Haven Of Sandpointe, LLC
2222 South Avenue A, Yuma, AZ 85364 · For profit - Limited Liability company · 143 certified beds · (928) 783-8831 Medicare & Medicaid certified
This home has serious findings on its record. Read them closely before you consider it.
- no federal fines or payment denials on record
- a high payroll-based staffing rating (4/5)
- lower-than-typical staff turnover (21% vs 45% nationally) — better care continuity
- CMS has flagged it for abuse
- it has abuse, neglect, or exploitation citations (F0600, F0602) — most recent Sep 2025
- it has citations for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0607, F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- it has citations for mishandling residents’ money or property (F0567, F0568)
- a high number of inspection citations overall (21) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its payroll- and facility-reported staffing and quality-measure scores sit well above its independent inspection score
- its independent health-inspection rating is low (2/5)
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 2 of 5 |
| StaffingFrom payroll records (PBJ) | 4 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Worth a closer look. This home's staffing and quality-measure ratings run 3 stars above its independent health-inspection score. The inspection is done by state surveyors; the quality-measure score leans on data the facility reports about itself, and staffing on its payroll (PBJ) submissions — so a gap this large is worth reading the inspection record for.
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 5 of 5 |
| Long-stay residentspeople who live here | 5 of 5 |
| Short-stay residentsrehab / post-hospital | 5 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 2 to 3 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 1.2% | 10.7% | 15.4% | better |
| Long-stay residents who lose too much weight | 7.9% | 5.3% | 5.4% | worse |
| Long-stay residents with a catheter left in their bladder | 0.0% | 0.8% | 0.9% | better |
| Long-stay residents with a urinary tract infection | 0.0% | 1.2% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.0% | 3.9% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.3% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 2.1% | 2.1% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 6.7% | 12.8% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 16.5% | 21.0% | 18.9% | better |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 94.6% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 0.6% | 4.4% | 4.7% | better |
| Long-stay residents with worsening bladder/bowel control | 14.1% | 20.6% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 9.0% | 10.6% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 1.2% | 1.2% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 72.5% | 87.3% | 79.4% | typical |
| Short-stay residents rehospitalized after admission | 24.8% | 23.7% | 22.6% | typical |
| Short-stay residents with an outpatient ER visit | 7.0% | 10.4% | 12.0% | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
51.4% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 68 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 86.8% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 38 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: this home’s payroll records show 0.28 therapist hours per resident per day in 2026Q1 — more than 41% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 30% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 51.4%CMS range 41.2–63.0 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 8.3%CMS range 5.8–12.8 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 86.8% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 71.0% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 65.8% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 100.0% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 100.0% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 0.0% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 0.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 7.7%CMS range 4.0–13.3 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.10 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 143 beds and averages 99.1 residents a day — about 69% occupied, or roughly 44 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.72 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.60 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.30 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 3.26 hrs/resident/day on weekends vs 3.90 on weekdays — 17% thinner on weekends. RN hours go from 0.63 to 0.54 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 21% is below the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
21 citations, most serious first. The 10 most serious are shown; the remaining 11 are one tap away and print in full.
- Potential for harm · Dcited before2025-09-16 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, review of clinical record, and facility policy, the facility failed to protect the residents' (#3, and #2) right to be free from physical abuse. The deficient practice could result in physical and psychosocial harm. -Regarding Resident #3: Resident #3 was admitted to the facility on [DATE], and re-admitted [DATE], with diagnoses that included Alzheimer's disease, dementia with agitation, history of falling, anxiety disorder, mental disorder not otherwise specified, and spinal stenosis.A quarterly minimum data set (MDS) assessment dated [DATE], revealed Resident #3 had a Brief Interview for Mental Status (BIMS) assessment score of 5, indicating severe cognitive impairment.A care plan for behaviors revised September 3, 2025, revealed that Resident #3 had a resident to resident altercation, and an additional intervention was initiated on September 3, 2025, which indicated for a medication review.A Behavior Note dated July 24, 2025, revealed that Resident #3 was verbally inappropriate with staff…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0567 — failed to protect residents' money held by the home — patternHonor the resident's right to manage his or her financial affairs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:16Number of residents cited:13The facility failed to ensure the protection/management of resident funds for 13 of 16 residentsBased on interviews, review of clinical records, facility 5 day report to the state agency (SA) and review of facility policy and procedures, the facility failed to ensure the protection/management of resident trust funds for 13 residents out of 16 (#3, #5, #18, #31, #32, #58, #63, #75, #76, #77, #86, #95, #96, #108, #109, #110). The deficient practice could result in continued misappropriation/exploitation of other residents.Findings Include:Resident #108 was admitted to the facility on [DATE], with diagnoses that included hypertension, dementia, muscle weakness and history of falling.A review of the minimum data set (MDS) dated [DATE] for Resident #108 revealed a brief interview mental status (BIMS) score of 09, which shows moderate cognitive impairment.Resident #75 was admitted to the facility on [DATE], with diagnoses that included dementia without…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0568 — patternProperly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:16Number of residents cited:13The facility failed to ensure the accounting and records of resident funds for 13 of 16 residentsBased on interviews, review of clinical records, facility 5 day report to the state agency (SA) and review of facility policy and procedures, the facility failed to ensure the accounting and records of resident trust funds for 13 residents out of 16 (#3, #5, #18, #31, #32, #58, #63, #75, #76, #77, #86, #95, #96, #108, #109, #110). The deficient practice could result in continued misappropriation/exploitation of other residents.Findings Include:Resident #108 was admitted to the facility on [DATE], with diagnoses that included hypertension, dementia, muscle weakness and history of falling.A review of the minimum data set (MDS) dated [DATE] for Resident #108 revealed a brief interview mental status (BIMS) score of 09, which shows moderate cognitive impairment.Resident #75 was admitted to the facility on [DATE], with diagnoses that included dementia without…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0602 — failed to protect residents from theft of their belongings — patternProtect each resident from the wrongful use of the resident's belongings or money.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:14Number of residents cited:97The facility failed to ensure residents are free from misappropriation for 14 of 97 residents.Based on interviews, review of clinical records, facility 5 day report to the state agency (SA) and review of facility policy and procedures, the facility failed to ensure 14 residents out of 16 (#3, #5, #18, #31, #63, #75, #76, #77, #86, #95, #96, #108, #109, #110) were free from misappropriation by a staff member (#148). The deficient practice could lead to misappropriation of resident money and belongings by other staff members.-Findings include:Resident #108 was admitted to the facility on [DATE], with diagnoses that included hypertension, dementia, muscle weakness and history of falling.A review of the minimum data set (MDS) dated [DATE] for Resident #108 revealed a brief interview mental status (BIMS) score of 09, which shows moderate cognitive impairment.Resident #75 was admitted to the facility on [DATE], with diagnoses that included dementia without…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0607 — failed to have anti-abuse policies — patternDevelop and implement policies and procedures to prevent abuse, neglect, and theft.
What the surveyor found here — an excerpt from the official record, may be distressing
Number of residents sampled:16Number of residents cited:13The facility failed to ensure the implementation of abuse misappropriation policy for 13 of 16 residentsBased on interviews, review of clinical records, facility 5 day report to the state agency (SA) and review of facility policy and procedures, the facility failed to ensure the implementation of their abuse/misappropriation policy for 13 residents out of 16 (#3, #5, #18, #31, #32, #58, #63, #75, #76, #77, #86, #95, #96, #108, #109, #110). The deficient practice could result in continued misappropriation/exploitation of other residents.Findings Include:An interview was conducted on August 7, 2025 at 3:12 p.m. with Certified Nursing Assistant (CNA) Staff #63 and revealed that when a resident has concerns over missing money or items, the staff will check with the business office, look in the resident room, then if can not find it, report it to the group.An interview was conducted on August 7, 2025 at 3:22 p.m. with Licensed Practical Nurse (LPN) Staff #5 and revealed that when a resident says they are missing money or items,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0609 — failed to report abuse allegations — patternTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
Number of residents sampled:16Number of residents cited:13The facility failed to ensure the reporting of alleged violations for 13 of 16 residents.Based on interviews, review of clinical records, facility 5 day report to the state agency (SA) and review of facility policy and procedures, the facility failed to ensure the reporting of misappropriation/exploitation for 13 residents out of 16 (#3, #5, #18, #31, #32, #58, #63, #75, #76, #77, #86, #95, #96, #108, #109, #110). The deficient practice could result in continued misappropriation/exploitation of other residents.Findings Include:An interview was conducted on August 7, 2025 at 3:38 p.m. with business office manager Staff #130 and revealed that about 1.5 years into the job as the assistant in the business office, Staff #130 noticed that things were not okay with the trust account. Staff #130 did not report because the previous executive director would have fired Staff #130 before getting everything straightened out, due to the friendship between the former executive director and staff #148. Staff #130 stated that it was a…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2025-08-13 · tag F0761 — failed to label and store drugs safely — patternEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interviews and policy review, the facility failed to ensure that medications were not left at the bedside for three residents (#86 and #93). The deficient practice could result in harm to the residents, and/or visitors who have access to medications. Findings include: -Resident #93 was admitted on [DATE] diagnosis included pneumonia, acute and chronic respiratory failure with hypoxia, acute and chronic respiratory failure with hypercapnia, chronic combined systolic (congestive) and diastolic (congestive) heart failure, and type 2 diabetes mellitus. The quarterly Admissions Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 14 indicating that resident is cognitively intact. Resident #93 care plan did not address that resident is able to self-administer medication Review of the physician’s orders revealed no orders to self-administer medications. Review of progress note revealed no interdisciplinary meeting for self-administer…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-08-13 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:26Number of residents cited:2The facility failed to protect the resident's right to be free from verbal and physical abuse in 2 of 26 residents.Based on closed record review, resident and staff interviews, as well as review of facility documentation and policy, and through observation of current practice, the facility failed to protect the resident's right to be free from verbal and physical abuse in 2 of 26 residents.Findings include:- Regarding Resident #26:Resident #26 was initially admitted to the facility on [DATE] and remains in the facility with medical diagnoses that included: end-stage renal disease, dementia, muscle weakness, glaucoma, lack of coordination, and anxiety disorder.The quarterly Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 10, indicating moderate cognitive impairment. The MDS revealed that the resident demonstrated no hallucinations, delusions, physical or verbal behaviors toward others or other behaviors not…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-08-13 · tag F0812 — failed to store, cook, and serve food safely — isolatedProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interviews, and policy review, the facility failed to ensure food items were labeled and dated, and food was prepared under sanitary conditions. The deficient practice could increase the risk of foodborne illness.Findings include:Regarding food labeling and dating:During the initial kitchen observation conducted on August 5, 2025, at 10:52 a.m., a small, light-colored round cake was found in the walk-in freezer. Upon inspection of the cake, it was noted that the cake was past its expiration date of 7/24. Additionally, a clear, plastic bag containing French toast sticks and another clear, plastic bag containing cinnamon rolls were found not marked with use-by or expiration dates. Upon verification that the cake had expired and the bags containing the French toast sticks and cinnamon rolls were undated, the three items were immediately removed from the freezer and disposed of in the trash.An interview with the Dietary Aide (staff #100) was conducted on August 5, 2025, at 10:58 a.m. He…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-08-13 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:26Number of residents cited:1The facility failed to ensure that the medical record for 1 resident (#107) out of 26 was complete and accurate.Based on resident and staff interviews, review of the clinical record, facility documentation, and policy, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete, accurately documented, and readily accessible for one resident (#107). The deficient practice could result in miscommunication between health care providers, leading to delayed or incorrect care and inappropriate treatment planning.Findings Include:Resident # 107 was initially admitted to the facility on [DATE] and discharged on 2/18/2025 with diagnoses that included: chronic obstructive pulmonary disease, age-related osteoporosis with current pathological fracture of the vertebrae, bipolar disorder, atherosclerotic heart disease, chronic diastolic heart failure, morbid obesity, hypertensive heart disease,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 11 citations
- Potential for harm · Dcited before2024-12-10 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, interviews, review of facility documentation and policy review, the facility failed to ensure resident #1 was free from abuse from resident #2. The deficient practice could result in residents experiencing emotional and mental trauma from abuse. Findings include: Related to resident #1- Resident #1 was admitted to the facility on [DATE] with diagnoses of type 2 diabetes, major depressive disorder, and partial paralysis on the left side following a stroke. Review of a quarterly Minimum Data Set (MDS), dated [DATE] revealed resident #1 completed a Brief Interview for Mental Status (BIMS) and scored a 15 which indicated the resident was cognitively intact. A review resident #1's progress note in her Electronic Health Record (EHR), a progress note dated November 26, 2024 at 4:32 PM indicated that resident #1 had made an inappropriate comment about her roommate's, at the time, mother. The roommate (resident #2) then grabbed resident #1's hair. Related to resident #2- Resident #2 was…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-11-26 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interviews, clinical record review, facility documents and facility policy, the facility failed to ensure a resident was free from abuse. This deficient practice could result in further incidents of physical abuse. Findings include: Resident #21 was admitted on [DATE] with diagnoses of anxiety disorder, and depression. A quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident had a BIMS (Brief interview for mental status) of 2, indicating that this resident was severely cognitively impaired and included inattention and disorganized thinking continuously present. A care plan dated April 15, 2024 included this resident had a behavior problem including impaired cognitive function, impaired safety awareness, wandering/exit-seeking, threatening, throwing water cups to staff despite staff reorientation/education and resident to resident altercation despite staff redirection with interventions. Interventions including intervene as necessary to protect the rights and safety of others. These…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-09-22 · tag F0697 — failed to manage pain — isolatedProvide safe, appropriate pain management for a resident who requires such services.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interviews, and facility policy, the facility failed to ensure one resident (#247) was provided services consistent with professional standards of practice. The deficient practice could result in unmanaged pain for the resident. Findings include: Resident #247 was admitted on [DATE] with diagnosis including surgical aftercare, bacteremia, sepsis, acute osteomyelitis, type 2 diabetes mellitus, peripheral vascular disease and right foot transmetatarsal amputation. Review of the electronic health record revealed that the BIMS (brief interview of mental status) had not yet been completed. A review of the physician's orders on September 14, 2023 revealed an order for pain evaluation each shift utilizing a 0 to 10 pain scale. A further review of the physician orders revealed an order to administer oxycodone-acetaminophen 5-325mg 1 tablet, by mouth, every 6 hours as needed for pain ranging 6 to 10. A review of the MAR (medication administration record) revealed the following…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-09-22 · tag F0867 — failed to act on quality-improvement findings — isolatedSet up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on staff interviews, and review of facility documentation and policies, the facility failed to ensure that the QAA (quality assessment and assurance) committee collected data and monitored it's performance regarding adverse events for performance improvement. Findings include: An interview was conducted on September 21, 2023 at 2:32 p.m. with staff #8 (Administrator) and staff #38 (DON). Staff #8 stated that meetings are held every 3rd Wednesday of the month. Staff #8 shared that information as related to any PIP (performance improvement plans) is shared forward to the departments involved in the PIP. The administrator stated that the QAA committee is currently working on a PIP for falls, which had been implemented on September 20, 2023. The team is also working on a PIP for medications administered outside of ordered parameters. Staff #8 stated that a previous PIP that had been on resident showers, which had been resolved. He stated that as a result of QAA committee, a shower team had been integrated but stated that the results showed that the previous method had been more…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2022-08-04 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — patternProvide appropriate pressure ulcer care and prevent new ulcers from developing.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interviews, clinical record reviews, and review of policy and procedure, the facility failed to ensure 3 residents (#69, #12, and #291) received care and services to promote the prevention, healing, and prevent the development of additional pressure ulcers/injury consistent with professional standards of practice. The sample size was 4 residents. The deficient practice increases the risk of pain, infection, and rehospitalization. Findings include: -Resident #69 admitted to the facility on [DATE] with diagnoses that included chronic kidney disease stage 3, type 2 diabetes mellitus with hyperglycemia, and unspecified arthritis. The admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident scored 15 on the Brief Interview for Mental Status (BIMS) assessment, indicating intact cognition. The resident required limited to extensive 1-person physical assistance for most Activities of Daily Living (ADLs), and had no pressure ulcers/injury to skin. Review of the discharged with return…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2022-08-04 · tag F0880 — failed to prevent and control infections — patternProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on staff interviews, clinical record review, and policy and procedures, the facility failed to ensure appropriate infection control guidelines were followed related to droplet precautions and catheter care for one resident (#86). The deficient practice increases the risk for transmission of infection. Findings include: Regarding Personal Protective Equipment (PPE) During an observation conducted on 08/01/22 at 12:33 p.m., a housekeeper was observed mopping the floor in a resident's room that had a droplet precaution sign on the door. A PPE cart was observed outside the room in the hallway. The housekeeper was observed wearing a gown, gloves, and a KN95 mask. She had not donned the protective eyewear or N95 mask as directed by the sign on the door. On 08/01/22 at 12:35 p.m. an interview was conducted with the housekeeper (staff #31). She stated that the resident in the room was on special precautions. She stated that the sign was on the door yesterday as well. Staff #31 said that sometimes she asks what the resident has, but that this time she had not asked. She stated that she…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-08-04 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, resident and staff interviews, clinical record review, and policy review, the facility failed to ensure one resident (#13) was treated with dignity by failing to knock and requesting permission before entering the resident's room. The sample size was 18. The deficient practice could result in residents not being treated in a dignified manner. Findings include: Resident #13 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus, Cerebral Palsy and hypertension. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident had intact cognition. An interview was conducted with the resident on 08/01/22 at 1:28 PM. The resident stated that often, the staff do not knock on the door before entering. During the interview, a CNA (Certified Nursing Assistant) was observed entering the resident's room without knocking. Further observations of residents' rooms revealed the following:…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-08-04 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interviews, facility documentation, and policy and procedures, the facility failed to ensure one resident (#0) was adequately supervised. The deficient practice increased the risk for resident-to-resident confrontations and accidents/hazards. Findings include: Resident #0 was admitted to the facility on [DATE] with diagnoses that included COVID-19, personal history of traumatic brain injury (TBI), and schizophrenia. Review of a Health Status Note dated 07/14/2020 at 5:47 p.m. revealed the resident had been admitted from the hospital positive for COVID-19 for recovery. The resident was described as alert and oriented to self and situation, and did not understand being placed in a skilled nursing facility. The resident was noted to be at risk for falling and wandering around trying to enter other rooms. The note included the resident had visual hallucinations, was able to answer questions, and did not know the date or place. Review of the clinical record did not reveal a…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-08-04 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, resident and staff interviews, and policy review, the facility failed to ensure one of three sampled residents (#86) received consistent catheter care. The deficient practice could result in residents having urinary tract infections. Findings include: Resident #86 was admitted to the facility on [DATE] with diagnoses that included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side and neuromuscular dysfunction of the bladder. The Comprehensive Care plan initiated on 7/14/2022 revealed the resident had a suprapubic catheter due to a neurogenic bladder. The goal was for the resident to remain free from catheter-related trauma and show no signs or symptoms of urinary infection. Interventions stated suprapubic catheter care every shift. Review of Treatment Administration for July 2022, revealed no evidence the resident was provided catheter care on July 15, 2022. The admission Minimum Data Set assessment dated [DATE] revealed a Brief Interview…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-08-04 · tag F0757 — failed to avoid unnecessary drugs — isolatedEnsure each resident’s drug regimen must be free from unnecessary drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, staff interviews, and policy review, the facility failed to ensure two residents (#17 and #36) were free from unnecessary medications. The sample was 5 residents. The deficient practice could result in residents receiving medications that may not be necessary. Finding include: -Resident #17 was admitted on [DATE] with diagnoses that included peripheral vascular disease, type 2 diabetes mellitus without complications, and venous thrombosis/embolism. A baseline care plan dated May 2, 2022 stated a problem for chronic pain and that the resident takes an opioid and non-opioid analgesic related to right leg removal of external fixation. The interventions included administering analgesia medication as per orders, and evaluating effectiveness of pain interventions. Regarding Norco A physician order dated May 3, 2022 stated Norco 10-325 milligrams (mg) one table by mouth every 4 hours as needed for pain 1-5, not to exceed 3 grams/24 hour. Review of the medication administration record…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-08-04 · tag F0758 — failed to limit and justify psychotropic drugs — isolatedImplement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, staff interviews, and policy review, the facility failed to ensure one resident (#17) who was receiving a psychotropic medication had ongoing behavior and adverse effects monitoring. The sample size was 5 residents. The deficient practice could result in residents receiving medications that may not be necessary. Findings include: Resident #17 was admitted on [DATE] with diagnoses that included major depressive disorder and anxiety disorder unspecified. A review of a physician order dated July 21, 2022, revealed an order for Duloxetine HCl Delayed Release Particles 30 milligrams 1 capsule by mouth one time a day for depression Review of the care plan problem dated July 21, 2022 stated resident #17 uses an antidepressant medication (Duloxetine) related to depression. The interventions included giving the antidepressant medication ordered by physician and monitoring/documenting side effects and effectiveness. An admission Minimum Data Set (MDS) assessment dated [DATE] revealed a…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to HAVEN HEALTH — 20 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 3 of 5 | 2.7 | +0.3 vs chain |
| Health inspection | 2 of 5 | 2.0 | ≈ chain avg |
| Staffing | 4 of 5 | 2.3 | +1.7 vs chain |
| Quality measures | 5 of 5 | 4.7 | +0.3 vs chain |
The other 19 homes this chain runs (chain average 2.7★, per CMS)
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| HAVEN HEALTH GROUP LLC | Organization | INDIRECT OWNERSHIP INTEREST | since 03/01/2020 |
| ROBERTSON, BRETT | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| SAMUELIAN, ROBERT | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| SAMUELIAN, SPENCER | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| SAMUELIAN, STEPHEN | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| SEASTRAND, JASON | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| WEST, CHRISTIAN | Individual | INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/01/2020 |
| HAVEN ARIZONA REAL ESTATE, LLC | Organization | 5% OR GREATER MORTGAGE INTEREST; ADP OF THE SNF | since 03/01/2020 |
| HAVEN REAL ESTATE PARTNERS, LLC | Organization | 5% OR GREATER MORTGAGE INTEREST; ADP OF THE SNF | since 03/01/2020 |
| HAVEN SANDPOINTE REAL ESTATE LLC | Organization | 5% OR GREATER MORTGAGE INTEREST; ADP OF THE SNF | since 03/01/2020 |
| HEALTH GROUP MANAGEMENT LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 11/21/2024 |
| EL AMIN, MOHEMED | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 01/01/2024 |
| ESPINOSA, STEPHANIE | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 10/14/2024 |
| FRAGOSO, LINDSAY | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 05/10/2021 |
| MUIR, MARK | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 01/01/2024 |
| NUKAYA, JACK | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/08/2024 |
| OGREN, PATRICIA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 09/01/2023 |
CMS files one row per role, so the 39 rows in the source record cover these 17 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
5 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 74% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $779K paid to related parties (affiliated landlords or management companies) in its most recent cost report.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in AZ
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Arizona Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 035096. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-08-13, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.