Inspection Reports for Golden Autumn Adult Care Home

13420 W Paradise Ln, Surprise, AZ 85374, Surprise, AZ, 8537

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Inspection Report Summary

The most recent inspection on April 2, 2024, included an enforcement action resulting in a $500 fine, which has been paid in full. Earlier inspections showed a pattern of deficiencies involving policy review, caregiver training documentation, medication administration and storage, disaster drills, oxygen container safety, fall prevention training, and resident service plan documentation. Complaint investigations were not listed in the available reports. Prior enforcement actions included a $250 fine in February 2023, also paid in full. The facility’s inspection history indicates ongoing issues with staff training and procedural documentation, with enforcement actions reflecting regulatory follow-up.

Deficiencies (last 2 years)

Deficiencies (over 2 years) 4.5 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

22% worse than Arizona average
Arizona average: 3.7 deficiencies/year

Deficiencies per year

8 6 4 2 0
2022
2024

Enforcement Action

Enforcement
Fines: 1 Total: $500.00 Date: Apr 2, 2024

Summary
The facility was fined $500.00, which has been paid in full as of 2024-04-15.

Fines & Penalties (1)
AmountReasonStatus
$500.00Fine associated with enforcement action #00111472Paid

Enforcement Action

Enforcement
Fines: 1 Total: $500.00 Date: Mar 12, 2024

Summary
The enforcement resulted in a civil fine of $500.00 for the expired CPR and first aid training violation.

Fines & Penalties (1)
AmountReasonStatus
$500.00One employee's CPR and first aid training was expired.

Inspection Report

Annual Inspection
Capacity: 10 Deficiencies: 6 Date: Mar 12, 2024

Visit Reason
Six deficiencies found related to policy review, caregiver training documentation, medication administration and storage, disaster drills, and oxygen container safety.

Findings
Six deficiencies found related to policy review, caregiver training documentation, medication administration and storage, disaster drills, and oxygen container safety.

Deficiencies (6)
C. A manager shall ensure that policies and procedures are: 3. Reviewed at least once every three years and updated as needed.
A. A manager shall ensure that: 10. Before providing assisted living services to a resident, a manager or caregiver provides current documentation of first aid and CPR training.
B. If an assisted living facility provides medication administration, a manager shall ensure that: 3. A medication administered to a resident is under direction of a medical practitioner.
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.
A. A manager shall ensure that: 4. A disaster drill for employees is conducted on each shift at least once every three months and documented.
A. A manager shall ensure that: 10. Oxygen containers are secured in an upright position.

Enforcement Action

Enforcement
Fines: 1 Total: $250.00 Date: Feb 14, 2023

Summary
The facility was fined $250.00 which has been paid in full as part of the enforcement resolution.

Fines & Penalties (1)
AmountReasonStatus
$250.00Fine associated with enforcement action #00113811Paid

Inspection Report

Annual Inspection
Capacity: 10 Deficiencies: 3 Date: Dec 8, 2022

Visit Reason
Three deficiencies found related to fall prevention training, completeness of resident service plans, and documentation of services provided.

Findings
Three deficiencies found related to fall prevention training, completeness of resident service plans, and documentation of services provided.

Deficiencies (3)
36-420.01. Health care institutions; fall prevention and fall recovery; training programs; definition A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery.
A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 3. Includes the level of medication assistance.
C. A manager shall ensure that: 1. A caregiver or an assistant caregiver: g. Documents the services provided in the resident's medical record.

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