Angels Home Assisted Living Care LLC.

“Based on observation and interview, the governing authority failed to designate, in writing, a manager who either had a certificate as an assisted living facility manager issued under Arizona Revised Statutes (A.R.S.) § 36-446.04(C), or a temporary certificate as an assisted living facility manager issued under A.R.S. § 36-446.06. The deficient practice posed a risk as the assisted living facility was unable to ensure compliance with applicable Rules. Findings include: 1. During a tour of the facility, the Compliance Officer observed no assisted living facility manager license posted in the facility.   2. In an interview, E1 reported E5 had decided not to continue as the manager after the facility was licensed. 3. In a phone interview, E5 reported E5 decided not to continue as manager in December 2024, sometime before Christmas.  4. E1 advised that E5 agreed to continue after their conversation in December and provided the Compliance Officer text messages from E5. The text message from E1 to E5 on January 28, 2025 stated, “Hello [E5], just wanted to know if you are still interested to continue working with me please if not let me know so I can see what to do I consider you first because we started some things together." E5 replied to E1 by text message on January 29, 2025 stating, “Good morning, I continue to stand with my notice sent to you in email dated Dec 21, 2024. I wish you all the best and should you have any future concerns feel free to send me an email.” 5. In an interview, E1 acknowledged the facility had no current assisted living facility manager at the time of inspection. E1 reported having an appointment at a school to become a licensed manager as well as connections with two other licensed managers to assist and possibly agree to be an interim manager.”

“Based on observation and interview, the manager failed to ensure the assisted living facility's license, the current phone numbers of the unit in the Department responsible for licensing and monitoring the assisted living facility, Adult Protective Services in the Department of Economic Security, the State Long-Term Care Ombudsman, and the Arizona Center for Disability Law were conspicuously posted. Findings include: 1. During tour of the facility, the Compliance Officer observed no evidence of postings to include, the facility's license, or the current telephone numbers of the unit in the Department responsible for licensing and monitoring the assisted living facility, Adult Protective Services in the Department of Economic Security, the State Long-Term Care Ombudsman, and the Arizona Center for Disability Law. 2. In an interview, E1 acknowledged the required documents were not conspicuously posted because the postings had been removed for an appraisal and needed to be re-hung.”

“Based on observation, interview, documentation and record review, the manager failed to ensure personnel records included items required in R9-10-806(C)(1), for one of two employees sampled. Findings included: 1. A review of facility documentation revealed a binder with timesheets for employees including hours worked by each employee. The documentation revealed E3 worked on March 16, 17, and 18, 2025. The documentation revealed E4 worked on March 3, 5, 6, 7, 10, 12, and 14, 2025.   2. In an interview, E1 reported E3 was an assistant caregiver and E4 was a caregiver.  3. E1 was unable to provide personnel records for E3 and E4.   4. In an interview, E1 acknowledged not having personnel records for E3 and E4, which included items required in R9-10-806(C)(1).”

“Based on record review and interview, the manager failed to ensure before or at the time of an individual's acceptance by an assisted living facility, there was a documented residency agreement with the assisted living facility which included the requirements in R9-10-807(D)(1-10) for three of seven resident records reviewed.  Findings include:  1. A review of R1's, R3’s, and R7’s medical record revealed no documented residency agreement. 2. In an interview, E1 reported having taken all documents home to work on and was sure there was a residency agreement for R1. E1 reported R3 did not have a residency agreement and was only in the home for daycare on Mondays, Wednesdays, and Fridays. E1 reported R7 was accepted by the previous manager and E1 has asked R7’s power of attorney to relocate R7. E1 acknowledged no written eviction notice had been issued. 3. In an interview, E1 acknowledged the residency agreement for R1 was not available, and the residency agreements for R3 and R7 were not completed.”

“Based on record review, and interview, before or within five working days after a resident's acceptance by an assisted living facility, the manager failed to obtain on the residency agreement, the signature of the resident, the resident's representative, the resident's legal guardian, or another individual who has been designated by the individual under A.R.S. § 36-3221 to make health care decisions on the individual's behalf, for seven of seven resident records reviewed.  Findings include: 1. A review of R1's medical record revealed no residency agreement.  2. A review of R2's medical record revealed a residency agreement, which was signed by the resident or resident’s representative on February 17, 2025. Based on R2's date of admission, this was more than five working days after acceptance. 3. A review of R3's medical record revealed no residency agreement. E1 reported R3 was only in the facility during the day on Monday, Wednesday, and Friday. 4. A review of R4's medical record revealed a residency agreement, which was signed by the resident or resident’s representative on February 17, 2025. Based on R4's date of admission, this was more than five working days after acceptance. 5. A review of R5's medical record revealed a residency agreement, which was not signed by the resident or resident’s representative. 6. A review of R6's medical record revealed a residency agreement, which was signed by the resident or resident’s representative on February 16, 2025. Based on R6's date of admission, this was more than five working days after acceptance. 7. A review of R7's medical record revealed no residency agreement. In an interview, E1 reported R7 was asked to move, though R7 was currently receiving services in the facility and no written eviction had been issued. 8. In an interview, E1 acknowledged the manager failed to ensure the residency agreements were signed by the resident or the resident's representative, before or within five working days after the resident's acceptance.”

“Based on record review and interview, the manager failed to ensure a medical record included all required information per R9-10-811.C.1-24. The deficient practice posed a health and safety risk.   Findings include: 1. In an interview, the Compliance Officer requested to review the medical records for R1, R2, R3, R4, R5, R6, and R7, who were observed residing at the facility. 2. E1 reported E1 was in the process of establishing each record and had taken some things home to work on, such as residency agreements and medication administration records. E2 provided the Compliance Officer with a binder from the previously licensed facility, which included basic information for each resident and outdated service plans. E1 provided some medical documentation for R1, including hospice records, two medication administration records partially filled out, and four residency agreements. 3. The Compliance Officer observed medication organizers set up for R1, R2, R3, R4, R5, R6, and R7. However, there was no documentation of the medication administered. E1 acknowledged all of the residents received medication administration, and the facility did not have documentation of the daily medication administered.   4. In an interview, E1 acknowledged not having the initial documentation of the resident's needs required in R9-10-807(B). E1 further reported the medical provider, who comes to the facility, has seen most of these residents for years and has agreed to complete the documentation.   5. In an interview, E1 acknowledged no service plans were available to review for R1, R2, R3, R4, R5, R6, and R7 because they were not developed. E1 reported a nurse would be completing the initial service plans “on Monday.” E1 acknowledged the facility did not have documentation of the services being provided since admission.   6. In an interview, E1 acknowledged R1’s, R2’s, R3’s, R4’s, R5’s, R6’s, and R7’s medical records did not include all documentation required in R9-10-807(B), including but not limited to completed residency agreements, initial documentation of the residents' needs, initial service plans, documentation of services provided, and documentation of medications administered to a resident.”

“Based on 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 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 review of Department records revealed the facility was licensed to provide directed care services. 2. During the on-site inspection, the Compliance Officer observed no alert sounded on the sliding door, leading to the back yard, when a resident exited. Upon further inspection, the Compliance Officer observed the alert was switched to the “OFF” position.   3. In an interview, E1 acknowledged a means of exiting the facility to an outside area, did not control or alert employees of the egress of a resident. E2 turned the alert back on.”

“Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During a tour of the facility, the Compliance Officer observed an open and unlocked cabinet in the kitchen. The cabinet included medication organizers set up with medications in them, labeled "R1," "R2," "R3," "R4," "R5," "R6," and "R7". The Compliance Officer observed bottles of “Acetaminophen,” “Carvedilol," and “Furosemide,” also in the cabinet and accessible to residents. 2. In an interview, E1 reported the they do not have the key to the cabinet and would move the medication until the lock was replaced. 3. In an interview, E1 acknowledged medications stored by the facility were not stored in a locked area.”

“Based on observation and interview, the manager failed to ensure poisonous or 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 the tour of the facility, the Compliance Officer observed a bottle of “Fabuloso” cleaner next to the toilet in an unlocked bathroom, which was accessible to residents.   2. During a tour of the facility, the Compliance Officer observed the following toxic materials in an unlocked cabinet in the laundry room, which was also unlocked and accessible to residents: “Dove Scalp Care 2in1 Anti-Dandruff” Shampoo; “Ultimate Fresh Dryer Sheets”; “Axe” body wash, “Xtra” laundry detergent; “Clorox Daily Shower” cleaner; “Clorox Multi-Purpose” cleaner; “Resolve” carpet cleaner; and “Shout” stain remover”. 3. In an interview, E1 acknowledged the toxic materials were unlocked and accessible to residents.”

“Based on documentation review, observation, and interview, the health care institution failed to ensure the license was valid only for the establishment, operation and maintenance of the class or subclass of health care institution, the type of services and, except for emergency admissions as prescribed by the director by rule, and the licensed capacity specified by the license. The deficient practice posed a risk to the health and safety of residents as the occupancy and operations of the health care institution were outside the scope of the licensed assisted living facility subclass. Findings include: 1. A tour of the facility revealed seven residents in the facility.   2. A review of Department records revealed the facility was licensed to operate as an “Assisted Living Home” with a total capacity of five directed care residents. 3. In an interview, E1 reported E1 asked R7’s power of attorney to relocate R7; however, a written eviction notice had not been issued.  4. In an interview, E1 reported R3 lived in the area and was in the facility during the day, three days per week, for daycare only. E1 reported this started in late February.  5. During a tour of the facility, the Compliance Officer observed an open door leading to a room, not listed on the licensed floor plan. In an interview, E2 reported R7 was residing in the unlicensed room of the facility. 6. In an interview, E1 acknowledged the facility was operating over their licensed capacity, providing daycare without a license, and utilizing a room not licensed for resident use.”