. There was no documentation of an inventory of the Lorazepam. 3. In documentation review, a facility policy titled, "Storing, Inventorying and Dispensing of Controlled Medications," on page 56, documented, "... When a controlled medication is received from the pharmacy (or the resident at the time of move-in), the RN or other designated staff person should count the number of tablets/capsules and enter this number on the Narcotic Inventory Sheet in the "Amount Received" column. The date, time, and signature of the person should also be entered on this form... Maintain Narcotic Inventory Sheets with the resident's current medication record...When assisting a resident in taking a controlled medication, a staff member should: Turn to the Narcotic Inventory Sheet with identifying information that corresponds to the label on the medication container. Write in the date, time and signature on the next blank line on the Narcotic Inventory Sheet... The number of each controlled medication on hand must be counted monthly, with this number compared to the last number in the "Amount Remaining" column on the Narcotic Inventory Sheet..." 4. During an interview, E1 reported being unaware Lorazepam was to be inventoried as a controlled substance. E1 and E4 acknowledged the facility stored and administered the Lorazepam medication, and did not maintain an inventory of the controlled substance per the facility's policy and procedures.”