Immanuel Campus Of Care: Resident-on-Resident Assault - AZ
The incident at Immanuel Campus of Care unfolded sometime before May 2026, when Resident 171 scratched Resident 170 on the underside and back of her forearm. Inspectors who arrived on May 22, 2026, following a complaint, documented three one-inch abrasions on the underside of Resident 170's forearm and one more on the posterior side. Four wounds, each roughly an inch long, from a fight over who controlled the TV.
Resident 170 told inspectors what started it: the volume was too loud, so she went to turn it down, and her roommate scratched her.
Resident 171 confirmed it. She told a licensed practical nurse that she scratched Resident 170 because of the TV remote.
That was more than most of the staff could say.
A certified nursing assistant, Staff 115, said she was passing out snacks when she heard the two residents yelling at each other. She didn't see a physical altercation. What she remembered was Resident 170 coming to report that her roommate had scratched her. The CNA also offered her own read on the dynamic between the two women: Resident 170, she said, tends to instigate or pick at Resident 171, which had led to arguments or fights before.
That detail, offered almost as an aside in a phone interview on May 20, is the kind of thing that raises a harder question. If staff knew that these two residents had a pattern of conflict, if a CNA could describe one of them as someone who tends to instigate, then what was the plan to keep them safe before something like this happened?
The inspection record doesn't answer that.
What it does show is what happened after Resident 170 was hurt. She went to the nursing station. She told staff she didn't want to go back to her room because Resident 171 had yelled at her. The LPN on duty, Staff 129, said she remembered telling the resident to call staff if she needed anything.
Call staff if she needed anything. The resident had just been scratched hard enough to leave four documented wounds, had walked herself to the nursing station to report it, and said she was afraid to go back to her room. The response was to tell her to use the call button.
Staff 129 said she didn't witness the scratching herself. She confirmed that both residents were in the same room when the incident happened. She said she remembered the facility interviewing her as part of the investigation afterward.
The administrator, Staff 48, was interviewed on the morning of May 22, the same day inspectors were on site. She reviewed the incident report and said she remembered placing Resident 170 on one-on-one care following the altercation, until the resident was transferred to a different unit. She described this as current practice: when there's a resident-to-resident altercation, the alleged resident, meaning the one accused of causing harm, receives one-on-one supervision until they can be moved to a different room or unit. The administrator said the risks were clear, that without intervention, further fighting could occur.
The facility substantiated the incident. It determined that what happened to Resident 170 was real, that her roommate had scratched her, and that it rose to the level of abuse under its own policy. The abuse policy, as inspectors reviewed it, states that residents must not be subjected to abuse by anyone, including other residents.
So the facility knew. It investigated, it substantiated, it moved the resident and put the other on one-on-one care. On paper, the response looks like a system that caught something and acted.
But the inspection was triggered by a complaint. Someone, somewhere, felt that what happened or how it was handled was serious enough to report to outside authorities. The complaint brought federal inspectors through the door on May 22, and what they found was enough to cite the facility for a deficiency.
The level of harm was classified as minimal harm or potential for actual harm. The number of residents affected was listed as few. In the bureaucratic grammar of CMS inspection reports, those are among the lower rungs of severity. Four scratches on a frightened woman's arm, a nurse telling her to call if she needs something, a roommate with a documented history of conflict still sharing her room until after the incident, these things fit into the category of minimal.
What the inspection record cannot capture is how long Resident 170 sat with those wounds before anyone did a formal assessment. It cannot say how long she had been sharing a room with someone staff already knew she clashed with. It cannot say whether anyone had tried to separate them before the scratching, or whether the CNA's observation about instigation had ever made it into a care plan or a conversation about room assignments.
The record shows what inspectors found on May 22. It shows four abrasions, two phone interviews with staff conducted two days earlier, one interview with the administrator on the day of the inspection, and a policy that says residents must not be subjected to abuse.
Resident 170 had walked herself to the nursing station. She had told staff she was afraid to go back to her room. She had four scratches on her arm to show why.
She was told to call if she needed anything.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Immanuel Campus of Care from 2026-05-22 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 19, 2026 · Our methodology
Immanuel Campus Of Care in PEORIA, AZ was cited for violations during a health inspection on May 22, 2026.
The incident at Immanuel Campus of Care unfolded sometime before May 2026, when Resident 171 scratched Resident 170 on the underside and back of her forearm.
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.