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Complaint Investigation

Desert Cove Nursing Center

September 19, 2025 · Chandler, AZ · 1750 West Frye Road
Citations 2
CMS Rating 2/5
Beds 120
Provider ID 035095
Healthcare Facility
Desert Cove Nursing Center
Chandler, AZ  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

Desert Cove Nursing Center in CHANDLER, AZ — inspection on September 19, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0677
Quality of Life and Care Deficiencies

patient.

They also allow observation of the condition of a patient's skin and assessment of joint

discoloration or redness, tolerance of the procedure, and teaching provided to the patient and family

revealed this facility will ensure nursing documentation is consistent with professional standards of practice, the state nurse practice act, and any state laws governing the scope of nursing practice.

The medical record must reflect the resident's condition and the care and services provided across all disciplines to ensure information is available to facilitate communication among the interdisciplinary team.

The medical record must contain an accurate representation of the actual experience of the resident and include enough information to provide a picture of the resident's progress, including his/her response to treatment and/or services, and changes in his/her condition, plan of care goals, objectives and/or interventions.

035095 09/19/2025

Desert Cove Nursing Center 1750 West Frye Road Chandler, AZ 85224

with the Social Services Director (Staff #36) on September 19, 2025, at 11:35 A.M.

Staff #36 stated

the issue addressed.

Staff #36 stated that Resident #5 will say care items have not been completed

interview was conducted with the Director of Nursing (DON / Staff #80) on September 19, 2025, at 11:51 A.M.

Staff #80 stated that daily catheter care includes cleansing with soap and water, emptying the catheter, and that some require flushing.

Additionally, the DON stated that the care is recorded on the MAR / TAR.

The DON stated that the importance of daily catheter care is to keep it clean and to prevent infection.

Additionally, Staff #80 stated that if a resident had a physician order to empty the catheter bag and monitor the output three times a day then that would be important to prevent infections and to prevent the bag from getting too full with urine backing up into the catheter tube.

Also, the DON stated that if the physician order indicated to empty the catheter bag three times a day, and it was only completed once a day, then that would not meet her expectations.

The MAR/TAR for August 2025 was reviewed together, and the DON stated that there were blank log entries for multiple dates and times, and that it could mean that the CNA did not get the information to the nurse.

The DON stated that there was no other way to tell if the catheter was emptied or not.

Review of the facility policy titled Indwelling Urinary Catheter (Foley) Management, revised June 27, 2023, revealed that the facility will ensure that residents admitted with a urinary catheter, or determined to need a urinary catheter for a medical indication will have the following areas addressed: insertion, ongoing care, and catheter removal protocols that adhere to professional standards of practice and infection prevention and control procedures and ongoing monitoring for changes in condition related to potential catheter acquired UTIs, recognizing, reporting and addressing such changes.

Additionally, a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible.

General guidelines for urinary catheter maintenance include to empty the collecting bag regularly using a separate, clean collecting container for each patient.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in CHANDLER, AZ, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Desert Cove Nursing Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.