The Ranch Estates of Tucson.

“Based on record review, documentation review, and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in A.R.S. 36-411(A) for one of ten personnel sampled.  Findings Include: 1. A review of E1's personnel file revealed a copy of a Fingerprint Clearance Card (FPC) with an expiration date of March 11, 2026. 2. A review of E1's personnel file revealed a "Fingerprint Clearance Card Application Receipt" which was dated March 30, 2026, indicating E1 had been fingerprinted on that date to renew the FPC. 3. A review of E1's emails revealed E1 was out of the office from March 2, 2026, through March 16, 2026. 4. In an interview, E1 indicated E1 was out of the office when the FPC expired. E1 stated E1 believed the FPC was good through the end of the month and applied for one as soon as E1 could. 5. In an exit interview, the findings were reviewed with E1 and no further information was provided.”

“Based on record review and interview, the manager failed to ensure that a resident had a service plan that was established, documented, and implemented that when initially developed and when updated, was signed and dated by the resident or resident’s representative, the manager, and the nurse who reviewed the service plan for one of ten residents sampled.  Findings Include: 1. A review of R3’s medical record revealed a service plan dated July 30, 2025; however, the service plan was not signed by the resident’s representative, the manager, and the nurse until October 16, 2025. 2. A review of R3’s medical records revealed a service plan dated January 13, 2026; however, the service plan was not signed by the resident’s representative, the manager, and the nurse until February 19, 2026. 3. In an interview, E1 reported they have had a hard time reaching R3's representative. E1 stated E1 was under the impression everyone had to sign the service plans the same day which is why all of the signatures on the service plan were late. 4. In an exit interview, the findings were reviewed with E1 and no further information was provided. This is a repeat deficiency from the Compliance/ Complaint investigation conducted on June 12, 2023.”

“Based on documentation review and interview, the manager failed to ensure that an evacuation drill was conducted at least once every six months. Findings include: 1. A review of the facility's evacuation drills revealed an evacuation drill dated July 16, 2024, July 30, 2025, and December 30, 2025; however, an evacuation drill for January 2025 was not available for review.  2. In an exit interview, the findings were reviewed with E1 and no further information was provided. This is a repeat deficiency from the Complaint/Compliance inspections conducted on May 29, 2024, and June 12, 2023.”

“Based on document review and interview, the manager failed to ensure a documented report identifying concerns about the delivery of services, and any changes or actions taken, was submitted to the governing authority.     Findings include:   1. A review of facility policy and procedures, last reviewed January 1, 2025, revealed a policy outlining quality management. The policy indicated a report, compliant with the facility’s quality management program, was to be sent to the governing authority on an annual basis.     2. A request was made to review the facility’s most recent quality management report to the governing authority. However, evidence of documentation of such a report was unavailable for review.     3. In an interview, E1 acknowledged the annual quality management report to the governing authority was unavailable for review.”

“Based on record review, documentation review, and interview, the manager failed to ensure, before providing assisted living services to a resident, a manager or caregiver provided current documentation of first aid training for one of six sampled caregivers. The deficient practice posed a risk if the employees were unable to meet a resident's needs during an emergency. Findings include: 1. A review of E4's personnel record revealed E4 was hired as a caregiver in January 2024. 2. A review of E4's personnel record revealed documentation of a "BASIC LIFE SUPPORT BLS Provider (CPR and AED) Program" with the American Heart Association logo affixed. However, current documentation of first aid training certification was unavailable for review at the time of the inspection. 3. A review of staff schedules revealed R4 was scheduled to work May 5, 6, 7, 12, 13, 14, 15, 19, 20, 21, 26, 27, 28, 29, 2024, at 2:00 pm to 10:00 pm. 4. A review of a policy and procedures revealed a policy titled "CPR and First Aid Training - Arizona" Policy: Before providing assisted living services to a resident, all wellness associates will provide current documentation of certification of First Aid and Cardiopulmonary Resuscitation (CPR) specific to Adults". 5. In an interview, E1, acknowledged E4's personnel records did not include documentation of first aid training.”

“Based on record review and interview, the manager failed to ensure an individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for two of 10 residents sampled. This deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings included: 1. A review of R1's medical records revealed a document titled "Treatment/Services Authorization - Arizona". The document was dated April 4, 2024, five days after R1 moved into the facility and not within 90 calendar days before R1 was accepted by the facility. 2. A review of R2's medical records revealed a document titled "Treatment/Services Authorization - Arizona". The document was dated February 8, 2024, one day after R2 moved into the facility and not within 90 calendar days before R2 was accepted by the facility. 3. In an interview, E1 acknowledged R1 and R2's documentation was not provided before the residents moved into the facility. This is a repeat citation from the compliance inspection conducted on June 12, 2023.”

“Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for one of five residents reviewed who received directed care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. A review of R4's medical record revealed a written service plan for directed care services dated November 30, 2023. The Compliance Officer asked E1 if R4 had a current service plan. The Compliance Officer received a service plan dated March 2, 2024, however, the service plan was not signed or dated by the manager, the nurse and the residents representative which is required for a directed care resident. 2. In an interview, E1 acknowledged R4 was receiving directed care services and the service plan was not updated at least once every three months as required.”

“Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk as a way to exit the facility in the event of an emergency was not posted. Findings include: 1. A review of the facility's documentation revealed an evacuation drill for employees and residents was conducted on October 31, 2023. There was no additional documentation of evidence to indicate an evacuation drill was conducted at least once every six months. 2. In an interview, E1 acknowledged an evacuation drill for employees and residents was not conducted at least once every six months. This is a repeat citation from the compliance inspection conducted on June 12, 2023.”

“Based on documentation review, observation, and interview, the manager failed to ensure a resident was not subjected to misappropriation of personal and private property by the assisted living facility's caregiver for three of eleven residents sampled. Findings: 1. A review of department documentation revealed the facility made a self-report regarding missing narcotics. The document revealed on Sunday, November 5, 2023, the assistant wellness director was doing a routine audit of the medication cart and found four carts of the drug Hydrocodone missing. The medications belonged to R9, R10, and R11. 2. E1 started an investigation and reported the following "We reached out to all med aides that had worked the carts. One Med Aide [E2] did not reply to our request to come in on E2's off day as an investigation was started. On November 7, 2023, at 6 am Med Aide [E2] informed our Wellness Director [E7] that [E2] resigned effective immediately 11/7/2023. The Executive Director [E1] reached out to [E2] by phone and text stating that we were performing an investigation and needed E2 to come in so we could ask E2 about the missing narcotics. Tuesday, November 7, 2023. E2 stated E2 would come in but did not show up as agreed upon. We called the Sheriff's Department to inform them that we had missing narcotics. [E1] called [E2] again and texted E2 stating that we were going to escalate the investigation. E2 stated E2 would come in on Thursday, November 9, 2023. We interviewed [E2]. E2 stated that E2 had not seen the missing narcotics. E2 did not give a reason for E2's resignation. .... The Executive Director called the Pima County Sheriff's Department and informed them of missing narcotics. The doctor, and the residents Medical POA have been contacted". 3. A review of a documentation provided by E1 revealed a Medication Cart/Refrigerator Audit for Cart two. The document stated "Log sheets are maintained and count correct? Missing 241 hydro, 232 hydro and 231 hydro reported to wellness director". E1 stated 241, 232, and 231 are residents R9, R10, and R11's room numbers. 4. A review of R9's medical record revealed a medication order for "Hydrocodone 5 MG - Acetaminophen 325 MG tablet, give 1 tablet by mouth every 4 hours as needed for pain". The Compliance Officer observed on the medication record for R9 this medication had not been given from January 1, 2024 until the Compliance Officer was on-site on January 22, 2024. 5. A review of R10's medical record revealed a medication order for "Hydrocodone 5 MG - Acetaminophen 325 MG oral tablet, take 1 orally every 4 hours PRN pain level over 5, NTE 4 doses/day". The Compliance Officer observed on the medication record for R10 this medication had not been given from January 1, 2024 until the Compliance Officer was on-site on January 22, 2024. 6. A review of R11's medical record revealed a medication order for "Hydrocodone 7.5 MG - Acetaminophen 325 MG 1 tablet by mouth every 4 hours as needed/PRN". The Compliance Officer observed on the medication record for R11 this medication had not been given from January 1, 2024 until the Compliance Officer was on-site on January 22, 2024. 7. In an interview, E1, acknowledged R9, R10, and R11 had misappropriation of their personal and private property, investigating the incident, and notifying the Pima County Sheriff's Department has an open case on this theft of narcotics.”