Inspection Report Summary
The most recent inspection on August 30, 2025, included enforcement action resulting in a fine that has been fully paid. Earlier inspections showed a pattern of deficiencies primarily related to caregiver skill verification, medication administration compliance, and documentation issues, with several enforcement actions and fines totaling several thousand dollars. Complaint investigations mostly found deficiencies involving CPR initiation, medication administration, and proper management oversight, while many complaints were unsubstantiated. Enforcement actions addressed repeated and uncorrected deficiencies, including failure to designate a qualified manager and failure to verify caregiver qualifications before providing care. The facility’s record shows ongoing challenges with compliance in key areas, with some improvements noted in investigations that found no deficiencies.
Deficiencies (last 3 years)
Deficiencies (over 3 years)
6.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
70% worse than Arizona average
Arizona average: 3.7 deficiencies/yearDeficiencies per year
8
6
4
2
0
Enforcement Action
Enforcement
Fines: 1
Total: $4,500.00
Date: Aug 30, 2025
Summary
The enforcement resulted in a fine which has been fully paid as of the due date.
Fines & Penalties (1)
| Amount | Reason | Status |
|---|---|---|
| $4,500.00 | Fine related to enforcement action against the facility | Paid |
Inspection Report
Capacity: 124
Deficiencies: 0
Date: Jul 16, 2025
Visit Reason
No deficiencies were found during the on-site modification to change occupancy to 38 directed care beds and 86 personal care beds.
Findings
No deficiencies were found during the on-site modification to change occupancy to 38 directed care beds and 86 personal care beds.
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 1
Date: Jun 19, 2025
Visit Reason
One deficiency found related to failure to initiate CPR in accordance with certification training during complaint investigation.
Complaint Details
Investigation of complaint 00131841
Findings
One deficiency found related to failure to initiate CPR in accordance with certification training during complaint investigation.
Deficiencies (1)
A.R.S. § 36-420.B.1. — Failure to initiate cardiopulmonary resuscitation (CPR) per certification training
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 0
Date: Jun 12, 2025
Visit Reason
No deficiencies were found during the on-site investigation of complaint 00133139.
Complaint Details
Investigation of complaint 00133139
Findings
No deficiencies were found during the on-site investigation of complaint 00133139.
Enforcement Action
Enforcement
Fines: 2
Total: $4,500.00
Date: May 20, 2025
Summary
The facility was found to have repeated and uncorrected deficiencies posing risks to resident health and safety, resulting in civil fines totaling $4500.00.
Fines & Penalties (2)
| Amount | Reason | Status |
|---|---|---|
| $2,000.00 | Failure to ensure caregiver skills and knowledge were verified and documented before providing physical health services. | — |
| $2,500.00 | Failure to ensure medication was administered in compliance with medication orders. | — |
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 2
Date: May 20, 2025
Visit Reason
Two deficiencies found related to failure to verify caregiver skills and ensure medication administration compliance.
Complaint Details
Investigation of complaint 00127968
Findings
Two deficiencies found related to failure to verify caregiver skills and ensure medication administration compliance.
Deficiencies (2)
R9-10-806.A.4.a-b. — Failure to verify and document caregiver skills and knowledge before providing care
R9-10-816.B.3.b. — Failure to ensure medication administered in compliance with orders
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 0
Date: Apr 1, 2025
Visit Reason
No deficiencies were found during the on-site investigation of complaint 00124918.
Complaint Details
Investigation of complaint 00124918
Findings
No deficiencies were found during the on-site investigation of complaint 00124918.
Enforcement Action
Enforcement
Fines: 1
Total: $2,900.00
Date: Feb 25, 2025
Summary
The enforcement resulted in a fine of $2,900.00 which has been paid in full.
Fines & Penalties (1)
| Amount | Reason | Status |
|---|---|---|
| $2,900.00 | Financial penalty related to enforcement action | Paid |
Enforcement Action
Enforcement
Fines: 1
Total: $2,900.00
Date: Feb 6, 2025
Summary
The facility was found non-compliant for not having a designated certified manager, posing a health and safety risk and inability to ensure compliance with applicable rules.
Fines & Penalties (1)
| Amount | Reason | Status |
|---|---|---|
| $2,900.00 | Failure to designate a certified assisted living facility manager as required by A.A.C. R9-10-803.A.3.b.i-ii. | Pending |
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 1
Date: Feb 6, 2025
Visit Reason
One deficiency found related to failure to designate a qualified manager in writing.
Complaint Details
Investigation of complaint AZ00223089
Findings
One deficiency found related to failure to designate a qualified manager in writing.
Deficiencies (1)
A. A governing authority shall: 3. Designate, in writing, a qualified manager
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 2
Date: Nov 22, 2024
Visit Reason
Two deficiencies found related to medication administration compliance and proper storage of garbage and refuse.
Complaint Details
Investigation of complaints AZ00217436, AZ00218673, AZ00218966, and AZ00218983
Findings
Two deficiencies found related to medication administration compliance and proper storage of garbage and refuse.
Deficiencies (2)
B. If an assisted living facility provides medication administration, a manager shall ensure medication is administered properly
A. A manager shall ensure that: 3. Garbage and refuse are stored in covered containers lined with plastic bags
Enforcement Action
Enforcement
Fines: 3
Total: $1,000.00
Date: Oct 8, 2024
Summary
The enforcement resulted in civil fines totaling $1,000 for repeated deficiencies from a prior inspection and failure to meet compliance requirements.
Fines & Penalties (3)
| Amount | Reason | Status |
|---|---|---|
| $250.00 | Documents requested by the Compliance Officer were not submitted within two hours. | Pending |
| $250.00 | One caregiver's skills and knowledge were not verified and documented before providing physical health services to residents. | Pending |
| $500.00 | One employee had no documentation of first aid training. | Pending |
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 0
Date: Sep 26, 2024
Visit Reason
No deficiencies were cited during the on-site investigation of complaint AZ00216585.
Complaint Details
Investigation of complaint AZ00216585
Findings
No deficiencies were cited during the on-site investigation of complaint AZ00216585.
Enforcement Action
Enforcement
Fines: 1
Total: $1,000.00
Date: Sep 24, 2024
Summary
The enforcement resulted in a $1,000 fine which has been paid in full.
Fines & Penalties (1)
| Amount | Reason | Status |
|---|---|---|
| $1,000.00 | Enforcement action fine | Paid |
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 1
Date: Sep 13, 2024
Visit Reason
One deficiency found related to medication administration compliance.
Complaint Details
Investigation of complaints AZ00214794, AZ00215256, and AZ00215742
Findings
One deficiency found related to medication administration compliance.
Deficiencies (1)
B. If an assisted living facility provides medication administration, a manager shall ensure medication is administered properly
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 5
Date: Aug 5, 2024
Visit Reason
Five deficiencies found related to documentation submission, abuse reporting, caregiver verification, first aid certification, and medication storage.
Complaint Details
Investigation of complaints AZ00201825, AZ00204181, AZ00204835, AZ00209668, AZ00210570, AZ00213450, and AZ00214009
Findings
Five deficiencies found related to documentation submission, abuse reporting, caregiver verification, first aid certification, and medication storage.
Deficiencies (5)
E. A manager shall ensure required documentation is provided to the Department within two hours after request
J. A manager shall immediately report suspected abuse, neglect, or exploitation
A. A manager shall ensure caregiver skills and knowledge are verified and documented before providing physical health services
A. A manager shall ensure caregiver provides current documentation of first aid training certification specific to adults
F. When medication is stored, it must be stored in a separate locked room, closet, cabinet, or self-contained unit
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 0
Date: Apr 24, 2024
Visit Reason
No deficiencies were cited during the on-site investigation of complaints AZ00208808 and AZ00208917.
Complaint Details
Investigation of complaints AZ00208808 and AZ00208917
Findings
No deficiencies were cited during the on-site investigation of complaints AZ00208808 and AZ00208917.
Inspection Report
Complaint Investigation
Capacity: 124
Deficiencies: 7
Date: Feb 1, 2023
Visit Reason
Seven deficiencies found related to governing authority compliance, documentation submission, first aid and CPR certification, personnel records, resident service plans, and disaster drills.
Complaint Details
Investigation of complaints #AZ00181286, AZ00189345, and AZ00189346
Findings
Seven deficiencies found related to governing authority compliance, documentation submission, first aid and CPR certification, personnel records, resident service plans, and disaster drills.
Deficiencies (7)
A. A governing authority shall ensure compliance with A.R.S. § 36-411
E. A manager shall ensure required documentation is provided to the Department within two hours after request
A. A manager shall ensure caregiver provides current documentation of first aid and CPR training
C. A manager shall ensure personnel records include documentation of education applicable to job duties
C. A manager shall ensure personnel records include evidence of freedom from infectious tuberculosis (TB)
A. Except as required, a manager shall ensure a resident has a written service plan completed within 14 calendar days
A. A manager shall ensure disaster drills for employees are conducted on each shift at least once every three months and documented
Enforcement Action
Enforcement
Fines: 3
Total: $1,250.00
Date: Feb 1, 2023
Summary
The facility was found to have provided false and misleading information regarding employee training and testing, and failed to conduct required disaster drills, resulting in civil fines.
Fines & Penalties (3)
| Amount | Reason | Status |
|---|---|---|
| $500.00 | Invalid CPR and first aid training for one employee; false and misleading information provided. | — |
| $500.00 | Altered TB test documentation for one employee; false and misleading information provided. | — |
| $250.00 | Failure to conduct employee disaster drills on each shift at least once every three months; repeat deficiency. | — |
Enforcement Action
Enforcement
Total: $0.00
Date: Nodate Enforcement
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