Immaculate Assisted Living, LLC

Cited requirement:A.R.S. § 36-420.04.A.1-9. Emergency responders; patient information; hospitals; discharge planning; patient screenings; discharge document A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or expe…

Provider-listed correction date: Feb 27, 2026. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-803.K.1. Administration K. A manager shall provide written notification to the Department of a resident’s: 1. Death, if the resident’s death is required to be reported according to A.R.S. § 11-593, within one working day after the resident’s death;

Provider-listed correction date: Feb 27, 2026. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-817.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 the 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: Mar 20, 2026. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-819.D.2.a-f. Emergency and Safety Standards D. When a resident has an accident, emergency, or injury that results in the resident needing medical services, a manager shall ensure that a caregiver or an assistant caregiver: 2. Documents the following: a. The date and time of the accident, emergency, or injury; b. A description of the accident, emergency, or injury; c. The names of individuals who observed the accident, emergency, or injury; d. The actions taken by the caregiver or assistant caregiver; e. The individuals notified by the caregiver or assistant caregiver; and f. Any action taken to prevent the accident, emergency, or injury from occurring in the future.

Provider-listed correction date: Feb 24, 2026. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-820.A.1.b. Environmental Standards A. A manager shall ensure that: 1. The premises and equipment used at the assisted living facility are: b. Free from a condition or situation that may cause a resident or other individual to suffer physical injury;

Provider-listed correction date: Feb 27, 2026. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-820.A.11. Environmental Standards 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;

Provider-listed correction date: Feb 27, 2026. 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: May 22, 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: May 23, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-807.G.3. Residency and Residency Agreements G. A manager may terminate residency of a resident as follows: 3. With a 30-calendar-day written notice of termination of residency, for any other reason.

Provider-listed correction date: May 23, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-807.H.1-5. Residency and Residency Agreements H. A manager shall ensure that the written notice of termination of residency in subsection (G) includes: 1. The date of notice; 2. The reason for termination; 3. The policy for refunding fees, charges, or deposits; 4. The deposition of a resident's fees, charges, and deposits; and 5. Contact information for the State Long-Term Care Ombudsman.

Provider-listed correction date: May 23, 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 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, date of termination of residency; 5. Docum…

Provider-listed correction date: May 30, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-819.A.1.b. Environmental Standards A. A manager shall ensure that: 1. The premises and equipment used at the assisted living facility are: b. Free from a condition or situation that may cause a resident or other individual to suffer physical injury;

Provider-listed correction date: May 23, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-819.A.4. Environmental Standards A. A manager shall ensure that: 4. Heating and cooling systems maintain the assisted living facility at a temperature between 70° F and 84° F at all times, unless individually controlled by a resident;

Provider-listed correction date: May 22, 2025. A provider’s plan does not establish agency-confirmed correction.