Inspection Reports for Gems Assisted Living IV
1502 Avalon Ave, Lake Havasu City, AZ 86404, USA, AZ, 86404
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Inspection Report
Complaint Investigation
Capacity: 10
Deficiencies: 17
Apr 9, 2025
Visit Reason
State-compiled facility profile showing 3 inspections from 2024-02 to 2025-04 with deficiency history
Findings
Across three inspections conducted between February 2024 and April 2025, multiple deficiencies were identified including failures in staff training on fall prevention, tuberculosis screening and infection control, fingerprint clearance compliance, CPR and first aid certification, medication administration and documentation, and resident service plans. Several deficiencies were repeat citations and posed risks to resident safety and compliance.
Complaint Details
The inspections included complaint investigations of multiple complaints (e.g., 00107544, 00108033, 00124025, AZ00206698, AZ00208591, AZ00193846, AZ00199675, AZ00200902, AZ00200903, AZ00201499, AZ00206036) with findings related to compliance and safety issues.
Deficiencies (17)
| Description |
|---|
| A.R.S. § 36-420.01.A. Health care institutions; fall prevention and fall recovery; training programs; definition: Failed to administer a training program for all staff regarding fall prevention and fall recovery. |
| R9-10-113.A.2.a-f. Tuberculosis Screening: Failed to implement tuberculosis infection control activities including annual training and education on TB signs and symptoms for six of nine sampled personnel. |
| R9-10-803.A.9. Administration: Failed to ensure compliance with fingerprint clearance card requirements for multiple employees, including expired or missing cards and lack of APS registry verification. |
| R9-10-806.A.10. Personnel: Failed to ensure current documentation of first aid and CPR training certification before providing assisted living services for two of nine sampled personnel. |
| R9-10-806.A.4.a-b. Personnel: Failed to verify and document caregiver skills and knowledge before providing physical health services for one of four sampled caregivers. |
| R9-10-806.A.8.a-b. Personnel: Failed to provide evidence of freedom from infectious tuberculosis on or before the date caregiver began providing services for one of four sampled caregivers. |
| R9-10-807.A.1-2. Residency and Residency Agreements: Failed to ensure residents provided evidence of freedom from infectious tuberculosis as required for two sampled residents. |
| R9-10-807.D.2.a-c. Residency and Residency Agreements: Failed to ensure residency agreement included terms of occupancy including date of occupancy for one of two sampled residents. |
| R9-10-808.A.3.c. Service Plans: Failed to ensure resident's written service plan included frequency of assisted living services for two sampled residents. |
| R9-10-808.C.1.g. Service Plans: Failed to ensure caregiver documented services provided in resident's medical record for one of two sampled residents. |
| R9-10-815.F.2.a-c. Directed Care Services: Failed to ensure means of exiting facility controlled or alerted employees of resident egress for residents without keys or special knowledge. |
| R9-10-816.F.3.d. Medication Services: Failed to implement policies and procedures for inventorying controlled substances including marking medications and maintaining required documentation. |
| A. A manager shall ensure that: 4. A caregiver's or assistant caregiver's skills and knowledge are verified and documented: Failed to verify and document skills and knowledge before providing physical health services for three of five sampled caregivers or assistant caregivers. |
| 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 controlled or alerted employees of resident egress: Failed to ensure door alerts were functional and active. |
| A. A manager shall ensure that: 1. Policies and procedures for medication services include: e. Procedures for assisting a resident in procuring medication: Failed to have policies and procedures for assisting residents in procuring medication. |
| 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: Failed to administer medications as ordered for two of three sampled residents. |
| F. When medication is stored by an assisted living facility, a manager shall ensure that: 3. Policies and procedures are established, documented, and implemented for: a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication: Failed to implement policies and procedures covering all aspects of medication management. |
Report Facts
Inspections on page: 3
Total deficiencies: 19
Complaint inspections: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Charlene Pruden | Licensed Manager | Named in multiple deficiency findings and responsible for correction |
| Tiffany Shaputis | House Manager | Named in multiple deficiency findings and responsible for correction |
| Carlos Serrano | House Manager | Named in multiple deficiency findings and responsible for correction |
| Vilma Urbina | Owner | Named in multiple deficiency findings and responsible for correction |
| E1 | Manager | Referenced in findings related to training, fingerprint clearance, CPR certification, and medication administration |
| E2 | Referenced in interviews related to medication and certification deficiencies | |
| E3 | Referenced in interviews and findings related to documentation and resident care | |
| E4 | Housekeeper | Referenced in findings related to training and medication administration |
| E5 | Driver/Caregiver | Referenced in findings related to training, fingerprint clearance, and skills documentation |
| E6 | Caregiver | Referenced in findings related to training and fingerprint clearance |
| E7 | Caregiver | Referenced in findings related to fingerprint clearance and CPR certification |
| E8 | Caregiver | Referenced in findings related to fingerprint clearance and skills documentation |
| E9 | Caregiver | Referenced in findings related to skills verification, TB screening, and fingerprint clearance |
| E10 | Housekeeper | Referenced in findings related to training and fingerprint clearance |
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