Deficiencies (last 3 years)
Deficiencies (over 3 years)
2.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
27% better than Arizona average
Arizona average: 3.7 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Aug 20, 2024
Visit Reason
The inspection was conducted due to a complaint regarding improper care and failure to use a gait belt during transfer of resident #23, which could result in injury.
Complaint Details
The complaint involved allegations that the CNA was rough and did not use a gait belt while transferring resident #23, causing pain and a fall backwards on the bed. The complaint was substantiated based on interviews and record reviews.
Findings
The facility failed to ensure resident safety by not using a gait belt during transfers of resident #23, causing pain and potential injury. Interviews with the resident, CNA, and Director of Nursing confirmed the deficient practice and staff shortages contributing to the issue.
Deficiencies (1)
Failure to use a gait belt during transfer of resident #23, causing pain and potential injury.
Report Facts
Date of survey completion: Aug 20, 2024
Years CNA employed: 3
Time of CNA abuse training: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant (Staff #198) | Named in complaint and interview regarding improper transfer of resident #23 | |
| Director of Nursing (Staff #87) | Interviewed regarding expectations for gait belt use and resident care planning |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Aug 20, 2024
Visit Reason
The inspection was conducted following a complaint regarding improper use of a gait belt and rough handling by a Certified Nursing Assistant (CNA) during the transfer of resident #23, which allegedly caused pain and potential injury.
Complaint Details
The complaint was substantiated based on interviews and documentation indicating that the CNA did not use a gait belt and transferred the resident in a manner that caused pain and a fall backwards on the bed. The CNA was found to have received abuse training but did not ask for assistance due to short staffing. The Director of Nursing confirmed expectations for gait belt use and awareness of the resident's care plan.
Findings
The facility failed to ensure resident safety by not using a gait belt during transfers of resident #23, resulting in pain and a fall backwards on the bed. Interviews with the resident, CNA, and Director of Nursing confirmed the lack of gait belt use and staff difficulties in safely transferring the resident. The CNA admitted to not asking for help due to short staffing. Facility policy requires gait belt use unless contraindicated.
Deficiencies (1)
Failure to ensure resident safety by not using a gait belt during transfer of resident #23, causing pain and potential injury.
Report Facts
Date of survey completion: Aug 20, 2024
Date of CNA interview: Aug 20, 2024
Date of resident interview: Jul 21, 2023
Date of physician order: Apr 2, 2024
Date of care plan initiation: Aug 5, 2024
Date of physician progress note: Aug 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff #198 | Certified Nursing Assistant | Named in complaint and interview regarding improper transfer of resident #23 |
| Staff #87 | Director of Nursing | Interviewed regarding expectations for gait belt use and resident care plan |
Inspection Report
Routine
Deficiencies: 1
Date: Feb 27, 2024
Visit Reason
The inspection was conducted to ensure the nursing home area was free from accident hazards and provided adequate supervision to prevent accidents, specifically focusing on the safety of a resident's oxygen tubing.
Findings
The facility failed to ensure that resident #27's oxygen tubing was safely secured, which could result in a preventable accident. Observations and staff interviews revealed that the oxygen tubing was placed above the bathroom door frame, posing a risk of the tubing being clamped by the door and potentially interrupting oxygen delivery.
Deficiencies (1)
Failed to ensure resident #27's oxygen tubing was safely secured, risking preventable accidents.
Report Facts
Oxygen liters ordered: 2
Oxygen liters observed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse staff #280 | Licensed Practical Nurse | Observed oxygen tubing placement and described maintenance adjustments |
| Director of Nursing | Director of Nursing | Provided information about facility's standard procedure for oxygen tubing clips and maintenance actions |
Inspection Report
Deficiencies: 1
Date: Feb 27, 2024
Visit Reason
The inspection was conducted to assess compliance with safety standards related to accident hazards and supervision in the nursing home, specifically focusing on the safe securing of oxygen tubing for resident #27.
Findings
The facility failed to ensure that resident #27's oxygen tubing was safely secured, posing a risk of preventable accidents. Observations and staff interviews revealed that the oxygen tubing was placed above the bathroom door frame, which could be clamped by the door and potentially prevent oxygen delivery.
Deficiencies (1)
Failed to ensure resident #27's oxygen tubing was safely secured to prevent accidents.
Report Facts
Oxygen order flow rate: 2
Oxygen order flow rate: 4
Observation date: Feb 21, 2024
Observation date: Feb 22, 2024
Progress note date: Jan 20, 2024
Oxygen flow rate: 3
Interview date: Feb 23, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) staff #280 | Observed and described oxygen tubing placement and risks during interview on 02/23/2024 | |
| Director of Nursing (DON) | Provided information about facility procedures for oxygen tubing clips during interview on 02/23/2024 |
Inspection Report
Deficiencies: 0
Date: Nov 23, 2022
Visit Reason
The document is a statement of deficiencies and plan of correction for a nursing home facility inspection conducted on 11/23/2022.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Deficiencies: 0
Date: Nov 23, 2022
Visit Reason
The document is a statement of deficiencies and plan of correction for a nursing home facility inspection.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Routine
Census: 33
Deficiencies: 2
Date: Nov 10, 2021
Visit Reason
The inspection was conducted to evaluate compliance with professional standards of care, infection prevention, and treatment protocols at the nursing home.
Findings
The facility failed to ensure that a resident received treatment and care according to physician orders, specifically regarding the use of an alternating pressure pad mattress and heel protector, which were not properly applied or operational. Additionally, the facility failed to maintain infection control standards related to glucometer disinfection, risking transmission of infection.
Deficiencies (2)
Failure to ensure interventions were implemented as ordered by the physician for resident #25, including non-operational APP mattress and lack of heel protector application.
Failure to ensure infection control standards were maintained regarding glucometer disinfection after use.
Report Facts
Facility census: 33
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Provided statements regarding facility policy and orders for pressure relieving devices |
| Lead CNA | Lead Certified Nursing Assistant | Reported APP mattress non-operational status and responsibility for reporting |
| Certified Nursing Assistant | Certified Nursing Assistant | Interviewed regarding resident care and use of pressure devices |
| Registered Nurse | Registered Nurse | Interviewed regarding physician orders and observations of resident care |
| Licensed Practical Nurse | Licensed Practical Nurse | Observed during medication administration and glucometer use |
| Assistant Director of Nursing | Assistant Director of Nursing | Interviewed regarding glucometer cleaning procedures |
Inspection Report
Routine
Census: 33
Deficiencies: 2
Date: Nov 10, 2021
Visit Reason
The inspection was conducted to assess compliance with professional standards of care, including treatment implementation, infection prevention, and control practices at VI at Grayhawk nursing facility.
Findings
The facility failed to ensure a resident received ordered interventions for skin integrity, including use of an alternating pressure pad mattress and heel protector, resulting in minimal harm risk. Additionally, infection control deficiencies were found related to improper cleaning of glucometers, posing a risk of infection transmission.
Deficiencies (2)
Failure to provide appropriate treatment and care according to physician orders, including non-operational alternating pressure pad mattress and lack of heel protector application.
Failure to maintain infection control standards regarding glucometers, including not disinfecting glucometers after use.
Report Facts
Facility census: 33
Deficiencies cited: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff #51 | Certified Nursing Assistant (CNA) | Interviewed regarding resident care and use of pressure relief devices |
| Staff #59 | Registered Nurse (RN) | Interviewed regarding physician orders and resident care |
| Staff #53 | Registered Nurse (RN) | Observed resident care and reported non-operational APP mattress |
| Staff #47 | Lead CNA | Interviewed about reporting non-operational APP mattress |
| Staff #18 | Director of Nursing (DON) | Interviewed regarding facility policies and physician orders |
| Staff #57 | Licensed Practical Nurse (LPN) | Observed medication administration and glucometer use |
| Staff #17 | Assistant Director of Nursing (ADON) | Interviewed about glucometer cleaning procedures |
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