Inspection Reports for
Life Care Center of Paradise Valley

The facility failed to ensure that mechanical lifts were cleaned and disinfected according to professional standards after resident use, which could result in the spread of infection and resident illness. Observations and interviews confirmed that staff did not clean the lifts or slings after use, contrary to facility policy and manufacturer instructions.

The facility failed to ensure that mechanical lifts were cleaned and disinfected according to professional standards after resident use, which could result in the spread of infection and resident illness. Observations and interviews confirmed that staff did not clean the lifts or slings after use, contrary to facility policy and manufacturer instructions.

The complaint was substantiated based on interviews with staff and the resident, who reported verbal abuse including derogatory name-calling and physical abuse including slapping and hitting with a tissue box by the resident's sister. The family member was prohibited from visiting the resident following the incident.

The facility failed to ensure resident #77 was free from verbal and physical abuse by a family member, resulting in emotional trauma. Interviews with staff and the resident confirmed the family member yelled, called the resident derogatory names, and physically struck the resident, leading to the family member being barred from visiting.

The facility failed to ensure a resident was treated with dignity and respect by a visitor, failed to develop an adequate discharge plan addressing oxygen and durable medical equipment needs for a resident, and failed to ensure an oxygen-dependent resident did not have an empty oxygen tank while in use. These deficiencies had the potential for minimal harm or delay in care.

The complaint investigation was triggered by an incident on June 12, 2024, where a visitor yelled and cursed at resident #25, threatening to throw him out of a window, due to concerns about another resident's exposed clothing. The visitor was removed and restricted to lobby visits. The investigation included interviews with staff and residents, and review of policies. The visitor's behavior was unusual and not previously observed. Resident #25 was upset but denied inappropriate behavior.

The facility failed to ensure resident #25 was treated with dignity and respect by a visitor, failed to accurately reflect resident #3's advance directives in the medical record, failed to implement care plan interventions for monitoring medication side effects for resident #60, failed to revise care plans with resident-specific nutritional goals for resident #76, failed to ensure discharge planning met resident #49's needs including DME and transportation, failed to ensure resident #49 did not have an empty oxygen tank while in use, failed to ensure occupational therapist staff had valid CPR and first aid certifications, and failed to adequately monitor side effects related to psychotropic medication for resident #60.

The complaint investigation found substantiated verbal abuse incidents between residents #10 and #17, including shouting, verbal insults, and threats of harm. Social Services and nursing staff intervened, and a psychiatric evaluation was ordered for resident #17. Resident #10 reported feeling unsafe but acknowledged understanding the need to avoid hurtful language.

The facility failed to ensure that two residents were free from verbal abuse, with documented incidents of verbal aggression and threatening behavior between residents #10 and #17. Staff intervened to separate the residents and arranged for psychiatric evaluation for resident #17.

The complaint involved Resident #8 reporting feeling threatened by a night shift Certified Nursing Assistant (Staff #30). The facility's investigation substantiated the allegation, leading to Staff #30's termination and reporting to the board of nursing.

The facility failed to ensure one resident was free from verbal abuse by a Certified Nursing Assistant. The investigation confirmed the staff member engaged in threatening verbal behavior, resulting in termination and reporting to the board of nursing.

The facility failed to ensure one resident (#8) was free from verbal abuse by a staff member, resulting in minimal harm or potential for actual harm. The staff member involved was terminated following the investigation, and the facility updated the resident's care plan to address behavior issues.

The complaint investigation found substantiated issues including failure to notify family of change in condition, resident-to-resident abuse, inadequate care plan updates, fall prevention failures, and infection control deficiencies.

The facility failed to notify family of a resident's change in condition, failed to prevent resident-to-resident abuse, did not update care plans after incidents, failed to implement fall prevention measures such as floor mats, and did not follow infection control protocols including use of enhanced barrier precautions and signage.

Complaint was submitted by resident #1 on September 30, 2018 at 5:50 p.m. The complaint was substantiated by findings that the facility destroyed medical records before the required six-year retention period.

The facility failed to ensure that medical records for resident #1 were retained for the required six years after discharge, as the records were destroyed prematurely. The facility transitioned to Electronic Medical Records in 2019 and did not store records onsite before the transition.

Complaint was submitted by resident #1 on September 30, 2018 at 5:50 p.m. The complaint was related to the failure to retain medical records as required by State law.

The facility failed to ensure that medical records for one resident were retained for the required six years after discharge, as the records had been destroyed prematurely. The facility transitioned to Electronic Medical Records in 2019 and used offsite storage, but did not retain records older than six years.

The complaint investigation substantiated that a CNA verbally abused a resident and that medications were potentially misappropriated for multiple residents. The CNA was terminated. Attempts to interview the CNA post-incident were unsuccessful. The facility lacked auditing policies to detect medication misappropriation.

The facility failed to protect one resident from staff verbal abuse and failed to ensure that physician-ordered medications were not misappropriated for 10 residents. The facility lacked policies and procedures to audit controlled substance records against medication administration records, potentially resulting in inadequate medication supplies and unsafe resident environments.

The complaint investigation was triggered by allegations of verbal abuse by a Certified Nursing Assistant (CNA staff #14) towards resident #54, including cursing and rough handling. Additional allegations involved verbal abuse by CNA staff #33 towards resident #43. The investigation found failures in abuse reporting, investigation, and timely notification to the State Agency. The alleged perpetrators were suspended pending investigation. The facility failed to report some allegations to the State Agency and did not conduct thorough investigations.

The facility failed to ensure residents were free from verbal abuse by staff, failed to implement and follow abuse reporting and investigation policies, failed to timely report abuse allegations to the State Agency, and failed to maintain mechanical lifts in safe operating condition. Multiple residents reported verbal abuse incidents involving staff, and investigations were incomplete or not reported. Mechanical lifts had maintenance issues and were sometimes out of service.

The facility had multiple deficiencies including failure to respect resident privacy, inadequate informed consent for psychotropic medication, lack of resident rights notification, inaccurate advance directives documentation, poor maintenance of resident rooms, verbal abuse by staff, failure to report and investigate abuse allegations, failure to notify Ombudsman of resident transfer, incomplete PASARR referrals, unqualified activities director and social worker, inadequate pressure ulcer care, catheter care deficiencies, lack of behavior monitoring for psychotropic medication, medication errors, unsecured medications, infection control lapses during continence care, and unsafe mechanical lifts.

The complaint investigation was triggered by Resident #9's injury during a manual transfer on 6/2/23. The resident reported pain and was later diagnosed with a femoral fracture. The CNA involved was suspended. An internal investigation determined the injury was not due to neglect or abuse but related to the resident's high risk and manual transfer due to unavailable lifts.

The facility failed to provide necessary services to Resident #9 to avoid physical harm, resulting in a major injury (femoral fracture). Staff manually transferred the resident despite orders to use mechanical lifts, which were unavailable due to dead batteries. An internal investigation found no evidence of neglect or abuse, but the injury was linked to the manual transfer. Several staff interviews and observations confirmed lift protocols and battery issues.