Inspection Report Summary
The most recent inspections on April 3, 2025, included multiple complaint surveys and investigations with no deficiencies cited. Earlier reports showed a pattern of deficiencies mainly related to care plans, accident and fall prevention, premises safety, and abuse reporting and prevention. Complaint investigations were generally unsubstantiated, with no fines, immediate jeopardy findings, or enforcement actions listed in the available reports. Prior inspections noted issues with medication administration, emergency preparedness, and documentation as well. The facility’s recent clean inspections suggest improvement compared to earlier findings.
Deficiencies (last 3 years)
Deficiencies (over 3 years)
8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
116% worse than Arizona average
Arizona average: 3.7 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Apr 3, 2025
Visit Reason
Onsite complaint survey conducted with no deficiencies noted.
Findings
Onsite complaint survey conducted with no deficiencies noted.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Apr 3, 2025
Visit Reason
Risk-based complaint survey conducted with no deficiencies cited.
Findings
Risk-based complaint survey conducted with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Feb 26, 2025
Visit Reason
Investigation of complaint with no deficiencies cited.
Findings
Investigation of complaint with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 1
Date: Jan 14, 2025
Visit Reason
Complaint survey citing one deficiency related to care plan and nursing care institution requirements.
Findings
Complaint survey citing one deficiency related to care plan and nursing care institution requirements.
Deficiencies (1)
R9-10-414.B — Care plan and nursing care institution requirements
Inspection Report
Complaint
Capacity: 30
Deficiencies: 1
Date: Dec 11, 2024
Visit Reason
Complaint survey citing one deficiency related to care plan and prevention of falls.
Findings
Complaint survey citing one deficiency related to care plan and prevention of falls.
Deficiencies (1)
R9-10-414.B — Care plan and nursing care institution requirements
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Oct 21, 2024
Visit Reason
Complaint survey with no deficiencies cited.
Findings
Complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Sep 30, 2024
Visit Reason
Complaint survey with no deficiencies cited.
Findings
Complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Aug 29, 2024
Visit Reason
Onsite complaint survey with no deficiencies cited.
Findings
Onsite complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 2
Date: Jun 21, 2024
Visit Reason
Investigation of complaints citing two deficiencies related to accident prevention and premises safety.
Findings
Investigation of complaints citing two deficiencies related to accident prevention and premises safety.
Deficiencies (2)
§483.25(d) — Accident and fall prevention
R9-10-425.A — Nursing care institution premises and equipment safety
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: May 23, 2024
Visit Reason
Complaint survey with no deficiencies cited.
Findings
Complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 2
Date: Apr 10, 2024
Visit Reason
Onsite complaint survey citing two deficiencies related to comprehensive care plans and medication administration.
Findings
Onsite complaint survey citing two deficiencies related to comprehensive care plans and medication administration.
Deficiencies (2)
§483.21(b)(3) — Comprehensive care plans
R9-10-421.B — Medication administration compliance
Inspection Report
Complaint
Capacity: 30
Deficiencies: 8
Date: Jan 12, 2024
Visit Reason
State compliance survey citing eight deficiencies including policies, transfer/discharge, care plans, accident prevention, medical records, and premises safety.
Findings
State compliance survey citing eight deficiencies including policies, transfer/discharge, care plans, accident prevention, medical records, and premises safety.
Deficiencies (8)
R9-10-403.C — Policies and procedures for physical and behavioral health services
§483.15(c) — Transfer and discharge requirements
§483.15(d) — Notice of bed-hold policy and return
§483.21(b)(3) — Comprehensive care plans
§483.25(d) — Accident and fall prevention
R9-10-411.C — Medical record transfer documentation
R9-10-414.B — Care plan and nursing care institution requirements
R9-10-425.A — Nursing care institution premises and equipment safety
Inspection Report
Capacity: 30
Deficiencies: 4
Date: Jan 12, 2024
Visit Reason
Recertification survey for Medicare under Life Safety Code 2012 citing four deficiencies related to emergency preparedness and safety.
Findings
Recertification survey for Medicare under Life Safety Code 2012 citing four deficiencies related to emergency preparedness and safety.
Deficiencies (4)
[(a) Emergency Plan] — Emergency preparedness planning
[(c) Emergency communication plan] — Emergency preparedness communication
Egress Doors — Means of egress door locking requirements
Electrical Equipment — Power cords and extension cords safety
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: Dec 21, 2023
Visit Reason
Complaint survey with no deficiencies cited.
Findings
Complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 4
Date: Sep 27, 2023
Visit Reason
Onsite complaint survey citing four deficiencies related to abuse reporting and prevention.
Findings
Onsite complaint survey citing four deficiencies related to abuse reporting and prevention.
Deficiencies (4)
R9-10-403.F — Abuse reporting requirements
§483.12 — Freedom from abuse, neglect, and exploitation
§483.12(c) — Response to allegations of abuse
R9-10-410.B — Protection from abuse
Inspection Report
Complaint
Capacity: 30
Deficiencies: 0
Date: May 4, 2023
Visit Reason
Onsite complaint survey with no deficiencies cited.
Findings
Onsite complaint survey with no deficiencies cited.
Inspection Report
Complaint
Capacity: 30
Deficiencies: 2
Date: Mar 23, 2023
Visit Reason
Onsite complaint survey citing two deficiencies related to skin integrity and care plan.
Findings
Onsite complaint survey citing two deficiencies related to skin integrity and care plan.
Deficiencies (2)
§483.25(b) — Skin integrity and pressure ulcer care
R9-10-414.B — Care plan and nursing care institution requirements
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