01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-14 | 7 | 2025-03-14 | 2 |
| Cycle 2 | 2023-10-05 | 10 | 2023-10-05 | 4 |
| Cycle 3 | 2022-08-18 | 7 | 2022-08-18 | 2 |
CMS CCN 0350912026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Haven Of Flagstaff
800 West University Avenue · Flagstaff, AZ 86001 · Coconino County
Certified beds83CMS provider file
Recent citation rows32current CMS citation release
Penalty rows1current 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
32 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 5 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-22 · HEALTHF0755Severity D · isolated; 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 · 2026-01-20 · complaint2025-04-29 · HEALTHF0689Severity G · isolated actual 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 · 2025-05-30 · complaint2025-03-14 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2025-04-092025-03-14 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2025-04-09 · complaint2025-03-14 · 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 · 2025-04-09 · complaint2025-03-14 · HEALTHF0609Severity D · isolated; 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 · 2025-04-09 · complaint2025-03-14 · HEALTHF0812Severity D · isolated; 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 · 2025-04-092025-03-14 · 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 · 2025-04-09 · complaint2025-03-14 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-04-222025-03-14 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2025-04-222024-10-23 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2024-12-09 · complaint2024-10-23 · HEALTHF0609Severity D · isolated; 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 · 2024-12-09 · complaint2024-10-23 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Past Non-Compliance · 2022-03-01 · complaint2023-12-14 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2024-01-03 · complaint2023-12-14 · HEALTHF0610Severity D · isolated; 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 · 2024-01-03 · complaint2023-10-05 · FIREE0039Severity E · pattern; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · HEALTHF0609Severity D · isolated; 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 · 2023-11-06 · complaint2023-10-05 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · HEALTHF0680Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure the activities program is directed by a qualified professional.
Correction field: Deficient, Provider has date of correction · 2023-11-06 · complaint2023-10-05 · HEALTHF0825Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or get specialized rehabilitative services as required for a resident.
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-11-062023-10-05 · FIREK0712Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2023-11-0603 / 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 |
|---|---|---|---|
| 2025-03-14 | Fine | $13,098 | 0 |
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 FLAGSTAFF 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
- HEALTH GROUP MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2013
- TERNION PHYSICIAN GROUP, PLLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2021
- ESPINOSA, STEPHANIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/14/2024
- FIGUEROA-DIAZ, VICENTEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2021
- FRAGOSO, LINDSAYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/10/2021
- LONGHURST, STOCKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/15/2020
- MCCULLOUGH, ERINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2021
- MILLER, CRYSTALIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/27/2023
- ROBERTSON, BRETTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2013
- SAMUELIAN, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2013
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 hours3.35per resident day
RN hours0.83per resident day
Weekend nurse hours3.09per resident day
Staff turnover43.8%CMS reported field
06 / LOCAL RECORDS
Open the Flagstaff ledger →