Cycle 1
Health 2025-01-17 · Fire 2025-01-17
18 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (8 deficiencies)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Tempe, AZ
Friendship Village Of Tempe
2-star overall rating with 1-star inspections with 18 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
2525 East Southern Avenue, Tempe, AZ
(480) 831-3184
Overall
2 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
128
Certified beds
Average residents
50
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1980-11-12
CMS approved date
Coverage
Medicare
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
2.39
Registered nurse staffing · state 0.72 · national 0.68
LPN hours / resident day
0.71
Licensed practical nurse staffing · state 1.04 · national 0.87
Aide hours / resident day
3.53
Nurse aide staffing · state 2.36 · national 2.35
Total nurse hours
6.63
All reported nurse hours · state 4.12 · national 3.89
Licensed hours
3.10
RN + LPN hours · state 1.76 · national 1.54
Weekend hours
6.23
Weekend nurse staffing · state 3.62 · national 3.43
Weekend RN hours
2.22
Weekend registered nurse coverage · state 0.51 · national 0.47
Physical therapist
0.14
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
2.36
CMS adjusted RN staffing hours
Adjusted total hours
6.53
CMS adjusted total nurse staffing hours
Case-mix index
1.39
Higher values indicate more complex resident acuity
RN turnover
38%
Annual RN turnover · state 45% · national 45%
Total nurse turnover
43%
Annual nurse turnover · state 48% · national 46%
SNF VBP
Value-based purchasing
Program rank
812
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
63.44
Composite VBP score used to determine payment impact.
Payment multiplier
1.0182
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.84
Baseline 18.30% · Performance 18.26% · Measure score 6.84 · Achievement 6.84 · Improvement 0
Healthcare-associated infections
6.84
Baseline 5.52% · Performance 5.79% · Measure score 6.84 · Achievement 6.84 · Improvement 0
Total nurse turnover
5.39
Baseline 31.32% · Performance 41.67% · Measure score 5.39 · Achievement 5.39 · Improvement 0
Adjusted total nurse staffing
6.31
Baseline 4.65 hours · Performance 4.87 hours · Measure score 6.31 · Achievement 6.31 · Improvement 1.51
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 8.41% |
10.72%
2.3 pts better
|
Better than the National Rate · Eligible stays 781 · Observed rate 6.66% · Lower 95% interval 6.78% |
| Discharge to community | 64.41% |
50.57%
13.8 pts better
|
Better than the National Rate · Eligible stays 761 · Observed rate 62.02% · Lower 95% interval 60.59% |
| Medicare spending per beneficiary | 0.94 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 98.61% |
95.27%
3.3 pts better
|
Numerator 426 · Denominator 432 |
| Falls with major injury | 0.46% |
0.77%
0.3 pts better
|
Numerator 2 · Denominator 432 |
| Discharge self-care score | 85.58% |
53.69%
31.9 pts better
|
Numerator 273 · Denominator 319 |
| Discharge mobility score | 80.25% |
50.94%
29.3 pts better
|
Numerator 256 · Denominator 319 |
| Pressure ulcers or injuries, new or worsened | 1.85% |
2.29%
0.4 pts better
|
Numerator 8 · Denominator 432 · Adjusted rate 2.2% |
| Healthcare-associated infections requiring hospitalization | 5.79% |
7.12%
1.3 pts better
|
No Different than the National Rate · Eligible stays 485 · Observed rate 4.54% · Lower 95% interval 4.13% |
| Staff COVID-19 vaccination coverage | 11.11% |
8.2%
2.9 pts better
|
Numerator 38 · Denominator 342 |
| Staff flu vaccination coverage | 55.88% |
42%
13.9 pts better
|
Numerator 209 · Denominator 374 |
| Discharge function score | 85.27% |
56.45%
28.8 pts better
|
Numerator 272 · Denominator 319 |
| Transfer of health information to provider | 99.02% |
95.95%
3.1 pts better
|
Numerator 303 · Denominator 306 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 52 · Denominator 52 |
| Resident COVID-19 vaccinations up to date | 40.55% |
25.2%
15.3 pts better
|
Numerator 88 · Denominator 217 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.1 |
1.7
0.6 pts better
|
1.9
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 2.9 · Expected 4.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.4 |
1.5
0.1 pts better
|
1.8
0.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 2.4 · Expected 2.9 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
97.1%
2.9 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 100.0% · Q3 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 76.0% |
94.6%
18.6 pts worse
|
95.5%
19.5 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 76.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.6% |
2.1%
3.5 pts worse
|
3.3%
2.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 4.8% · Q3 10.0% · 4Q avg 5.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 1.4% |
4.2%
2.8 pts better
|
11.4%
10 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 0.0% · Q3 5.0% · 4Q avg 1.4% |
| Percentage of long-stay residents who lose too much weight | 12.3% |
5.3%
7 pts worse
|
5.4%
6.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 12.3% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 20.0% |
20.5%
0.5 pts better
|
19.6%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 25.0% · 4Q avg 20.0% |
| Percentage of long-stay residents who received an antipsychotic medication | 22.4% |
11.8%
10.6 pts worse
|
16.7%
5.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 22.4% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.3%
0.3 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 0.0% · Q3 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 14.1% |
14.5%
0.4 pts better
|
16.3%
2.2 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 14.1% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 15.3% |
10.8%
4.5 pts worse
|
14.9%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 15.0% · 4Q avg 15.3% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 3.3% |
0.9%
2.4 pts worse
|
1.0%
2.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 3.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 4.3% |
1.2%
3.1 pts worse
|
1.7%
2.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 10.0% · Q3 5.0% · 4Q avg 4.3% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 20.5% |
20.5%
About the same
|
19.8%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 20.5% |
| Percentage of long-stay residents with pressure ulcers | 9.1% |
4.8%
4.3 pts worse
|
5.1%
4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 8.5% · Q3 14.8% · 4Q avg 9.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.7% |
91.1%
8.6 pts better
|
81.7%
18 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.4% · Q2 100.0% · Q3 100.0% · Q4 99.6% · 4Q avg 99.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 12.0% |
10.7%
1.3 pts worse
|
12.0%
About the same
|
Short Stay · 20240701-20250630 · Adjusted 12.0% · Observed 11.1% · Expected 10.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.2% |
1.1%
0.1 pts worse
|
1.6%
0.4 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 1.8% · Q3 1.0% · Q4 0.5% · 4Q avg 1.2% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 92.7% |
87.3%
5.4 pts better
|
79.7%
13 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 92.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 23.4% |
24.6%
1.2 pts better
|
23.9%
0.5 pts better
|
Short Stay · 20240701-20250630 · Adjusted 23.4% · Observed 22.6% · Expected 23.0% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-10-06 · Fire 2023-10-06
3 health deficiencies
Top issue: Nursing and Physician Services (1 deficiency)
6 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Cycle 3
Health 2022-08-04 · Fire 2022-08-04
4 health deficiencies
Top issue: Resident Assessment and Care Planning (2 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2025-01-17
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2025-02-18
E · Potential for more than minimal harm
2023-10-06
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-11-02
E · Potential for more than minimal harm
2023-10-06
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-11-02
E · Potential for more than minimal harm
2023-10-06
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2023-11-02
D · Potential for more than minimal harm
2023-10-06
K342 · Smoke Deficiencies
Fire Safety
Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.
Corrected 2023-11-02
D · Potential for more than minimal harm
2023-10-06
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-11-02
D · Potential for more than minimal harm
2023-10-06
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2023-11-02
D · Potential for more than minimal harm
2022-08-04
K921 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2022-08-29
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-04-01
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-04-01
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-03-20
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2025-04-15
D · Potential for more than minimal harm
2025-03-20
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-03-06
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-03-06
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-03-06
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-04-23
D · Potential for more than minimal harm
2025-03-06
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-04-23
E · Potential for more than minimal harm
2025-01-17
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-03-03
E · Potential for more than minimal harm
2025-01-17
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2025-03-03
E · Potential for more than minimal harm
2025-01-17
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-02-19
E · Potential for more than minimal harm
2025-01-17
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F623 · Resident Rights Deficiencies
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2025-02-18
D · Potential for more than minimal harm
2025-01-17
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-03-03
D · Potential for more than minimal harm
2025-01-17
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-03-03
E · Potential for more than minimal harm
2023-10-06
F732 · Nursing and Physician Services Deficiencies
Health
Post nurse staffing information every day.
Corrected 2023-10-31
E · Potential for more than minimal harm
2023-10-06
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2023-10-31
E · Potential for more than minimal harm
2022-08-04
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2022-08-25
E · Potential for more than minimal harm
2022-08-04
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-08-25
D · Potential for more than minimal harm
2022-08-04
F625 · Resident Rights Deficiencies
Health
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected 2022-08-25
D · Potential for more than minimal harm
2022-08-04
F655 · Resident Assessment and Care Planning Deficiencies
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2022-08-25
Penalties and ownership
What sits behind the stars
Ownership
Tempe Life Care Village Inc
5% Or Greater Direct Ownership Interest · Organization
Camberg, Kevin
Corporate Director · Individual
Cassano, Donald
Corporate Director · Individual
Combs, Suzanne
Operational/Managerial Control · Individual
Crawford, Cathlene
Corporate Director · Individual
Foster, Shelley
Corporate Director · Individual
Jensen, Darrell
Corporate Director · Individual
Jensen, Darrell
Corporate Officer · Individual
Life Care Services LLC
Operational/Managerial Control · Organization
Marvin, Cole
Operational/Managerial Control · Individual
Pearson, Todd
Corporate Director · Individual
Pearson, Todd
Corporate Officer · Individual
Pulsifer, Marc
Corporate Director · Individual
Pulsifer, Marc
Corporate Officer · Individual
Reck, Ross
Corporate Director · Individual
Reck, Ross
Corporate Officer · Individual
Schmidt, Jadyne
Operational/Managerial Control · Individual
The Bank Of New York Mellon Trust Company
5% Or Greater Security Interest · Organization
Wells, Shirley
Corporate Director · Individual
Woods, Corey
Corporate Director · Individual
Nearby options
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Tempe, AZ
5-star overall rating with 5-star inspections with 1 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#2
River Park Post Acute
Chandler, AZ
5-star overall rating with 4-star inspections with 5 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Sandridge Post Acute
Mesa, AZ
3-star overall rating with 2-star inspections with abuse icon flag with 11 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
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