Royal Paradise Care LLC.

“Based on record review, documentation review, and interview, the manager failed to ensure that a personnel record for each employee included initial training and continued competency training in fall prevention and fall recovery for one of two employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E1’s personnel record revealed the initial fall prevention and recovery training was completed on Febuary 13, 2025. However, there was no documentation for the annual training. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.”

“Based on documentation review, record review, and interview, the manager of an assisted living center who contacted emergency responders on behalf of a resident failed to provide to the emergency responders a written document that included all information required in A.R.S. § 36-420.04, for one of three applicable residents sampled. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident.   Findings include: 1. A review of facility documentation revealed an incident report dated April 14, 2026. The report revealed R3 had been transported to the hospital for back pain. 2. A review of R3's medical record revealed a standardized form that failed to include all information required in A.R.S. § 36-420.04, including basic information about the resident's physical and mental conditions, as well as dates of recent episodes.  3. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeat deficiency from a complaint investigation conducted on June 20, 2025.”

“Based on record review and interview, the manager failed to ensure a resident had a written service plan that was signed and dated by the resident or the resident's representative. This posed a health and safety risk if the resident or the resident's representative did not acknowledge the services that were to be provided.   Findings include:   1. A review of R2's medical record did not include documentation that the resident's service plan was signed and dated by the resident or the resident's representative for the service plan dated March 7, 2026. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeat deficiency from the compliance inspection conducted on June 4, 2024.”

“Based on record review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented the assisted living services in the resident's service plan for one of three sampled residents. The deficient practice posed a risk as services were not documented as being provided per a resident's service plan. Findings include: 1. A review of R1's medical record revealed a service plan dated February 22, 2026. The service plan stated: “Provide incontinence checks every 3-4 hours.” However, in a review of the Activities of Daily Living Sheets for March and April 2026, there was no documentation of incontinence checks. 2. In an interview with E2, E2 reported that the incontinence checks are being completed but not documented. 3. In an exit interview with E1 and E2, the findings were reviewed, and no additional information was provided.”

“Based on record review and interview, the manager failed to provide to the emergency responder a written document that included all required documentation for one of one resident sampled. Findings include: 1. A review of R1's medical record revealed a progress report dated June 15, 2025. The progress report revealed R1 had an accident, emergency, or injury, the facility contacted an emergency responder, and R1 was taken to the hospital. However, the documented information provided to the emergency responder did not include the following: -The reason or reasons the emergency responder was requested on behalf of R1; -The name, address, and telephone number of the resident's current pharmacy; -The point-of-contact information for the assisted living home, including the cell phone number and email address; and -A copy of R1's health insurance portability and accountability act (HIPAA) release authorizing a receiving hospital to communicate with the assisted living home to plan for R1's discharge. 2. In an interview, E1 reported that E1 was not familiar with the entire statute. E1 had not yet updated the facility documentation to include the required information.”

“Based on record review and interview, the manager failed to ensure a service plan included documentation of the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated, for one of three residents reviewed receiving directed care services. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated January 2025. This service plan revealed no documentation of R1's weight. In addition, R1's record revealed no documentation of R1's weight or documentation from a medical practitioner stating weighing R1 was contraindicated. 2. During an interview, E1 acknowledged R1's service plan did not include documentation of R1's weight, and documentation was not available in R1's record from a medical practitioner stating weighing R1 was contraindicated.”

“Based on observation and interview, the manager failed to ensure a food menu was prepared at least one week in advance. Findings include: 1. The compliance Officer observed that a food menu was posted on a bulletin board located in the kitchen area. However, the food menu was dated March 1, 2025, through March 31, 2025.   2. In an interview, E1 reported that a current food menu was not posted. E1 acknowledged that a current food menu was not prepared at least one week in advance.”

“Based on record review, documentation review, and interview, the manager failed to ensure a current therapeutic diet manual was available for use by employees. Findings include: 1. A review of R3's medical record revealed a physician order form signed and dated by a medical practitioner in May 2024. The form stated, "keto diet...". 2. The Compliance Officer requested the facility's current therapeutic diet manual. A printed-out copy from the Maryland Department of Health and Mental Hygiene was dated 2014. However, the Keto diet was not identified in the manual. 3. In an interview, E1 acknowledged that there was no therapeutic diet manual available for review for a keto diet.”

“Based on documentation review and interview, the manager failed to immediately report suspected abuse according to A.R.S. \'a7 46-454. The deficient practice posed a risk as a peace officer or the adult protective services central intake was unable to assess if there was an immediate health and safety concern for the resident and other residents residing in the assisted living facility. Findings include: A.R.S. \'a7 46-454(A) ... other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services (APS) central intake unit ... All of the above reports shall be made immediately by telephone or online. A.R.S. \'a7 46-454(B) If an individual prescribed in subsection A of this section is an employee or agent of a health care institution as defined in section 36-401 and the health care institution's procedures require that all suspected abuse, neglect and exploitation be reported to adult protective services as required by law... R9-10-101(111) "Immediate" means without delay. 1. A review of facility documentation showed an email was sent to the facility on July 10, 2024 from [O1]. The email reported, "[R1] recently told [O1] that [E1] has told [R1] that [E1] loves [R1]! [R1] has responded with the same feelings. [R1] thinks they are in love and [R1] wants [O1] to be happy for [R1]. [O1] see this as a dangerous situation. [O1] would prefer that [E1] not be allowed to handle any of [R1] personal care ..." 2. A review of facility documentation showed an email was sent to the facility on July 12, 2024. This email revealed that E1 has R1's phone number and has called R1. 3. A review of facility documentation showed E1 was taken off the schedule on July 11, 2024. 4. A review of the police report revealed that R1 reported that it was "consensual" and R1 confirmed that E1 and R1 were intimate. 5. In an interview, E2 acknowledged APS was not notified and E2 was not aware that if there was a suspicion of abuse, neglect or exploitation it has to be immediately reported to APS or a peace officer.”

“Based on record review, documentation review and interview, the manager failed to ensure a caregiver's skills and knowledge was verified and documented before providing physical health services and according to policies and procedures, for two of two caregivers sampled. The deficient practice posed a risk to the health and safety of residents if caregivers did not have the skills and knowledge before providing services to residents. Findings include: 1. A review of E1's and E2's personnel file revealed documentation of the verification of E1's and E2's skills and knowledge was not available for review. 2. A review of facility policy and procedures revealed a policy titled, "Caregivers, assistant caregivers, and Volunteers" stated in section 2.C) " ... A caregiver's or assistant caregiver's skills and knowledge are verified and documented before the caregiver or the assistant caregiver provides physical health services or behavioral health services, and according to the policies and procedures." 3. During an interview, E2 looked through E1's and E2's personnel record and acknowledged the skills and knowledge verification documentation was not available for review.”

“Based on record review and interview, the manager failed to ensure a written service plan was signed and dated by the resident or resident's representative, for one of two sampled residents. The deficient practice posed a health and safety risk if the resident or representative did not acknowledge the services that were to be provided. Findings include: 1. A review of R2's medical record revealed a written service plan for personal care services dated February 26, 2024. However, the service plan did not include a signature and date from R2 or R2's representative. 2. In an interview, E1 acknowledged R2's service plan did not include a signature and date from R2 or R2's representative. This is a repeat citation from the previous compliance inspection conducted on February 9, 2023.”