Emmanuel Care Home.

“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 two of three resident records reviewed.  Findings include:  1. A review of R1's medical record revealed a documented residency agreement. However, the residency agreement did not include the terms of occupancy, including the date of occupancy or expected date of occupancy, and the monthly resident responsibilities. The document also did not include the manager's signature and date signed.  2. A review of R3's medical record revealed a documented residency agreement. However, the residency agreement did not include the terms of occupancy, including the date of occupancy or expected date of occupancy, and the monthly resident responsibilities. 3. In an interview, E2 acknowledged R1's and R3's residency agreements did not include all requirements in R9-10-807(D)(1-10). This is a repeat deficiency from the on-site compliance inspection conducted on October 2, 2023.”

“Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit.  Findings include: 1. During a tour of the facility, the Compliance Officer inspected the kitchen refrigerator and found a bottle of “Latanoprost Ophthalmic Solution” unsecured, in the door of the refrigerator. 2. In an interview, E1 acknowledged the medication was stored unsecured in the refrigerator door.”

“Based on document review and interview, the manager failed to ensure a caregiver immediately reported a medication error to the medical practitioner who ordered the medication or, if the medical practitioner who ordered the medication is not available, another medical practitioner.   Findings include:   1. A review of facility documentation revealed an incident report dated December 14, 2024. The incident report detailed on December 14, 2024, R3 tested positive for COVID and was offered “Paxlovid.” R3 accepted “Paxlovid” from E3 and later R3 denied R3 tested positive for COVID. The incident report stated O1, the medical provider, left an order for all of O1’s patients to be administered “Paxlovid” if they test positive for COVID. According to the incident report, E2 later learned R3 was no longer a patient of O1.    2. A review of R3's medical record revealed no evidence of a prescription for Paxlovid.    3. In an interview, E1 reported O1 gave a blanket order and provided the prescription E1 was provided. The prescription was signed by the provider and included the order, “Ok to take Paxlovid DX: COVID”. However, the order was not valid and did not have a patient name, type, frequency, or route.    4. Further review of the incident report detailed E3 contacted R3’s case manager and emergency contact, and did not contact the prescriber or E3’s medical practitioner.     5. In an interview, E1 acknowledged E3 did not immediately report the medication error to the medical practitioner who ordered the medication or to another medical practitioner.”

“Based on record review and interview, the manager accepted and retained an individual when the primary condition for which the individual needed assisted living services was a behavioral health issue, for one of two resident records reviewed. The deficient practice posed a risk as R1's primary condition was not a physical health issue and the facility is not authorized to provide behavioral health services. Findings include: Arizona Administrative Code (A.A.C.) R9-10-101.32. states "Behavioral health issue" means "an individual's condition related to a mental disorder, a personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors." 1. A review of R1's medical record revealed a service plan for directed care services, initiated on January 31, 2023, with two updates. The service plan stated, "Medical Diagnosis/Health Problems: Hypertension, Diabetes?, Obsessive Compulsive Disease"; "Physical/Cognitive/Functional Impairments: Unable to perform ADL's without assistance; Unable to manage his own medications"; and "Diagnosis requiring no treatment/or meds only: Anxiety Disorder". The service plan revealed R1 used a 4 wheeled walker. Further review revealed no assistance needed for "Bed Mobility ...Turning ...Transfers ...Wheeling ...Eating ...Grooming ...Oral Care ...Toileting ...". For bathing, the service plan stated R1 needed "set up". For medication, the service plan stated "Hand pills/observe taking". For dressing, the service plan stated, "Complete ...Has the ability to dress (self) but requests assistance". 2. In an interview, E1 and E4 reported R1 did need assisted living services though agreed the service plan did not identify a primary physical health reason as for the services. 3. In an interview, E1 agreed R1 needed assisted living services and behavioral care. E1 did not believe the manager accepted and retained an individual when the primary condition for which the individual needed assisted living services was a behavioral health issue, though understood the documentation did not support this statement.”

“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 two of two resident records reviewed. Findings include: 1. A review of R1's medical record revealed a documented residency agreement. However, the residency agreement did not include the following: - The individual's name, - The date of occupancy or expected date of occupancy, and - The manager's signature and date signed. 2. A review of R2's medical record revealed a documented residency agreement. However, the residency agreement did not include the following: - The individual's name, and - The date of occupancy or expected date of occupancy. 3. In an interview, E2 acknowledged R1's and R2's residency agreements did not include all requirements in R9-10-807(D)(1-10).”

“Based on documentation review, observation, and interview, the manager failed to ensure a facility authorized to provide directed care services had a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort and provided access to an outside area, which alerted employees of the egress of a resident from the facility. Findings include: 1. A review of the Department's documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed when exiting from back door leading to the secured backyard, no alarm sounded to alert employees of the egress of a resident from the facility. Further inspection revealed only one side of the door alert was present on the door. 3. In an interview, E1 acknowledged the back door did not alert employees of the egress of a resident from the facility.”