Project Narrative

1. Provide completed and signed Community Residence registration form 
Attached 
2. Provide completed and signed Occupancy Conformation Worksheet 
Attached 
3. Provide a signed Property Owner Authorization form 
Attached 
Please provide a typed narrative with the following information about the Community 
Residence:  
Here’s a concise general scope of services for an assisted living group home. 
General Scope of Services 
The assisted living group home provides a residential setting with supportive care for 
residents who require assistance with daily activities but do not need continuous skilled 
nursing care. Services may include personal care assistance, medication support, meal 
services, housekeeping, laundry, supervision, activity programming, health care 
coordination, and general monitoring of resident well-being. The home also promotes 
resident dignity, choice, independence, and safety in a comfortable, home-like 
environment. This assisted living group home provides long-term care housing including 
personal care, and supportive services for individuals who need help with daily living 
activities while maintaining as much independence as possible. Services include: 
• 
24-hour supervision and oversight 
• 
Assistance with activities of daily living (ADLs) such as bathing, dressing, 
grooming, toileting, and mobility 
• 
Medication management and medication administration in accordance with 
applicable laws and physician orders 
• 
Meal planning and preparation, including snacks and accommodation for special 
dietary needs; i.e., low sodium, low sugar, low carb, and pureed regime 
• 
Housekeeping and laundry services 
• 
Coordination of health care services, including scheduling medical appointments 
and communicating with health care providers as appropriate

• 
Observation and reporting of changes in residents’ physical, mental, or emotional 
condition 
• 
Social, recreational, and wellness activities 
• 
Transportation arrangements or assistance for appointments, errands, and 
community activities, if offered 
• 
Safety monitoring and emergency response 
• 
Support with instrumental activities of daily living (IADLs) such as reminders, 
organization, and routine assistance 
 
• 
The name and address of the facility  
Assisted Living Oasis of Mesa LLC 
• 
The name, telephone number, email address and mailing address of the person 
responsible for the facility  
Jennifer Gatt PHD 
gatt@swneuropsychology.com  
 3121 E San Juan Ave Phoenix, AZ 85016  
 Telephone – 602-818-1516 (mobile) 
• 
The type of Community Residence: Family Community Residence or Transitional 
Community Residence (refer to definitions in Section 11-86-2 of the MZO)  
 Family Community Residence 
• 
Type of facility, i.e., Assisted Living, Behavioral Health or Sober Living.  
Residential Assisted Living Facility  
• 
The number of residents 10 
• 
The age range of the residents  55 plus 
• 
The minimum length of residency of an individual?  
12 months or longer 
• 
Provide rules, charter or other governing document of the Community Residence to 
substantiate the length of tenancy.

See facility residency agreement attached. 
• 
What Arizona State agency will be licensing this facility?  Or provide certification by 
the Arizona Recovery Housing Association or a “Permanent” Oxford House Charter if 
not required to be licensed by the State of Arizona.  
Arizona Department of Health Services Residential Licensing 
• 
Indicate whether or not all residents are capable of recognizing and responding to 
emergency situations without assistance from staff.  
Residents can recognize and respond to emergency situations independently or with 
staff assistance. As required by ADHS, they participate in evacuation drills every six 
months, and the evacuation drill form is attached. 
• 
Does the residence have fire sprinklers?  If yes, provide a copy of a third-party 
inspection report which was conducted within one-year of the Community 
Residence application submittal.  
Yes – see inspection report. 
• 
Are the fire sprinklers monitored by an off-site agency?  If yes, please provide 
verification of off-site monitoring.  
Yes – see monitoring agreement.  
Explain what services are provided at the facility.  
Policy Statement: Specific Scope of Services 
To ensure residents receive appropriate care and to maintain community safety, each 
resident will be assessed before or at admission—and throughout their stay—for physical, 
cognitive, functional, emotional, and psychological needs. 
On or before admission, the resident or their representative must provide documentation 
dated within 90 days of admission that recommends the services needed—such as 
supervisory, personal, directed, or behavioral care—and is signed by a medical practitioner 
or behavioral health professional. 
To support resident safety and service delivery, the manager or a caregiver must be present 
whenever a resident is in the assisted living home. Supervision and services will be 
provided day and night in accordance with the policy and procedures listed below that align 
and comply with DHS Article 8 – Assisted Living Facilities, always.

The facility shall not accept or retain individuals who require: 
1. Behavioral Health Services (other than Behavioral Care) 
2. Restraints, including the use of bed rails 
3. Continuous medical or nursing services 
4. Services outside the scope based on the licensed level of care (Supervisory Care 
Services, Personal Care Services, Directed Care Services, And Memory Care 
Services) 
The assisted living manager and the facility will coordinate the provision of assisted living 
services, including identifying, organizing, coordinating, and monitoring the services 
needed by a resident. The facility manager or designee will conduct an assessment to 
assist in determining eligibility, develop individualized Service Plans, arrange for services, 
maintain contact with participants, and monitor service delivery monthly. 
Procedures: 
A resident or their representative has the right to make choices and receive services in a 
manner that promotes the resident’s dignity, autonomy, independence, and quality of life. 
These services are disclosed and agreed to in the residency agreement and the service 
plan. 
Coordinating the provision of assisted living services includes identifying, organizing, 
coordinating, and monitoring the services needed by a resident. The facility manager or 
designee will conduct an assessment to determine eligibility, develop individualized 
Service Plans, arrange for services, maintain contact with participants, and monitor service 
delivery monthly. 
Resident level of care is determined based on an assessment conducted before or at 
the time of admission, considering each individual’s need for general supervision, daily 
awareness of functional and continuing needs, medication management, assistance with 
Activities of Daily Living, and mental and cognitive condition. 
Before or at the time of admission, the resident or their representative will complete a 
“Preliminary Admission Information” form. This will assess, evaluate, and document 
preferences, including: 
1. Food allergies 
2. Food preferences (likes and dislikes) 
3. Social and recreational preferences 
4. Hobbies and interests

The resident’s preferences will be communicated to the appropriate personnel, who will 
strive to plan activities and food services accordingly. 
The facility will provide assisted living services to elderly adults and adults with physical or 
developmental disabilities in a safe and calm environment, adhering to all local, state, and 
federal regulations regarding nonmedical providers. 
A manager shall not accept or retain a resident who requires restraints or exhibits behaviors 
that could pose a threat to themselves or others. 
A manager shall not accept or retain an individual with a stage 3 or 4 pressure sore, 
who is bedbound or chair-bound, or who requires behavioral care under the directed level 
of care unless proper authorizations are obtained from the resident representative and 
primary care provider or a behavioral specialist or medical practitioner. 
The assisted living manager will train caregivers and personnel, checking and 
demonstrating their skills and knowledge prior to providing services such as treatment, 
medication administration, and use of special equipment, as outlined in “Orientation and 
In-Service Training” and “Employees and Volunteers Qualifications” Policies and 
Procedures. 
The assisted living manager will ensure the facility has caregivers capable of meeting both 
scheduled and unscheduled needs based on residents’ service plans. 
1. The assisted living manager will ensure each resident’s service plan is completed 
no later than 14 days after acceptance and updated within 14 days of any 
significant change in physical, cognitive, or functional condition, and according 
to the level of care: every 12 months for supervisory care services, every 6 
months for personal care services, or every 3 months for directed care services. 
A nurse or medical practitioner will review the service plan for residents requiring 
medication administration or intermittent nursing services. Additionally, a medical 
practitioner or behavioral health professional will review the service plan for 
residents requiring behavioral care under the directed level of care. 
The assisted living manager will ensure that documentation dated not more than 90 days 
prior to admission is provided by the resident or their representative. This documentation 
must specify the need for supervisory, personal, or directed care services, intermittent 
medical services, and intermittent nursing services, and confirm that the resident does not 
require restraints or behavioral health services. Documentation must be appropriately 
signed and maintained in resident records. 
The assisted living manager will ensure personnel are oriented regarding ancillary services, 
supportive services, and social services provided based on resident needs and

documented in resident records. Personnel will also be oriented regarding health-related 
services, including skilled nursing provided by external providers, and these services will be 
documented in resident records. 
Care will be provided according to the amount, type, and frequency specified in the service 
plan. The assisted living manager may assist in coordinating podiatry services, though 
facility employees are not to provide podiatry care, except for filing rough edges. 
The assisted living manager will designate employees monthly to take each resident’s vitals 
and measure weight unless otherwise directed by a doctor. The facility provides a chair 
scale for residents unable to stand safely. 
Other services will be provided according to the signed residency agreement. Recreational 
activities and meals will be based on a preplanned activity calendar and menus. 
The assisted living manager will offer influenza and pneumonia vaccinations on site 
annually through ancillary services or primary care providers, documenting compliance, 
including refusals. 
During overnight hours, if the assisted living manager or caregiver is not awake, they must 
be able to hear and respond to residents’ needs. Except for overnight hours, the manager or 
caregiver is always awake. 
The caregiver on duty will check every two hours on residents receiving directed care 
services during nighttime hours to ensure safety and meet their needs. 
5. Explain how the residents are supervised at the facility.  
Policy Topic: Monitoring Residents 
Provision of Assisted Living Services 
Responsible Person: Manager and Manager Designee 
1. Purpose 
This policy establishes standards for monitoring residents in a manner that promotes 
health, safety, security, and timely response to resident needs while protecting privacy, 
dignity, autonomy, and confidentiality. The facility will use the least intrusive monitoring 
method appropriate to the resident’s assessed needs and in accordance with applicable 
law, licensing requirements, and organizational policies.

2. Scope 
This policy applies to all employees, contractors, volunteers, agency staff, administrators, 
and other individuals acting on behalf of the facility. It applies to all resident-monitoring 
activities conducted in resident apartments or rooms, common areas, and other facility 
spaces, including direct staff observation, wellness checks, alarm-based systems, motion 
or door sensors, wander-management systems, call systems, and any approved video 
monitoring. 
3. Policy Statement 
The facility is committed to providing a safe residential environment while recognizing each 
resident’s right to respectful, person-centered care. Monitoring shall never be used for staff 
convenience, coercion, punishment, retaliation, humiliation, or unnecessary intrusion. 
Decisions about monitoring shall be based on documented risk, clinical or service needs, 
resident preferences, legal authority, and applicable state and federal requirements. 
4. Resident Rights and Guiding Principles 
• 
Residents shall be treated with dignity, respect, and consideration in all monitoring 
practices. 
• 
Residents shall be informed, to the extent required by law and policy, about 
monitoring methods that affect them. 
• 
Residents retain privacy rights in bedrooms, bathrooms, changing areas, and 
personal communications, subject only to lawful and clearly documented 
exceptions. 
• 
Monitoring shall be proportionate to assessed need and regularly reviewed for 
continued necessity. 
• 
The facility shall support resident choice and participation in decisions regarding 
monitoring whenever possible. 
• 
No resident shall be subject to discrimination, coercion, or reprisal for raising 
concerns related to monitoring. 
Monitoring Residents specific to Level of Care Requirements  
 
Monitoring Policy for Supervisory Care Assisted Living Residents 
Guidelines for Monitoring Resident Whereabouts for Supervisory Care

Purpose 
This policy establishes procedures for staff to maintain consistent and general awareness 
of each resident’s location within the assisted living facility. The goal is to promote resident 
safety, support independence, and ensure timely assistance when needed. 
Scope 
This policy applies to all staff members responsible for the care, supervision, and well-
being of residents in the assisted living facility. 
Policy Statement 
Staff will maintain a general, ongoing awareness of the location and well-being of all 
residents. This is achieved through regular checks, active observation, and documentation 
of any significant changes in resident routines or behaviors. These measures are designed 
to balance resident safety with respect for privacy and autonomy. 
Procedures - The assisted living manager will ensure that: 
1. Scheduled Location Checks 
• Staff will conduct routine location checks on all residents at intervals of every 2 to 4 
hours throughout the day and evening shifts. 
• During overnight shifts, location checks should occur at least every 4 hours, with 
increased frequency for residents assessed as high risk or as directed in their care 
plans. 
• Each check should be documented, noting the resident’s location and general 
condition. 
2. Observation During Meals and Activities 
• Staff will observe residents during scheduled meals and group activities, using these 
times to confirm attendance and assess well-being. 
• Absences or late arrivals should be noted, and efforts made to confirm the 
resident’s whereabouts in a timely manner. 
3. Monitoring Changes in Routine or Behavior 
• Staff will remain attentive to any changes in a resident’s typical patterns—such as 
missing meals, not attending usual activities, or spending extended time alone. 
• Unexplained changes should be promptly reported to a supervisor and documented 
in the resident’s record.

• If a resident cannot be located, staff must immediately follow the facility’s missing 
resident protocol. 
4. Documentation and Communication 
• All location checks and notable observations must be accurately documented in the 
appropriate log or electronic record. 
• Any concerns regarding a resident’s location or behavior must be communicated 
promptly to supervisory staff and, if necessary, to family members or responsible 
parties. 
5. Respect for Resident Privacy 
• All monitoring activities should be conducted in a manner that respects resident 
privacy and dignity. Staff should avoid unnecessary intrusions and ensure that 
residents are informed of routine checks. 
Review and Training 
This policy will be reviewed annually and as needed. New staff will receive training on these 
procedures during orientation, with periodic refresher training for all staff. 
Conclusion 
Maintaining general awareness of resident location is essential for safety and quality of care 
in assisted living. Staff adherence to these procedures helps ensure a secure, supportive 
environment for all residents. 
 
Monitoring Policy for Personal Care Assisted Living Residents 
Guidelines for Staff to Monitor Residents Needing Assistance with Activities of 
Daily Living (ADLs) 
Purpose 
This policy outlines the procedures and expectations for staff members to effectively 
monitor assisted living residents who require help with activities of daily living (ADLs). The 
goal is to ensure resident safety, promote well-being, and maintain accountability 
throughout the facility.

Scope 
This policy applies to all staff members responsible for direct resident care, including 
nurses, aides, and caregivers, in the assisted living facility. 
Monitoring Procedures – The facility manager will ensure the following: 
1. Scheduled Resident Checks 
• Staff will conduct resident checks at least every 1–2 hours for individuals identified 
as needing assistance with ADLs. 
• Checks will be documented in the resident’s care record, noting time, observations, 
and any interventions provided. 
2. Visual Confirmation During ADLs 
• Staff are required to visually confirm resident safety during transfers (e.g., moving 
from bed to chair), ambulation (walking), bathing, and toileting. 
• For tasks involving mobility or risk of falls, staff will remain with the resident until the 
activity is safely completed. 
• Any observed hazards or unsafe conditions will be reported and addressed 
immediately. 
3. Resident Location Awareness 
• Staff will be aware of the resident’s location within the facility throughout the day, 
especially for those at risk of wandering or falls. 
• Residents who require supervision will not be left unattended in areas where safety 
cannot be assured. 
• Staff will communicate during shift changes to ensure continuous monitoring and 
awareness of each resident’s status and whereabouts. 
4. Documentation and Communication 
• All resident checks, assistance provided, and observations will be accurately 
documented in the care plan or log. 
• Any changes in resident condition, unusual incidents, or concerns will be promptly 
communicated to supervisory staff and, when appropriate, to the resident’s family or 
responsible party. 
5. Staff Training and Accountability 
• Staff will receive training on safe transfer techniques, fall prevention, and proper 
procedures for monitoring residents requiring assistance with ADLs.

• Supervisors will regularly review documentation and monitor compliance with this 
policy. 
Examples of Monitoring in Practice 
• Hourly Safety Checks: Staff check on a resident with mobility issues every hour, 
ensuring they have access to call buttons, water, and are positioned safely. 
• Assisted Transfers: A caregiver remains present and provides hands-on assistance 
when a resident moves from bed to wheelchair, confirming the transfer is completed 
safely. 
• Supervised Bathing: Staff assist and observe a resident during bathing, ensuring 
proper support and preventing slips or falls. 
• Toileting Support: Staff accompany and assist residents during toileting, visually 
confirming safety and hygiene, and documenting any difficulties or changes. 
• Location Tracking: Staff use sign-in/out sheets or electronic tracking systems to 
know where residents are (e.g., in their rooms, common areas, or participating in 
activities). 
Review and Revision 
This policy will be reviewed annually or as needed to ensure continued effectiveness and 
compliance with industry best practices and regulatory requirements. 
Monitoring Policy on Directed Care Residents Oversight  
Ensuring Frequent Supervision for Residents with Cognitive Impairment 
Purpose 
The purpose of this policy is to establish clear guidelines for staff to provide constant or 
frequent oversight for residents with cognitive impairment. This ensures the safety, well-
being, and dignity of each resident, while minimizing risks associated with wandering, exit-
seeking, and other behaviors commonly exhibited by individuals with cognitive challenges. 
Scope 
This policy applies to all staff members who provide direct care or are responsible for the 
supervision of residents diagnosed with cognitive impairment, including dementia and 
related conditions.

Oversight Procedures – The facility manager will ensure the following: 
1. Frequent Checks: Staff will perform and document visual checks of residents with 
cognitive impairment at intervals no longer than every 30 to 60 minutes. These 
checks should verify the resident’s location, safety, and engagement in appropriate 
activities. 
2. Immediate Response to Door Alarms: Staff are required to respond immediately to 
any door alarms or alerts signaling potential exit-seeking or wandering. Upon 
activation, staff should promptly locate the resident and ensure their safety. 
3. Redirection Strategies: If a resident is found wandering or attempting to exit, staff 
should use gentle redirection techniques. This may include engaging the resident in 
conversation, guiding them to a safe area, or offering an activity aligned with their 
interests. 
4. Continuous Awareness of Whereabouts: Staff will maintain ongoing awareness of 
the resident’s specific whereabouts at all times. This includes knowing which 
activities residents are participating in, their physical location within the facility, and 
any changes in behavior or condition. 
5. Documentation: All oversight activities, including checks, responses to alarms, and 
instances of redirection, will be documented in the resident’s care record according 
to facility protocols. 
Staff Training 
All staff responsible for directed care will receive regular training on recognizing signs of 
cognitive impairment, implementing oversight procedures, responding to alarms, and 
utilizing redirection techniques effectively. Training will also cover the importance of 
maintaining the dignity and autonomy of each resident. 
Communication and Collaboration 
Staff will communicate regularly with one another regarding the status and location of 
residents with cognitive impairment. Any concerns or incidents should be reported 
promptly to supervisory personnel. Collaboration with families and external healthcare 
providers is encouraged to ensure comprehensive care. 
Review and Compliance 
Compliance with this policy will be monitored through regular audits and supervisory 
observation. The policy will be reviewed annually or as needed to reflect changes in best 
practices, regulatory requirements, or residents needs.

Examples of Oversight in Practice 
• Staff check on Resident A every 30 minutes and record their location and activity in 
the care log. 
• When a door alarm sounds, staff immediately respond, locate the resident, and 
document the incident and intervention. 
• If Resident B is observed wandering, staff gently redirect them to a familiar activity or 
communal area. 
• Staff maintain a daily schedule and roster indicating which team member is 
responsible for monitoring specific residents at any given time. 
Conclusion 
This policy is designed to ensure all residents with cognitive impairment receive the 
constant or frequent oversight necessary to promote safety, support independence, and 
enhance quality of life within the care community. 
 
 
6. Provide a site plan of the property.  Please include the address of the property on the 
site plan, label the major street names and provide a compass orienting the map. 
See Attached 
7. Provide a floor plan of the facility 
See Attached