Advance Health Care Of Scottsdale

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

to law enforcement because she felt that, as time went on, the daughter was recanting her allegations and was not wanting to report, and they ultimately decided not to. The administrator further stated that she did not contact Adult Protective Services (APS) because she conferred with the ombudsman who told her not to because it appeared everything was in order. The administrator stated that she did not know if the allegation was substantiated or unsubstantiated, and that the resident was making accusations with all people and all sexes, and the allegation appeared to be vague and widespread, as if it did not occur. The administrator also stated that reporting to APS and the police was optional. Review of a policy titled, Abuse Policy and Procedure, was updated on November 8, 2024 and revealed that sexual abuse was defined as, but not limited to, sexual harassment, sexual coercion, or sexual assault. The policy also revealed that all alleged or suspected violations involving abuse would be promptly reported to the Administrator and/or Director of Nursing. The policy revealed that the Administrator or Director of Nursing would then ensure the safety of the patient, begin the investigation, and if necessary, report information to the police, Department ofHealth and Welfare, family, MD, and/or any other appropriate agency. The policy further revealed that the facility would report to law enforcement immediately when there was reasonable cause to believe that abuse or sexual assault resulted in death or serious physical injury jeopardizing the life, health, or safety of

the patient. The policy also revealed that any investigation and follow through would abide by facility policies and State and Federal laws and regulations. The policy revealed that the covered individual (the term covered individual means each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility) would report to the State Agency and one or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime against any individual who is a resident/patient of, or is receiving care from the facility. Review of the State Operations Manual (SOM), S483.12(c)(1), the facility must ensure that all alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause

the allegations do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. Sexual abuse, is defined at S483.5 as non-consensual sexual contact of any type with a resident. Review of the Arizona Revised Statute (A.R.S.) 46-454 (A-D) revealed that a health professional, long-term care provider, or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advance Health Care of Scottsdale

9846 North 95th Street Scottsdale, AZ 85258

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

residents, violation of the law, and penalties or fines. The administrator stated that she recalled an incident with Resident #11 regarding an allegation of sexual abuse, and that the allegation was vague and she could only identify that the person involved was a male. The administrator also stated that she reported the allegation to AZDHS because it was an allegation of sexual abuse, and that they reported it to the ombudsman and the facility's corporate body, however they did not report to any other entity or agency. The administrator stated that she did not report to law enforcement because she felt that, as time went on, the daughter was recanting her allegations and was not wanting to report, and they ultimately decided not to.

The administrator further stated that she did not contact Adult Protective Services (APS) because she conferred with the ombudsman who told her not to because it appeared everything was in order. The administrator stated that she did not know if the allegation was substantiated or unsubstantiated, and that

the resident was making accusations with all people and all sexes, and the allegation appeared to be vague and widespread, as if it did not occur. The administrator also stated that reporting to APS and the police was optional. Review of a policy titled, Abuse Policy and Procedure, was updated on November 8, 2024 and revealed that sexual abuse was defined as, but not limited to, sexual harassment, sexual coercion, or sexual assault. The policy also revealed that all alleged or suspected violations involving abuse would be promptly reported to the Administrator and/or Director of Nursing. The policy revealed that the Administrator or Director of Nursing would then ensure the safety of the patient, begin the investigation, and if necessary, report information to the police, Department ofHealth and Welfare, family, MD, and/or any other appropriate agency. The policy further revealed that the facility would report to law enforcement immediately when there was reasonable cause to believe that abuse or sexual assault resulted in death or serious physical injury jeopardizing the life, health, or safety of the patient. The policy also revealed that any investigation and follow through would abide by facility policies and State and Federal laws and regulations. The policy revealed that the covered individual (the term covered individual means each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility) would report to the State Agency and one or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime against any individual who is a resident/patient of, or is receiving care from the facility. Review of the State Operations Manual (SOM), S483.12(c)(1), the facility must ensure that all alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegations do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. Sexual abuse, is defined at S483.5 as non-consensual sexual contact of any type with a resident. Review of the Arizona Revised Statute (A.R.S.) 46-454 (A-D) revealed that a health professional, long-term care provider, or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advance Health Care of Scottsdale

9846 North 95th Street Scottsdale, AZ 85258

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

to document allegations of abuse, including sexual abuse, in the clinical record so they can have a trail of what they did around the situation and to establish what occurred so they can prevent future situations. The DON further stated that nursing staff needed to document allegations of abuse in the clinical record under progress notes for the safety of the patient, and the note would need to include the direct quote from the patient and a summary of what the patient reported. The DON also stated that if an allegation of abuse was not documented in the clinical record there would be potential risk that they would not be able to monitor

the situation closely enough. The DON stated that there was no documentation in the clinical record of Resident #11 regarding the allegation of sexual abuse. Review of a policy titled, Charting Requirements, was updated in June of 2024 and revealed that any incident would be charted on and addressed in the medical record every shift for 72 hours after onset and then daily until resolved. Review of a policy titled, Change in Patient Condition, was updated in July of 2023 and revealed that the nurse supervisor or charge nurse would record in the patient's medical record any information relative to changes in the patient's medical or mental condition or status. The policy also revealed that a change in patient condition would include an accident or incident involving the patient, an injury of unknown origin, or a significant change in

the patient's physical/emotional/mental condition. Review of the Code of Federal Regulations (CFR), S483.70(h)(1), revealed that in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized.

Event ID:

Facility ID:

If continuation sheet