Sweet Home Adult Care Home LLC

Cited requirement:R9-10-803.C.1.r. Administration C. A manager shall ensure that policies and procedures are: 1. Established, documented, and implemented to protect the health and safety of a resident that: r. Cover assistance in the self-administration of medication, and medication administration;

Provider-listed correction date: Dec 9, 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: Dec 9, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-811.C.1-24. Medical Records C. A manager shall ensure that a resident’s medical record contains: 1. Resident information that includes: a. The resident’s name, and b. The resident’s date of birth; 2. The names, addresses, and telephone numbers of: a. The resident’s primary care provider; b. Other persons, such as a home health agency or hospice service agency, involved in the care of the resident; and c. An individual to be contacted in the event of an emergency, significant change in the resident’s condition, or termination of residency; 3. If applicable, the name and contact information of the resident’s representative and: a. The document signed by the resident consenting for the resident’s representative to act on the resident’s behalf; or b. If the resident’s representative: i. Has a health care power of attorney established under A.R.S. § 36-3221 or a mental health care power of attorney executed under A.R.S. § 36-3282, a copy of the health care power of attorney or mental health care power of attorney; or ii. Is a legal guardian, a copy of the court order establishing guardianship; 4. The date of acceptance and, if applicable, the date of termination of residency; 5. …

Provider-listed correction date: Dec 9, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-817.B.3.c. Medication Services B. If an assisted living facility provides medication administration, a manager shall ensure that: 3. A medication administered to a resident: c. Is documented in the resident’s medical record.

Provider-listed correction date: Dec 9, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:F. A manager of an assisted living facility authorized to provide directed care services shall ensure that: 2. There is 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 that meets one of the following: a. Provides access to an outside area that: i. Allows the resident to be at least 30 feet away from the facility, and ii. Controls or alerts employees of the egress of a resident from the facility;

Correction information is not available in the records reviewed.

Cited requirement:A. A manager shall ensure that: 11. Poisonous or toxic materials stored by the assisted living facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents;

Correction information is not available in the records reviewed.