Heavenly Haven Assisted Living Home LLC.

“Based on document review, record review and interview, the manager of an assisted living center who contacted an emergency responder on behalf of a resident failed to provide to the emergency responder a written document that included all required documentation, for one of two residents sampled. Findings include: 1. A review of facility documentation revealed one incident report involving R3 in which 9-1-1 was called and R3 was ultimately "transported to the hospital." 2. A review of R3's medical record revealed evidence of the standardized form provided to the emergency responder. However, the form did not contain evidence of documentation of why emergency medical services were contacted. Further, evidence of documentation of R3's health insurance portability and accountability act release, advanced directives and medications, including dosages and frequency of administration, provided to the emergency responders was not available for review. 3. In an interview, advised being aware of the implementation of A.R.S. 36-420.02. E1 reported providing all of the required documentation to the emergency responders, however E1 acknowledged they did not copy all the documentation provided, to include the standardized form or required information.”