Silver Bells Adult Care Home.

“Based on observation, documentation review, and interview, the manager failed to implement policies and procedures for discarding expired medication. The deficient practice posed a health and safety risk to a resident if the facility provided a resident with an expired medication. Findings include; 1. During an environmental inspection with E1, the Compliance Officer observed that expired medications were stored in a medication cabinet in the kitchen: Prilosec expired "08/2024." Miralax expired "2024/12." Cough and Cold Syrup expired "07/2021." Orajel Max 20%, for a discharged resident, expired "08/14/2023." Bisacodyl Suppositories, expired "07/20/2022." Acetaminophen suppositories2, expired "07/2022." Fluticasone Nasal Spray, expired, "01/2025." Hemorrhoidal suppository, expired, "01/17/2025." Triamcinolon Cream 0.1% expired "08/07/2021." 2. In documentation review, the facility's medication policies documented, "... 22. Any resident medication which is discontinued by physician's order, ecpired medication, including deseased residents' medication shall be offered back to the resident's respresentative, returned to pharmacy or disposed of by mixing the pills with hot water and cooking flour (coffee grinds, or kitty litter may be used if cooking flour is not available), closing the container's lid on securely and shake... The medication disposal will be recorded in the Medication Disposal Form..." 3. During an interview, E1 acknowledged the facility did not implement its policies and procedures for discarding expired medication.”

“Based on observation and interview, the manager failed to ensure that facility equipment and food contact surfaces were clean. The deficient practice posed a health and safety risk to residents if food surfaces were not maintained in a clean manner.   Findings include:   1. During an environmental inspection with E1, the Compliance Officer observed the facility's oven (inside door) was heavily soiled with a brown/black substance.   2. During an interview, E1 acknowledged the oven was not maintained in a clean manner.”

“Based on documentation review, 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 required patient information was not prepared in case of 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 and E2 reported they were in the process of creating the standardized forms for all residents, and 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 documentation review, record review, observation, and interview, for one of five employees reviewed, the manager failed to establish and document a job description for an employee. The deficient practice posed a risk to the health and safety of residents, if the facility did not establish a job description which covered the duties, and qualifications, including required skills and knowledge, education, and experience for employees and volunteers. Findings include: 1. In observation, the Compliance Officer observed E5 was on site, and worked at the facility during the compliance inspection. 2. In record review, E5's personnel record (hired on November 21, 2023) included a job description, titled "Caregiver Job Description." E5's personnel record did not include documentation E5 completed a caregiver training program, or had a caregiver certificate. 3. During an interview, E1 and E2 reported E5 was a cook and a housekeeper, and was not a caregiver. 4. In documentation review, a review of the facility's policies and procedures revealed the facility did not have a job description for E5's position as a cook and housekeeper. 5. During an interview, E1 and E2 acknowledged the facility did not establish and document policies and procedures covering a job description for a cook and a housekeeper, who was working at the facility, as required pursuant to R9-10-803.C.1.a.”

“Based on observation, record review, and interview, for one of three caregivers reviewed, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services or behavioral health services. The deficient practice posed a health and safety risk to residents, if a caregiver did not have the documented skills and knowledge to provide care and services for a resident. Findings include: 1. In observation, E4 was observed working as a caregiver during the inspection, and was the only certified caregiver on site. 2. In record review, E4's personnel record (hired on November 19, 2023, did not include documentation the caregiver's skills and knowledge were verified and documented before the caregiver provided services to the residents. 3. During an interview, E1 and E2 reported E4 worked at the facility and was a live in caregiver. E1 and E2 acknowledged E4's personnel record did not include documentation E4's skills and knowledge were verified and documented, before providing care and services for residents.”

“Based on record review and interview, for one of three resident records reviewed, the manager failed to ensure an entry in a resident's medical record was not changed to make the initial entry illegible. The deficient practice posed a risk if documentation in a resident's medical record was altered and illegible. Findings include: 1. In record review, E3's medication administration record, dated December 2023, included illegible ink markings for Trazadone medication 50mg, documentation entered on dates December 9-11, and for Trazadone medication 25, mg, documentation entered on December 1 - 13, 4pm. 2. During an interview, E1 reported there was a mix up in the documentation of the Trazadone medication administration, and acknowledged the original entries were written over with a pen, and made illegible.”

“Based on record review, observation, and interview, for one of three residents reviewed, who received medication administration, the manager failed to ensure a resident's medical record included the dosage of a medication administered to a resident. The deficient practice posed a risk if documentation of a medication administered to a resident did not include the dosage administered to the resident, ensuring the resident was administered the correct dosage per the resident's medication orders. Findings include: 1. In record review, R2's medication administration record (MAR), dated December 2023, included documentation R2 received Mirtazapine, daily at 8pm, Haldol twice daily, Triamcinolone twice daily, Citalopram daily, Omeprazole daily, Furosemide daily, and Hydrocodone twice daily, as ordered. However, the MAR did not include documentation of the dosage of the medications that were administered to R2. 2. In observation, R2's medications were observed on site. 3. During an interview, E1 and E2 acknowledged the resident's MAR did not include documentation of the dosage of the medications administered to R2.”

“Based on observation, record review, documentation review, and interview, for one of three residents reviewed, who received a controlled substance, 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 by the facility. Findings include: 1. In observation, R2 had Hydrocodone/APAP Norco medication (a schedule II controlled substance) and Lorazepam Intensol oral concentrate (a Schedule IV controlled substance), on site and stored by the facility. The Hydrocodone/APAP medication bottle indicated 30 tablets of the medication was dispensed on December 12, 2023. The Compliance Officer observed 27 pills remained in the bottle. The Lorazepam medication bottle revealed 6 ml of medication remained in the bottle. 2. In record review, R2's medical record (received directed care and medication administration services) included a medication order for Hydrocodone/APAP Norco; take one tab po 2 x day, and Lorazepam, 2mg, take 0.25ml-0.5ml under the tongue QHS. R2's medication administration record dated December 2023, indicated R2 received the medications, as ordered. R2's record did not include an inventory of the medications. 3. In documentation review, a facility policy, titled "Medications..." documented, "... As soon as possible, medication will be inventoried and placed in the resident's labeled medication bin... Narcotics will be controlled and stored by the facility... Daily narcotic administration will be recorded on each resident MR. As needed narcotic administration will be recorded on the Narcotic Administration Record separate for each resident to ensure proper inventory..." 4. During an interview, E1 and E2 acknowledged an inventory of the resident's controlled substances was not maintained.”

“Based on observation and interview, the manager failed to ensure food stored by the facility was free from spoilage, and was safe for human consumption. Findings include: 1. During an environmental inspection, the surveyor observed expired dry foods stored by the facility. The foods included: four packages of Ramen noodles, dated February 8, 2023, Pudding mix, dated November 21, 2021, Gravy mixes, dated July 19, 2021, September 31, 2021, and January 10, 2022. 2. During an interview, E1 acknowledged the facility stored expired food on the premises.”

“Based on observation and interview, the manager failed to ensure a bathroom which was accessible from a common area contained paper towels in a dispenser or a mechanical hand dryer. The deficient practice posed a potential infection control risk. Findings include: 1. During an environmental inspection, the compliance officer observed two bathrooms accessible from a common area had paper towel dispensers; however, the dispensers were empty, and did not contain paper towels. The bathrooms were observed to have hand towels hanging in the bathroom. 2. During an interview, E1 and E2 acknowledged the bathrooms did not contain paper towels in a dispenser or a mechanical hand dryer.”

“Based on observation, record review, documentation review, and interview, for one of three residents reviewed, who received opioid medication, without an active malignancy or an end of life condition, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record; an identification of the resident's need for the opioid before the opioid was administered, and the monitoring of the effect of the opioid administered. The deficient practice posed a risk to a resident's health and safety if the facility did not appropriately assess and monitor opioid administration for a resident. Findings include: 1. In observation, R2 had Hydrocodone/APAP Norco medication (a schedule II controlled substance), on site and stored by the facility. The Hydrocodone/APAP medication bottle indicated 30 tablets of the medication was dispensed on December 12, 2023. The Compliance Officer observed 27 pills remained in the bottle. 2. In record review, R2's medical record (received directed care and medication administration services) included a medication order for Hydrocodone/APAP Norco; take one tab po 2 x day. R2's medication administration record dated December 2023, indicated R2 received the medication daily December 6 - 14, 2023. R2's record did not include documentation of an identification of the need for the medication, and the monitoring of the effect of the opioid administered. 3. In documentation review, a facility policy, titled, Opioid Prescribing & Treatment, documented, "...document when and how much opioid medication was administered in order to keep track of how much is left... Identify the resident's pain before the ... opioid is administered... Monitor the resident's response to the opioid... " 4. During an interview, E1 and E2 reported the Hydrocodone medication was administered to R2 for pain, and acknowledged the caregivers did not document an identification of the need for the opioid medication, and the monitoring of the effect of the medication administered..”