Deficiencies per Year
4
3
2
1
0
Unclassified
Inspection Report
Capacity: 10
Deficiencies: 4
Apr 21, 2025
Visit Reason
State-compiled facility profile showing 3 inspections from 2023-08-11 to 2025-04-21 with deficiency history and complaint investigation details.
Findings
Across three inspections, the facility had four deficiencies related to unsafe storage of toxic materials, unapproved facility modifications, missing manager signatures on residency agreements, and unsigned service plans. One inspection found no deficiencies.
Complaint Details
Complaint investigation AZ00210733 was conducted on December 3, 2024, resulting in two deficiencies related to toxic material storage and unapproved facility modifications.
Deficiencies (4)
| Description |
|---|
| A. A manager shall ensure that: 11. Poisonous or toxic materials stored by the assisted living facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents; - Toxic materials were stored unlocked in shed and pantry posing health and safety risk. |
| R9-10-110. Modification of a Health Care Institution E. A licensee shall not implement a modification described in subsection (C) until an approval or amended license is issued by the Department. - Facility implemented modifications without approval or amended license. |
| D. Before or at the time of an individual's acceptance by an assisted living facility, a manager shall ensure that there is a documented residency agreement with the assisted living facility that includes: 10. The manager's signature and date signed. - Residency agreements for four residents lacked manager's signature and date. |
| A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 5. When initially developed and when updated, is signed and dated by: b. The manager; - Service plans for two residents were not signed and dated by the manager. |
Report Facts
Inspections on page: 3
Total deficiencies: 4
Complaint inspections: 1
Total capacity: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 | Manager | Named in deficiencies related to toxic material storage, facility modifications, and missing signatures on residency agreements and service plans |
| E2 | Acknowledged missing manager signatures on residency agreements and service plans |
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