Sandstone Of Tucson Rehab Centre

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

interventions, call a family member, 1:1 time, activities, and pharmacological interventions. The LPN stated for those residents that are not able to be re-directed, they are provided with increased supervision and use de-escalation techniques such as offer them a snack, medications if prescribed monitor the resident. The LPN stated she has received yearly abuse trainings and was able to define the different types of abuse and detail the facility process for abuse allegations. Staff #8 stated when there is an allegation of abuse you would speak with the CNA's, separate the residents, notify the on-call supervisor, receive direction from them, complete a risk management report. The LPN stated when someone reports an incident staff are to notify the supervisor, document the incident in the nurses note, document witness and interventions provided- complete a resident assessment, 15-30-minute checks, and 1:1 intervention if needed. The LPN stated she was informed as she was arriving on shift by CNA (staff #10) that Residents #2 and #4 were yelling at each other and that Resident #4 had walked over to Resident #2's side of the room and threatened to hit him. She stated she checked on the residents to ensure they were safe and both were in bed on their side of the room. She stated the facility protocol is separate the residents, check that they are alright and that the incident is nit ongoing, assess the residents completing skin checks and vital signs. The LPN stated she was informed by CNA (staff#10) there was no resident contact and that she did not want them to be close to each other. The LPN stated room changes occur when two residents are not able to be together and would need to be approved by administration, and felt the incident between Resident #2 and #4 would be considered verbal abuse and a room change should have happened. Staff #8 further stated

the risk of not reporting abuse to the state you are not considering the safety of the resident. A facility policy titled, Abuse and Neglect, adopted May 1, 2024 revealed that it is the policy of this facility to provide professional care and services in an environment that is free from any type of abuse, corporal punishment, involuntary seclusion, misappropriation of property, exploitation, neglect, or mistreatment. This includes but is not limited to freedom from any physical or chemical restraint not required to treat the resident's medical symptoms. The facility follows the federal guidelines dedicated to prevention of abuse and timely and thorough investigations of allegations. These guidelines include compliance with the seven (7) federal components of prevention and investigation. A facility policy titled, Room Transfer, adopted May 1, 2024 revealed that it is the policy of this facility that resident room transfers are based on nursing need services and/or resident request. If conflict arises between roommates, the facility has the right to transfer the residents as necessary for safety reasons and avoid further escalation of the situation.

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

08/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sandstone of Tucson Rehab Centre

2900 East Milber Street Tucson, AZ 85714

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

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

vital signs. The LPN stated she was informed by CNA (staff#10) there was no resident contact and that she did not want them to be close to each other. The LPN stated room changes occur when two residents are not able to be together and would need to be approved by administration, and felt the incident between Resident #2 and #4 would be considered verbal abuse and a room change should have happened. Staff #8 further stated the risk of not reporting abuse to the state you are not considering the safety of the resident.

A facility policy titled, Abuse and Neglect, adopted May 1, 2024, revealed that the facility follows the federal guidelines dedicated to prevention of abuse. If abuse is suspected the facility will take immediate steps to assure the protection of the residents which may include separation from the alleged abuser, notify the appropriate designated state agencies, that an investigation is being initiated immediately following intervention for the resident's safety. The abuse coordinator along with the interdisciplinary team will assess

the next appropriate steps to assure resident safety. Protect residents from harm during the investigation, if

the allegation of abuse involves 2 or more resident they will be immediately separated, affected residents will be assessed for injury, a full assessment of physical and psychosocial well-being, keep resident on 1:1.

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

08/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sandstone of Tucson Rehab Centre

2900 East Milber Street Tucson, AZ 85714

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

the incident in the nurses note, document witness and interventions provided- complete a resident assessment, 15-30-minute checks, and 1:1 intervention if needed. The LPN stated she was informed as

she was arriving on shift by CNA (staff #10) that Residents #2 and #4 were yelling at each other and that Resident #4 had walked over to Resident #2's side of the room and threatened to hit him. The LPN stated

she was informed by CNA (staff#10) there was no resident contact and that she did not want them to be close to each other. Staff #8 further stated the risk of not reporting abuse to the state you are not considering the safety of the resident. A facility policy titled, Abuse and Neglect, adopted May 1, 2024, revealed that the facility follows the federal guidelines dedicated to prevention of abuse. If abuse is suspected the facility will take immediate steps to assure the protection of the residents which may include separation from the alleged abuser, notify the appropriate designated state agencies, that an investigation is being initiated immediately following intervention for the resident's safety.

Event ID:

Facility ID:

If continuation sheet