Life Care Center Of Sierra Vista

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

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

residents who are a vulnerable group. According to staff #90 he remembered that there was a concern that resident #46 was being exploited by resident friend #666 but there were no specific details. There was picture of the resident friend #666 posted at the reception desk informing staff to not allow him in the facility.

Another state agency was contacted involved. The ADON noted that he was unsure if the facility would do

an investigation since they cannot easily do one on someone not affiliated with the facility. However, he said that exploitation is considered as abuse and that the facility investigates all allegation of abuse. Staff #90 said that the facility should have probably investigated in collaboration with the other state agency. Review of the facility policy titled Abuse - Identification of Types reviewed May 6, 2025 stated that the facility staff should report any suspected abuse, neglect, or exploitation to the Executive Director or Director of Nursing.

The facility policy titled Area of Focus: Incident and Reportable Event Management reviewed November 25, 2024 noted that alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source, and misappropriation of resident property are reported immediately, but no later than 2-hours after the allegation is made. The policy also noted that all alleged violations are thoroughly investigated to prevent further abuse, neglect, exploitation or mistreatment.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Sierra Vista

2305 East Wilcox Drive Sierra Vista, AZ 85635

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

state agency was contacted and investigated the allegation. The facility policy titled Area of Focus: Incident and Reportable Event Management reviewed November 25, 2024 noted that alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source, and misappropriation of resident property are reported immediately, but no later than 2-hours after the allegation is made. The policy also noted that all alleged violations are thoroughly investigated to prevent further abuse, neglect, exploitation or mistreatment. Review of the facility policy titled Abuse - Identification of Types reviewed May 6, 2025 stated that the facility staff should report any suspected abuse, neglect, or exploitation to the Executive Director or Director of Nursing.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Sierra Vista

2305 East Wilcox Drive Sierra Vista, AZ 85635

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 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical records, review of facility documentation, review of the State Agency (SA) database, staff interviews, and review of policy and procedure the facility failed to ensure an allegation of exploitation (resident #46) was fully investigated. The deficient practice could result in allegations of abuse to include exploitation not being investigated and abuse/exploitation occurring in the facility. Findings include: Resident #46 was initially admitted to the facility on [DATE REDACTED] and re-admitted on [DATE REDACTED] with diagnoses of fatty liver, hypertension, and protein-calorie malnutrition. A report submitted from another state agency was received by the State Agency (SA) on June 19, 2025 regarding an allegation of exploitation pertaining to resident #46. Review of the SA database revealed that the facility failed to submit a self-report regarding the allegation of exploitation. Further review of the SA database indicated that the facility failed to submit a thorough investigation regarding the allegation of exploitation. A written request for a copy of the incident report and the facility investigation pertaining to resident #46 was submitted to the facility on September 7, 2025 at 1:40 p.m. An email response was received from the Executive Director (ED/staff #411) on September 7, 2025 at 2:07 which stated that there are no incident or investigation found. An interview with

a Licensed Practical Nurse (LPN/staff #24) was conducted on September 9, 2025 at 4:18 a.m. Staff #24 stated that it is important to investigate allegations of abuse to ensure the issue does not further escalate, ensure that the issue is not ignored, and have proof of what happened to document facts. The impact of not investigating allegations is that it can impact the resident (victim) poorly leading to depression and feeling like they are not seen/heard as human beings. Staff #24 is unfamiliar with the exploitation issue concerning resident #46. During an interview with a Certified Nursing Assistant (CNA/staff #101) conducted on September 9 2025 at 5:04 a.m., staff #101 stated that allegations of abuse/exploitation have to be investigated because residents are human beings and they have rights and those rights should not be violated. According to the CNA, the impact of not investigating allegations of abuse/exploitation is that the residents can end up depressed, the resident will be talking about the issue and each time there is a caregiver there can be hostility. An interview with the Social Services Assistant (SS Asst/staff #32) and the Social Services Director (SS Dir/staff #93) was conducted on September 9, 2025 at 10:02 a.m. Staff #93 noted that they found out about the exploitation due to non-payment of cost share. The SS Dir said that resident friend #666 visited resident #46 and there was an allegation of financial. exploitation. According to staff #93, the other state agency investigated the allegation of financial exploitation. During the course of

the investigation, resident friend #666 was restricted from vising resident #46 per the previous administrator. An interview with the Assistant Director of Nursing (ADON/staff #90) was conducted on September 9, 2025 at 11:04 a.m. Staff #90 stated that his expectation is that any allegation of abuse is reported immediately to ensure that residents are protected and it can be investigated. According to the ADON he remembered that there was a concern that resident #46 was being exploited by resident friend #666 but there were no specific details. Staff #90 stated that exploitation is considered abuse and that all allegations of abuse is investigated by the facility. He noted that the allegation should have been investigated in collaboration with the other state agency. The facility policy titled Area of Focus: Incident and Reportable Event Management reviewed November 25, 2024 noted that all alleged violations are thoroughly investigated to prevent further abuse, neglect, exploitation or mistreatment.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet