Inspection Reports for
Blue Sky Manor Assisted Living & Memory Care
1510 W 5th Pl, Mesa, AZ 85201, United States, AZ, 85201
Back to Facility Profile6 Reports
Inspection Report — Jul 7, 2025
Annual Inspection
Date: Jul 7, 2025
Visit Reason
On-site complaint investigation and annual compliance inspection of complaints 00135312, 00135744, 00135328, and 00102640 at an Assisted Living Home, conducted 7 July 2025.
Complaint Details
The following deficiencies were found during the on-site compliance inspection and investigation of complaints 00135312, 00135744, 00135328, and 00102640 conducted on July 7, 2025.
Findings
The inspection found one deficiency related to unsecured oxygen tanks posing a potential risk to resident health and safety.
Deficiencies (1)
R9-10-820 — The manager failed to ensure that oxygen tanks were secured in an upright position for one of five residents sampled, posing a potential risk to health and safety.
Report Facts
Deficiencies cited: 1
Complaints investigated: 4
Inspection Report — Oct 10, 2023
Enforcement
Date: Oct 10, 2023
Visit Reason
Civil monetary penalty, action 00112412 (invoice INV-258912), assessed 10 October 2023.
Findings
A $1,750.00 penalty was assessed and paid in full on 3 December 2023.
Report Facts
Penalty amount: 1750
Amount paid: 1750
Amount remaining: 0
Inspection Report — Sep 18, 2023
Annual Inspection
Date: Sep 18, 2023
Visit Reason
On-site complaint investigation and compliance (annual) inspection of complaint AZ00194259 at an Assisted Living Home, conducted on September 18, 2023.
Complaint Details
The following deficiencies were found during the compliance inspection and investigation of complaint AZ00194259 conducted on September 18, 2023.
Findings
This inspection found sixteen deficiencies related to policy reviews, documentation, resident care, and facility conditions. The facility failed to maintain required records, provide services according to plans, and ensure safety measures such as proper hot water temperature and tuberculosis screening.
Deficiencies (16)
The manager failed to ensure policies and procedures were reviewed at least once every three years, with documentation last dated December 4, 2015, and no evidence of subsequent review.
The manager failed to provide documentation required by Article 8 to the Department within two hours after a request, preventing determination of substantial compliance.
The manager failed to maintain documentation of caregivers and assistant caregivers working each day, including hours worked, for at least 12 months.
The manager failed to ensure personnel records included documentation of skills and knowledge applicable to job duties for two caregivers.
The manager accepted and retained a resident without the ability to provide the assisted living services needed, as the facility had not provided a requested lower bed for the resident.
The manager failed to ensure residency agreements contained provisions allowing termination of residency in compliance with regulations for four residents.
The manager failed to ensure written service plans were completed within 14 calendar days after acceptance for two residents, posing a risk due to lack of service direction.
The manager failed to ensure caregivers provided assistance with activities of daily living according to residents' service plans for two residents.
The manager failed to ensure caregivers documented services provided in residents' medical records for all eight residents sampled, resulting in unverifiable services and misleading documentation.
R9-10-807 — The manager failed to ensure a resident's medical record contained all required information, including signed residency agreements, infectious tuberculosis test, service plans, and other mandated documentation.
The manager failed to ensure medication administered to a resident was in compliance with a medication order, as a resident received a medication without a corresponding order.
The manager failed to ensure a refrigerator used to store food and medication contained a thermometer, risking improper storage conditions.
The manager failed to ensure the disaster plan was reviewed at least once every 12 months, with requested documentation not provided.
The manager failed to ensure the premises and equipment were free from conditions that could cause physical injury, including use of bricks as an assistive device and broken bathroom tiles.
The manager failed to maintain hot water temperatures between 95º F and 120º F in resident areas, with observed temperatures up to 133.5º F posing a burn risk.
R9-10-113 — The chief administrative officer failed to implement required tuberculosis infection control activities, including baseline screening, annual training, and risk assessment.
Report Facts
Deficiencies cited: 16
Inspection Report — Jan 17, 2023
Enforcement
Date: Jan 17, 2023
Visit Reason
Civil monetary penalty, action 00113923 (invoice INV-260178), assessed 17 January 2023.
Findings
A $250.00 penalty was assessed and paid in full on 7 March 2023.
Report Facts
Penalty amount: 250
Amount paid: 250
Amount remaining: 0
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