Handmaker Home for the Aging: Admin Violations - AZ]
Let it go, the assistant director of nursing and the assistant administrator told her. Stop escalating it. The residents involved were in the behavioral unit, and they would forget about it anyway.
They did not forget. According to the inspection report filed after a September 2025 complaint investigation, verbal abuse and intimidation continued after that initial incident. No thorough investigation was documented. No report to the state agency was filed.
And the person who helped make that call, the assistant administrator who told the nursing assistant to stand down, may not have been legally authorized to hold that role at all.
Federal inspectors reviewing Handmaker Home's records found no evidence that the facility's assistant administrator, identified in the report as staff #103, had ever been formally appointed to the position by the facility's governing board. That appointment is not a formality. Under Arizona administrative rules, the assistant administrator is designated as the person accountable for the nursing care institution when the licensed administrator is not on the premises. At Handmaker, that responsibility had been handed to someone whose paperwork did not confirm she had been authorized to carry it.
The job description in her personnel file, dated September 1, 2023, had a blank where the CEO's approval signature should have been. In its place, a handwritten line had been added noting human resources, signed by staff #103 herself, on September 13, 2023. She had, in effect, signed her own approval.
Her resume told a longer story. Staff #103 had worked at Handmaker in several capacities over the years, starting as a receptionist, then as a marketing representative, then as a marketing and admissions coordinator. As of September 2024, her title became assistant administrator, a role she also combined with marketing and admissions director responsibilities. Her educational background listed attendance at a community college from 1978 to 1980, with no degree noted. Before her work in healthcare administration, she had spent roughly 24 years training horses and giving riding lessons.
No licenses. No certifications. No governing board appointment. A business card that said "Assistant Administrator."
When inspectors sat down with staff #103 and the facility's licensed nursing home administrator, staff #110, on September 11, 2025, the administrator acknowledged that the facility had no policy for assistant administrator appointment. He also said he was not aware that the assistant administrator was required to be appointed by the governing board. He identified no risk in the situation.
That is a striking position for a licensed administrator to take. The assistant administrator's authority to act in his absence, her authority to receive abuse reports, direct investigations, and decide what rises to the level of state notification, all of it rested on an appointment that had never formally happened. And the administrator running the facility did not know that was a problem.
The abuse incident that surfaced during the inspection illustrates why the question of who holds authority matters in practice, not just on paper.
A certified nursing assistant, staff #101, told inspectors in an interview on September 10, 2025, that she had reported an incident of abuse to both the assistant director of nursing and the assistant administrator. The response from both was the same: let it go. The residents were in the behavioral unit. They would forget.
A registered nurse, staff #108, described in a separate interview how the facility's system was supposed to work. If resident-to-resident abuse occurred, she said, staff would separate the residents, check for injuries, confirm their safety, and then report to the assistant director of nursing, the assistant administrator, and the administrator. Those three people, she said, would conduct investigations and ensure proper notifications were made.
That is the system as designed. What inspectors found in the documentation told a different story. The verbal abuse and intimidation did not stop after the initial report. There was no evidence of a thorough investigation in the facility's records. There was no evidence of a report to the state agency.
The person at the center of that failure, the assistant administrator who received the report and helped decide to let it go, held her position without the governing board ever formally putting her there.
Handmaker Home for the Aging is a Jewish-affiliated senior care community in Tucson that has operated for decades. The inspection that produced this report was a complaint investigation, meaning someone contacted regulators with a concern before inspectors arrived. The report covers a single deficiency tag, F0835, which addresses whether a facility is administered in a way that allows it to use its resources effectively and efficiently. CMS rated the level of harm as minimal harm or potential for actual harm. The deficiency was noted as affecting few residents.
That classification, minimal harm, sits at the lower end of the federal harm scale. But the facts underneath it are not minor. A staff member reported abuse and was told to drop it. The person who told her that had been signing her own administrative approvals. The licensed administrator responsible for the building did not know his second-in-command lacked proper authorization. And the abuse, whatever its specifics, continued.
The inspection report does not name the residents involved in the behavioral unit. It does not describe the nature of the verbal abuse or the intimidation, beyond confirming that both occurred and that both continued after the initial report. It does not say how long the situation went on before someone contacted regulators.
What it says is that a nursing assistant did the right thing. She saw something, and she reported it to the people she was supposed to report it to. Those people told her she was wrong to push it. The residents, they said, would forget.
The inspection report does not say whether they did.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Handmaker Home For the Aging from 2025-09-12 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 28, 2026 · Our methodology
HANDMAKER HOME FOR THE AGING in TUCSON, AZ was cited for violations during a health inspection on September 12, 2025.
Let it go, the assistant director of nursing and the assistant administrator told her.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.