01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-21 | 21 | 2025-05-21 | 1 |
| Cycle 2 | 2024-04-11 | 8 | 2024-04-11 | 6 |
| Cycle 3 | 2022-11-17 | 17 | 2022-11-17 | 7 |
CMS CCN 0350932026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Haven Of Cottonwood
197 South Willard Street · Cottonwood, AZ 86326 · Yavapai County
Certified beds80CMS provider file
Recent citation rows60current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
60 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 9 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-08-27 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-11-21 · complaint2025-07-01 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-08-11 · complaint2025-05-21 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0552Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure that residents are fully informed and understand their health status, care and treatments.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0584Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0607Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0609Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0610Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0636Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0679Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0689Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0697Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0727Severity E · pattern; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0755Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure 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.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0812Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-05-21 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-05-21 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has plan of correction2025-04-03 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-05-16 · complaint03 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SAMUELIAN, ROBERTIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/01/2013
- SAMUELIAN, SPENCERIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/01/2013
- SAMUELIAN, STEPHENIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/01/2013
- SEASTRAND, JASONIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/01/2013
- WEST, CHRISTIANIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 02/01/2013
- HAVEN ARIZONA REAL ESTATE, LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 02/01/2013
- HAVEN COTTONWOOD REAL ESTATE LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 02/01/2013
- HAVEN REAL ESTATE PARTNERS, LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 02/01/2013
- ROBERTSON, BRETTIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2013
- HEALTH GROUP MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/25/2024
- ESPINOSA, STEPHANIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/14/2024
- FRAGOSO, LINDSAYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/10/2021
- HAMMER, RONALDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/28/2024
- LONGHURST, STOCKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/15/2020
- NIELSEN, CODYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/26/2024
- SAMUELIAN, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/22/2025
- SAMUELIAN, SPENCERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/22/2025
- SAMUELIAN, STEPHENIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/22/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours2.80per resident day
RN hours0.45per resident day
Weekend nurse hours2.50per resident day
Staff turnover59.7%CMS reported field
06 / LOCAL RECORDS
Open the Arizona ledger →Other published facilities nearby
No second facility in the same city met the directory rule.