01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-11-19 | 19 | 2025-11-19 | 2 |
| Cycle 2 | 2024-06-06 | 15 | 2024-06-06 | 2 |
| Cycle 3 | 2022-12-08 | 14 | 2022-12-08 | 0 |
CMS CCN 0352772026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Haven Of Lakeside
3401 North Lockwood Drive · Lakeside, AZ 85929 · Navajo County
Certified beds112CMS provider file
Recent citation rows52current 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
52 rows in the current release
1 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.
2026-01-27 · 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: Deficient, Provider has date of correction · 2026-03-01 · complaint2026-01-27 · 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 · 2026-03-01 · complaint2026-01-21 · 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 · 2026-03-01 · complaint2026-01-21 · 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 · 2026-03-01 · complaint2026-01-21 · 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 · 2026-03-01 · complaint2025-11-19 · HEALTHF0578Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · 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 · 2025-12-052025-11-19 · HEALTHF0658Severity E · pattern; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · 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 · 2025-12-052025-11-19 · 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 · 2025-12-052025-11-19 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0732Severity E · pattern; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0759Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · 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 · 2025-12-052025-11-19 · HEALTHF0940Severity E · pattern; potential for more than minimal harm
Administration Deficiencies
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0942Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0943Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0945Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · HEALTHF0949Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Correction field: Deficient, Provider has date of correction · 2025-12-052025-11-19 · FIREK0341Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install a fire alarm system that can be heard throughout the facility.
Correction field: Deficient, Provider has date of correction · 2026-03-232025-11-19 · 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 · 2026-03-232025-07-16 · 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: Past Non-Compliance · 2024-08-16 · complaint2025-07-09 · 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 · 2025-08-08 · complaint2025-07-09 · 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 · 2025-08-08 · 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 |
|---|---|---|---|
| 2025-06-11 | Fine | $8,278 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ROBERTSON, BRETTIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- SAMUELIAN, ROBERTIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- SAMUELIAN, SPENCERIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- SAMUELIAN, STEPHENIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- SEASTRAND, JASONIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- WEST, CHRISTIANIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/01/2015
- HAVEN HEALTH PROPERTIES LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 03/01/2015
- HAVEN LAKESIDE REAL ESTATE LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 03/01/2015
- ESPINOSA, STEPHANIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/14/2024
- FRAGOSO, LINDSAYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/10/2021
- CLARK GLOBALMED, LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/13/2025
- HEALTH GROUP MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/25/2024
- CLARK, RANDOLPHIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2015
- ESPINOSA, STEPHANIEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/13/2025
- FAIR, RYANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/21/2019
- FRAGOSO, LINDSAYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/13/2025
- HANSEN, CALEBIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/20/2023
- LONGHURST, STOCKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/15/2020
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 hours3.42per resident day
RN hours0.58per resident day
Weekend nurse hours3.15per resident day
Staff turnover51.2%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.