HAVEN HEALTH SKY HARBOR, LLC

1880 EAST VAN BUREN STREET
PHOENIX, AZ, 85006
6022534570
CCN: 035290
2
Overall
1
Health
1
Staffing
5
Quality
ChainHAVEN HEALTH
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (1)
This facility's name matches one or more entities on the OIG List of Excluded Individuals/Entities (LEIE). Excluded parties are prohibited from participation in Medicare and Medicaid programs.
APACHE HEALTH LLC
1128a1
Excluded 2024-10-20
Ownership
NameRole%
HAVEN HEALTH GROUP LLC5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
ROBERTSON, BRETT5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
SAMUELIAN, ROBERT5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
SAMUELIAN, SPENCER5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
SAMUELIAN, STEPHEN5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
WEST, CHRISTIAN5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
HAVEN HEALTH PROPERTIES LLC5% OR GREATER INDIRECT OWNERSHIP INTEREST8%
HEALTH GROUP MANAGEMENT LLC5% OR GREATER INDIRECT OWNERSHIP INTEREST8%
HAVEN SKY HARBOR REAL ESTATE LLC5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE
FRAGOSO, LINDSAYCORPORATE OFFICERNOT APPLICABLE
SEASTRAND, JASONCORPORATE OFFICERNOT APPLICABLE
ESPINOSA, STEPHANIECORPORATE OFFICERNOT APPLICABLE
GREINER, RUSSELLOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
KNIGHT, TASHAYOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
NASSER, MOHAMMADOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
ROBERTSON, BRETTOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SAMUELIAN, ROBERTOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SAMUELIAN, SPENCEROPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SAMUELIAN, STEPHENOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SEASTRAND, JASONOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
WEST, CHRISTIANOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
BRADY, MITCHELLOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
HEALTH GROUP MANAGEMENT LLCOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
ESPINOSA, STEPHANIEOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
FRAGOSO, LINDSAYOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Penalties (1)
DateTypeAmount
2023-04-28Fine$44K
Health Deficiencies (46)
2025-11-13 · Health
E
F842 · 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.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
2025-08-12 · Health
E
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
E
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
E
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
2025-03-24 · Health
D
F842 · 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.
2024-10-22 · Health
D
F657 · 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.
2024-08-01 · Health
D
F622 · Resident Rights Deficiencies
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
2024-05-06 · Health
D
F940 · Administration Deficiencies
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
E
F867 · Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
E
F842 · 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.
E
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F804 · Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
D
F790 · Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for each resident.
E
F757 · Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
D
F727 · 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.
D
F725 · Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
E
F679 · Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
D
F677 · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
F676 · Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
D
F656 · 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.
2024-04-11 · Health
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
2024-01-10 · Health
E
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
2023-04-28 · Health
G
F600 · 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.
2022-12-15 · Health
D
F945 · 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.
D
F943 · 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.
D
F942 · Resident Rights Deficiencies
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
E
F882 · Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
D
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
E
F758 · Pharmacy Service Deficiencies
Implement 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.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F677 · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
2021-09-23 · Health
E
F885 · Infection Control Deficiencies
Report COVID19 data to residents and families.
D
F790 · Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for each resident.
D
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
D
F697 · Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
E
F686 · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
F685 · Quality of Life and Care Deficiencies
Assist a resident in gaining access to vision and hearing services.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F676 · Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
D
F656 · 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.
D
F655 · Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
D
F636 · 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.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
4.62
3.68
RN Hrs/Resident/Day
0.61
0.54
LPN Hrs/Resident/Day
1.45
0.81
CNA Hrs/Resident/Day
2.56
2.33
PT Hrs/Resident/Day
0.05
0.12
Data as of 2026-03-01