Eternity Assisted Living LLC

Cited requirement:A.R.S. § 36-424.C. Inspections; suspension or revocation of license; report to board of examiners of nursing care institution administrators and assisted living facility managers C. On a determination by the director that there is reasonable cause to believe a health care institution is not adhering to the licensing requirements of this chapter, the director and any duly designated employee or agent of the director, including county health representatives and county or municipal fire inspectors, consistent with standard medical practices, may enter on and into the premises of any health care institution that is licensed or required to be licensed pursuant to this chapter at any reasonable time for the purpose of determining the state of compliance with this chapter, the rules adopted pursuant to this chapter and local fire ordinances or rules. Any application for licensure under this chapter constitutes permission for and complete acquiescence in any entry or inspection of the premises during the pendency of the application and, if licensed, during the term of the license. If an inspection reveals that the health care institution is not adhering to the licensing requirements estab…

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-113.A.2.a-f. Tuberculosis Screening A. If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that: 2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, baseline screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1); b. If an individual may have a latent tuberculosis infection, as defined in A.A.C. R9-6-1201: i. Referring the individual for assessment or treatment; and ii. Annually obtaining documentation of the individual's freedom fr…

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-803.A.5. Administration A. A governing authority shall: 5. Review and evaluate the effectiveness of the quality management program at least once every 12 months;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-803.B.3.a-b. Administration 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.

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-804.2.a-b. Quality Management A manager shall ensure that: 2. A documented report is submitted to the governing authority that includes: a. An identification of each concern about the delivery of services related to resident care, and b. Any change made or action taken as a result of the identification of a concern about the delivery of services related to resident care;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.A.4.a-b. Personnel A. A manager shall ensure that: 4. A caregiver's or assistant caregiver's skills and knowledge are verified and documented: a. Before the caregiver or assistant caregiver provides physical health services or behavioral health services, and b. According to policies and procedures;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.A.5.a-c. Personnel 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;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.A.7. Personnel A. A manager shall ensure that: 7. Documentation is maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.A.9. Personnel A. A manager shall ensure that: 9. Before providing assisted living services to a resident, a caregiver or an assistant caregiver receives orientation that is specific to the duties to be performed by the caregiver or assistant caregiver; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.B.3. Personnel B. A manager of an assisted living home shall ensure that: 3. As part of the policies and procedures required in R9-10-803(C)(1)(h), a plan is established, documented, and implemented to ensure that the manager or a caregiver is available as back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work is not available or not able to provide the required assisted living services; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.B.4.a-b. Personnel B. A manager of an assisted living home shall ensure that: 4. At least the manager or a caregiver is present at an assisted living home when a resident is present in the assisted living home and: a. Except for nighttime hours, the manager or care- giver is awake; and b. If the manager or caregiver is not awake during nighttime hours: i. The manager or caregiver can hear and respond to a resident needing assistance; and ii. If the assisted living home is authorized to pro- vide directed care services, policies and proce- dures are developed, documented, and implemented to establish a process for check- ing on a resident receiving directed care ser- vices during nighttime hours to ensure the resident’s health and safety.

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-806.C.1.a-c. Personnel C. A manager shall ensure that a personnel record for each employee or volunteer: 1. Includes: a. The individual's name, date of birth, and contact telephone number; b. The individual's starting date of employment or volunteer service and, if applicable, the ending date; and c. Documentation of: i. The individual's qualifications, including skills and knowledge applicable to the individual's job duties; ii. The individual's education and experience applicable to the individual's job duties; iii. The individual's completed orientation and in-service education required by policies and procedures; iv. The individual's license or certification, if the individual is required to be licensed or certified in this Article or in policies and procedures; v. If the individual is a behavioral health technician, clinical oversight required in R9-10-115; vi. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (A)(8); vii. Cardiopulmonary resuscitation training, if required for the individual in this Article or policies and procedures; viii First aid training, if required for the individual in this Article or polici…

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-807.B.1.a-b. Residency and Residency Agreements B. A manager shall ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: 1. If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: a. Includes whether the individual requires: i. Continuous medical services, ii. Continuous or intermittent nursing services, or iii. Restraints; and b. Is dated and signed by a: i. Physician, ii. Registered nurse practitioner, iii. Registered nurse, or iv. Physician assistant; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-808.A.3.b. Service Plans A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 3. Includes the following: b. The level of service the resident is expected to receive;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-808.A.3.c. Service Plans A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 3. Includes the following: c. The amount, type, and frequency of assisted living services being provided to the resident, including medication administration or assistance in the self-administration of medication;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-808.A.5.a-d. Service Plans A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 5. When initially developed and when updated, is signed and dated by: a. The resident or resident's representative; b. The manager; c. If a review is required in subsection (A)(3)(d), the nurse or medical practitioner who reviewed the service plan; and d. If a review is required in subsection (A)(3)(e)(ii), the medical practitioner or behavioral health professional who reviewed the service plan.

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-808.C.1.g. Service Plans C. A manager shall ensure that: 1. A caregiver or an assistant caregiver: g. Documents the services provided in the resident's medical record; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-810.A. Resident Rights A. A manager shall ensure that, at the time of acceptance, a resident or the resident's representative receives a written copy of the requirements in subsection (B) and the resident rights in subsection (C).

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-810.B.3.a.i-ii. Resident Rights B. A manager shall ensure that: 3. A resident or the resident's representative: a. Is informed of the following: i. The policy on health care directives, and ii. The resident complaint process;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.A.1.a-f. Medication Services A. A manager shall ensure that: 1. Policies and procedures for medication services include: a. Procedures for preventing, responding to, and reporting a medication error; b. Procedures for responding to and reporting an unexpected reaction to a medication; c. Procedures to ensure that a resident's medication regimen and method of administration is reviewed by a medical practitioner to ensure the medication regimen meets the resident's needs; d. Procedures for: i. Documenting, as applicable, medication administration and assistance in the self-administration of medication; and ii. Monitoring a resident who self-administers medication; e. Procedures for assisting a resident in procuring medication; and f. If applicable, procedures for providing medication administration or assistance in the self-administration of medication off the premises; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.B.2.a. Medication Services B. If an assisted living facility provides medication administration, a manager shall ensure that: 2. Policies and procedures for medication administration: a. Are reviewed and approved by a medical practitioner, registered nurse, or pharmacist;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.B.3.a-c. Medication Services B. If an assisted living facility provides medication administration, a manager shall ensure that: 3. A medication administered to a resident: a. Is administered by an individual under direction of a medical practitioner, b. Is administered in compliance with a medication order, and c. Is documented in the resident's medical record.

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.C.3. Medication Services C. If an assisted living facility provides assistance in the self-administration of medication, a manager shall ensure that: 3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a medical practitioner or nurse; and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.D.1. Medication Services D. A manager shall ensure that: 1. A current drug reference guide is available for use by personnel members, and

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-816.F.1. Medication Services F. When medication is stored by an assisted living facility, a manager shall ensure that: 1. Medication is stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-817.C.1. Food Services C. A manager shall ensure that food is obtained, prepared, served, and stored as follows: 1. Food is free from spoilage, filth, or other contamination and is safe for human consumption;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-818.A.2. Emergency and Safety Standards A. A manager shall ensure that: 2. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-818.B.1-2. Emergency and Safety Standards B. A manager shall ensure that: 1. A resident receives orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours after the resident's acceptance by the assisted living facility, 2. The resident's orientation is documented.

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-819.A.14.a-c. Environmental Standards A. A manager shall ensure that: 14. If pets or animals are allowed in the assisted living facility, pets or animals are: a. Controlled to prevent endangering the residents and to maintain sanitation; b. Licensed consistent with local ordinances; and c. For a dog or cat, vaccinated against rabies;

Provider-listed correction date: Aug 1, 2025. A provider’s plan does not establish agency-confirmed correction.