Lamba Care Home.

“36-420.01. Health care institutions; fall prevention and fall recovery; training programs; definition A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery. The training program shall include initial training and continued competency training in fall prevention and fall recovery. A health care institution may use information and training materials from the department's Arizona falls prevention coalition in developing the training program.”

“B. A manager: 3. Except as provided in subsection (A)(6), designates, in writing, a caregiver who is: a. At least 21 years of age, and b. Present on the assisted living facility's premises and accountable for the assisted living facility when the manager is not present on the assisted living facility premises.”

“E. A manager shall ensure that, unless otherwise stated: 1. Documentation required by this Article is provided to the Department within two hours after a Department request; and”

“A. A manager shall ensure that: 5. An assisted living facility has a manager, caregivers, and assistant caregivers with the qualifications, experience, skills, and knowledge necessary to: a. Provide the assisted living services, behavioral health services, behavioral care, and ancillary services in the assisted living facility's scope of services; b. Meet the needs of a resident; and c. Ensure the health and safety of a resident;”

“A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 1. Is completed no later than 14 calendar days after the resident's date of acceptance;”

“A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 4. Is reviewed and updated based on changes in the requirements in subsections (A)(3)(a) through (f): a. No later than 14 calendar days after a significant change in the resident's physical, cognitive, or functional condition; and”

“B. If an assisted living facility provides medication administration, a manager shall ensure that: 3. A medication administered to a resident: b. Is administered in compliance with a medication order, and”

“Based on record review, and interview, the health care institution failed to administer a training program regarding fall prevention and fall recovery, for one of two personnel records reviewed. Findings include: 1. A review of E2's personnel record revealed training, in fall prevention and fall recovery, was not available for review. 2. In an interview, E1 acknowledged documented training in fall prevention and fall recovery had not been completed for E2.”

“Based on documentation review, and interview, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility's premises. Findings include: 1. During a facility tour, the Compliance Officer observed a document posted on the wall titled, "Designation of Management," which listed the name of one individual designated as acting manager, E3 2. In an interview, E1 confirmed E3 no longer worked at the facility. E1 acknowledged the the facility did not have a designated caregiver who would be present on the assisted living premises, when the manager was not present. E1 advised E1 does not leave the premises.”

“Based on record review and interview, the manager failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. On September 27, 2024, the Compliance Officer requested the following documents during the on-site inspection: - Complete medical records, for three residents, including the Medication Administration Record (MAR) and documentation of services provided. 2. E1 reported the MAR and ADL logs were provided to R3's case manager and were unable to be located during the on-site inspection. 3. In an interview, E1 acknowledged the requested MAR and ADL logs were not provided within two hours of the Department's request.”

“Based on documentation review, record review, interview, and observation, the manager failed to ensure the facility had a manager and caregivers with the skills and knowledge necessary to meet the needs of a resident and ensure the health and safety of a resident. Findings include: 1. A review of R2's medical record revealed an incident report dated April 9, 2024 at 2pm. The report detailed a fall involving R2. The document stated the fall was unwitnessed and R2 was assessed to not have injuries. The report stated, "E1 found R2 on the floor, and R2 had no injuries, no bleeding, then I decided to call the 911, and they came took V/S was normal and helped R2 back in bed." 2. In an interview E1 reported the reason for calling 911, when R2 was uninjured, was because E1 was unable to get R2 up alone because R2 was much larger than E1. E1 reported E1 was the only caregiver and has no back up at this time. 3. A review of the facility's policies and procedures revealed a policy titled, "STAFFING ATTENDANCE POLICY AND PROCEDURE". the policy stated," ... e) That one Caregiver, who is on sight, is able to provide Personal and Directed Care services ..." and " ... 4. At least one qualified Caregiver who is at least 21 yrs. Must be designated and onsite of this facility when the manager is absent from the premises ...". 4. Further review of R2's medical record revealed a Hoyer lift was delivered to the facility four days after the fall occurred. 5. In an interview, E1 acknowledged the facility did not have enough caregivers and stated it was difficult to find and keep caregiving staff. E1 neither acknowledged nor disputed that the facility did not have a manager and caregivers with the skills and knowledge necessary to meet the needs of a resident and ensure the health and safety of a resident.”

“Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after the resident's date of acceptance, for one of three resident records reviewed. The deficient practice posed a risk if the assisted living facility was unable to meet the needs of R2. Findings include: 1. A review of R2's medical record revealed no service plan was available for review. However, based on R2's date of acceptance, a completed service plan was required. 2. In an interview, E1 acknowledged a service plan for R2 was not completed. R2's medical record contained a service plan from a hospice agency.”

“Based on record review and interview, the manager failed to ensure a resident had a written service plan that was reviewed and updated no later than 14 calendar days after a significant change in the resident's physical, cognitive, or functional condition, for one of three resident records reviewed. Findings include: 1. A review of R1's medical record revealed a service plan for supervisory care services dated February 27, 2024. The service plan detailed R1 "self showers" 5 days per week; "eats 100% of meals"; and intermittent assistance with incontinence, "[R1] MAY NEED BREIFS AT TIMES - MOST OF THE TIME [R1] IS ABLE TO USE THE RESTROOM". 2. A review of R1's medical record revealed R1 was admitted to hospice services on July 5, 2024. The notes from the hospice report stated R1 was complete assistance with dressing grooming and showering; had a decreased intake of food; max assist with toileting; and increased confusion. In an interview, E1 reported R1 was no longer able to find R1's room. 3. A review of R1's medical record revealed no service plan update. 4. In an interview, E1 acknowledged R1's service plan was not updated within 14 calendar days after a significant change of condition.”

“Based on record review, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of three residents sampled. The deficient practice posed a risk if medications were not administered as ordered. Findings include: 1. A review of R2's medical record revealed R2 received medication administration. 2. A review of R2's medical record revealed the following orders signed on March 15, 2024: - "Apixaban Oral Tablet 2.5 MG", "Administer one tablet by mouth twice daily"; and - "Metoprolol Tartrate Oral Tablet 25 MG", "Administer one tablet by mouth twice daily". 3. A review of R2's Medication Administration Record (MAR) revealed documentation of administration of the following medications administered from March 15, 2024 through May 14, 2024: - Eliquis 2.5 MG, also known by the generic name Apixaban, was administered "Give half PO BID"; and - Metoprolol 50 MG was administered "Give 1 tab PO BID". 4. A review of R3's medical record revealed no evidence of a MAR. 5. In an interview E1 acknowledged medication administered to R2 was not in compliance with a signed order. This is a repeat citation from the on-site complaint inspection conducted on March 2, 2022 and the on-site compliance inspection conducted on June 19, 2023.”