Chandler Post Acute and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Chandler Post Acute and Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, patternF600Aug 6, 2021

  Based on clinical record review, interviews, facility documentation, health plan documentation, review of the State Agency (SA) database, and facility policies, the facility failed to ensure one resident (#1) was free from physical and psychosocial abuse and the facility failed to prevent further abuse for the residents after staff were made aware of an allegation of potential staff to resident abuse. The sample size was 3 residents. As a result, the Conditions of Immediate Jeopardy (IJ) and Substandard Quality of Care (SQC) were identified. The resident census was 106. The deficient practice could result in further resident abuse. Findings include: On August 5, 2021 at 1:12 pm, the Condition of IJ was identified. […]

• Actual harm, isolatedF684Dec 12, 2025

  Based on record review, staff interviews, review of facility documents and policy, the facility failed to ensure that a medication was administered following the physician ordered parameters for one resident (#135). The deficient practice resulted in hospitalization due to lowered blood pressure. Findings included:Resident #135 was admitted to the facility on [DATE].Review of the hospital records revealed the resident #135 had a past medical history of urinary tract infection (UTI), Chronic Obstructive Pulmonary Disease (COPD), Obstructive Sleep Apnea (OSA), Hypertension, and Cerebrovascular Disease (CVA).The admission progress note dated November 10, 2025 included the resident arrived at the facility; and that the resident was alert, oriented x 4, awake and able to make needs known. […]

• No harm, potential for more than minimal, patternF880Dec 12, 2025

  Based on the clinical record review, observations, interviews, facility documentation, and policy, the facility failed to ensure hand hygiene was performed and PPE was appropriately applied for one resident (Resident #9) , and infection control measures were implemented for a resident with a urinary catheter (Resident #71) and during a dressing change (Resident #166). This deficient practice can result in contamination and spread of infection. Findings include: Regarding Resident # 71 Resident #71 was admitted to the facility on [DATE], with conditions that included encounter for orthopedic aftercare following surgical amputation, acquired absence of right leg above knee, long-term (current) use of anticoagulants, need for assistance with personal care, generalized muscle weakness, and… […]

• No harm, potential for more than minimal, patternF919Dec 12, 2025

  Based on observation, staff interviews, facility documents, and policy, the facility failed to ensure several residents' rooms were equipped with a working communication system to call for staff assistance. The deficient practice could place residents' safety at risk.Findings include:An observation in the behavioral unit was conducted on December 9, 2025 at 10:50 AM and revealed the call light in one room (#1) was on the floor behind the resident's bed and was out of reach.An observation of another room (#2) in the behavioral unit was conducted on December 9, 2025 at 1:33 PM, and there was no call light available for resident use. In a later observation of room (#1) conducted on December 9, 2025 at 3:20 PM, the same room (#1) continued to have the call light out of the resident's reach. […]

• No harm, potential for more than minimal, patternF607Aug 6, 2021

  Based on clinical record reviews, staff and resident interviews, facility documentation, health plan documentation, review of the State Agency (SA) database, and review of facility policies, the facility failed to implement the abuse prevention policy by failing to ensure that allegations of abuse for two residents (#4 and #1) were reported and investigated timely and the facility failed to ensure a staff member (staff #3) was removed from duty pending the investigation of an allegation of abuse by one resident (#1). The sample size was 3 residents. The deficient practice could result in failure to implement the abuse policy for abuse allegations. Findings include: -Resident #4 was admitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]