Desert Terrace Healthcare Center

Name: Desert Terrace Healthcare Center
Address: 2509 NORTH 24TH STREET, Phoenix, AZ, 85008, US
Telephone: 6022731347

2509 North 24th Street, Phoenix, AZ 85008 · Maricopa County · 108 certified beds · avg 87 residents/day · certified since Aug 1, 1972

Abuse citation flag (CMS)

Part of chain: THE ENSIGN GROUP (342 facilities, chain avg rating 3.2★)

The abuse flag means inspectors cited this facility for abuse that caused harm to a resident within the past year, or potential for harm in each of the last two years. Source: CMS.

2/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

3.63

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 3/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

All citations in the current public record (24)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Jun 25, 2026	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Apr 9, 2026	D · Potential for harm, one-off	The facility employed staff who were not licensed, certified, or registered as required by state law. · from a complaint
Jan 22, 2026	D · Potential for harm, one-off	The facility did not honor residents' right to manage their own money and financial affairs. · from a complaint
Jan 22, 2026	D · Potential for harm, one-off	The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection. · from a complaint
Jan 22, 2026	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
Jan 22, 2026	D · Potential for harm, one-off	The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. · from a complaint
Dec 3, 2025	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Sep 26, 2025	D · Potential for harm, one-off	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Jan 24, 2025	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Oct 10, 2024	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Jul 3, 2024	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Jan 16, 2024	E · Potential for harm, repeated	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint
Oct 20, 2023	D · Potential for harm, one-off	The facility's activities program was not run by a qualified professional. The person directing recreation and social activities must have proper training or credentials.
Sep 9, 2022	E · Potential for harm, repeated	The facility allowed residents to lose the ability to do daily activities — like bathing, dressing, and eating — when there was no medical reason for the decline. Good care helps residents keep the abilities they have.
Sep 9, 2022	E · Potential for harm, repeated	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Sep 9, 2022	E · Potential for harm, repeated	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Sep 9, 2022	E · Potential for harm, repeated	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist.
Sep 9, 2022	E · Potential for harm, repeated	The facility did not keep residents' medications free from unnecessary drugs. Residents should only take medicines they truly need, at the right dose, for a clear reason.
Sep 9, 2022	D · Potential for harm, one-off	The facility did not make sure residents were fully informed about their own health, care, and treatments in a way they could understand.
Sep 9, 2022	D · Potential for harm, one-off	The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.
Sep 9, 2022	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow.
Sep 9, 2022	D · Potential for harm, one-off	The facility did not provide proper care for residents with a colostomy, urostomy, or ileostomy — surgical openings in the abdomen that let waste leave the body into a pouch. These require regular, skilled attention to stay clean and healthy.
Sep 9, 2022	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Sep 9, 2022	B · Minimal risk, repeated	The facility did not post its nurse staffing information every day. Nursing homes must publicly display how many nurses and aides are on duty each day.

Inspection trend by year

Citations from standard inspections stayed about the same across the last two inspection cycles (1 → 1).

Year	Citations	Worst severity that year
2022	11	E
2023	1	D
2024	3	E
2025	3	D
2026	6	D

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

No fines or payment denials in the published 3-year window.

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Arizona avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	3.63	3.97	3.95	bottom 47% in Arizona; bottom 43% in the U.S.
Registered Nurse hours	0.59	0.69	0.69	top 50% in Arizona; top 49% in the U.S.
Weekend total nurse staffing	3.21	3.50	3.50	bottom 47% in Arizona; bottom 42% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.41	0.49	0.48	top 49% in Arizona; top 46% in the U.S.
Total nursing staff turnover (%)	55.4	45.2	45.8	bottom 21% in Arizona; bottom 24% in the U.S.
RN turnover (%)	41.7	43.6	42.9	top 44% in Arizona; top 50% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.35, RN 0.54, weekend 2.96. Staffing rating: 3/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 5/5 · long-stay residents: 5/5 · short-stay residents: 3/5

Who owns this facility

For profit - Corporation

Owner / manager	Type	Role	Stake	Since
Burnam, Soon	Individual	Managing Control - Governing Body	NOT APPLICABLE	09/25/2006
Burnam, Soon	Individual	Corporate Officer	NOT APPLICABLE	09/25/2006
Caretrust GP LLC	Organization	ADP of the SNF	NOT APPLICABLE	04/01/2002
Caretrust Reit INC	Organization	ADP of the SNF	NOT APPLICABLE	04/01/2002
Ctr Partnership LP	Organization	ADP of the SNF	NOT APPLICABLE	01/01/2022
Eaton, Alex	Individual	Managing Control - Governing Body	NOT APPLICABLE	12/19/2025
Eaton, Alex	Individual	Operational/Managerial Control	NOT APPLICABLE	12/19/2025
Eaton, Alex	Individual	ADP of the SNF	NOT APPLICABLE	12/19/2025
Ensign Services INC	Organization	ADP of the SNF	NOT APPLICABLE	08/01/2002
Hasan, Omair	Individual	Managing Control - Governing Body	NOT APPLICABLE	03/30/2020
Hasan, Omair	Individual	Operational/Managerial Control	NOT APPLICABLE	03/30/2020
Hasan, Omair	Individual	ADP of the SNF	NOT APPLICABLE	03/30/2020
Keetch, Chad	Individual	Corporate Officer	NOT APPLICABLE	03/01/2011
Peterson, Forrest	Individual	Corporate Director	NOT APPLICABLE	01/01/2019
Port, Barry	Individual	Individual Is an Owner, Partner or Trustee of Any ADP of the SNF	NOT APPLICABLE	07/10/2025
Terrace Holdings Az LLC	Organization	ADP of the SNF	NOT APPLICABLE	04/01/2002

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
"How do you verify licenses and certifications for every caregiver before they start, and how often do you recheck them?"
"How are residents' personal funds handled here, and what records can families review?"
"What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
"When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
"Can you show me how medications are stored and secured on the units, including controlled drugs?"
"How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
"How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
Desert Haven Care Center	0.7 mi	Phoenix, AZ	★☆☆☆☆	1/5	abuse
Haven Health Sky Harbor, LLC	1.8 mi	Phoenix, AZ	★★☆☆☆	1/5
Camelback Post Acute Care and Rehabilitation	2.3 mi	Phoenix, AZ	★★★☆☆	2/5
Haven of Phoenix	4.3 mi	Phoenix, AZ	★★★☆☆	2/5	abuse
Maryland Gardens Post Acute	4.5 mi	Phoenix, AZ	★★★☆☆	2/5	abuse
The Terraces of Phoenix	5.0 mi	Phoenix, AZ	★★★★★	4/5
The Rehabilitation Center at the Palazzo	5.5 mi	Phoenix, AZ	★★★★☆	3/5
Resolve Harmony Center, LLC	5.7 mi	Phoenix, AZ	★☆☆☆☆	1/5	abuse
Rehab at Scottsdale Village Square	5.8 mi	Scottsdale, AZ		—/5	abuseSFF
Beatitudes Campus	6.0 mi	Phoenix, AZ	★★★☆☆	2/5
Mirabella at Asu	6.4 mi	Tempe, AZ	★★★☆☆	3/5
Haven of Scottsdale	6.4 mi	Scottsdale, AZ	★★☆☆☆	1/5

Compare this facility with the 3 closest →

All facilities in Phoenix →

Facility data as of CMS processing date 2026-08-01. CCN 035014.

The Care File

Visit checklist — Desert Terrace Healthcare Center

2509 North 24th Street, Phoenix, AZ 85008 · 6022731347

Health inspection rating 2/5 · CMS overall 3/5 · ▲ FEDERAL ABUSE CITATION FLAG· Fines (3y): $0

Questions for the administrator:

☐ "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
☐ "How do you verify licenses and certifications for every caregiver before they start, and how often do you recheck them?"
☐ "How are residents' personal funds handled here, and what records can families review?"
☐ "What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
☐ "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
☐ "Can you show me how medications are stored and secured on the units, including controlled drugs?"
☐ "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
☐ "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 035014 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)