Haven of Camp Verde

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.

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

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.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

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

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.

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

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.

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

Smoke Deficiencies

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Pharmacy Service Deficiencies

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

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.

Administration Deficiencies

Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

Egress Deficiencies

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Smoke Deficiencies

Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.

Violation cited

Violation cited

Violation cited

Violation cited

Violation cited

Violation cited

Violation cited

Violation cited

Based on observation the facility failed to maintain several doors in the building. Failing to maintain doors in the facility could allow heat and/or smoke to transfer which will cause harm to the patients and/or staff. NFPA 101, Life Safety Code, 2012 edition, Chapter 19, Section 19.3.6.3.5. "Doors shall be provided with a means for keeping the door closed that is acceptable to the authority having jurisdiction." NFPA 80 2010 edition, Chapter 5 Section 5.2.14 Maintenance of Closing Mechanisms. 5.2.14.1 Self-closing devices shall be kept in working condition at all times. Chapter 19, Section 19.3.6.3 Corridor Doors Section 19.3.6.3.1* Doors protecting corridor openings in other than required enclosures of vertical openings, exits, or hazardous areas shall be substantial doors, such as those constructed of 1-3/4 inch solid-bonded core wood, or capable of resisting fire for at least 20 minutes. Doors in fully sprinklered smoke compartments are only required to resist the passage of smoke. Doors shall be provided with a means suitable for keeping the door closed. Findings include: Observations made while on tour on February 05, 2025, revealed the following: 1. Room 101, the door has gaps along the top and side above the handle. 2. Room 102, the door has gaps along the top and side above the handle. 3. Room 103, the door has gaps along the top and side above the handle. 4. Room 104, the door has gaps along the top and side above the handle. 5. Room 201, the door has gaps along the top and side above the handle. 6. Room 205, the door has gaps along both sides. 7. Room 208, the door has gaps along the top and side above the handle. 8. Room 227, the door has a hanger for personal protective equipment which prevents the door from closing. 9. Room 232, the door has a hanger for personal protective equipment which prevents the door from closing. The management team confirmed the door deficiencies during the facility tour and exit conference conducted on February 05, 2025.

Based on observation it was determined the facility failed to fill penetrations of the smoke barrier in the facility. Failing to seal the penetrations, holes, and openings in the smoke barriers will allow smoke and heat to penetrate other wings or possibly the whole facility which could cause harm to the patients in the time of a fire. NFPA 101 Life Safety Code, 2012, Chapter 19, Section 19.3.7.3 "Any required smoke barrier shall be constructed in accordance with Section 8.5 and shall have a fire resistance rating of at least \'bd hour." Chapter 8, Section 8.5.6.2 Penetrations for cables cable trays, conduits, pipes, tubes, vents wires and similar items to accommodate electrical, plumbing and communications systems that pass through a wall, floor or /ceiling assembly constructed as a smoke barrier, or through the ceiling membrane of the roof /ceiling of a smoke barrier assembly shall be protected by a system or material capable of restricting the transfer of smoke. Findings include: Observations made during a facility tour conducted on February 04, 2025, revealed that the facility failed to maintain the fire/ smoke barrier in the following areas: 1. Penetration above the ceiling tile on the dining room wall at the 90-minute door measuring approximately 18"X24". The management team confirmed during the facility tour and exit conference conducted on February 05, 2025, the above listed penetration had not been sealed.

Violation cited

Violation cited

Violation cited

Violation cited

Violation cited

Based on observation, record review and interview, the governing authority failed to designate a certified manager. Findings include: 1. During an interview, E1 stated that E1 was the facility administrator, but was not a certified manager. E1 further stated that there had not been a certified manager overseeing the facility since O1 left. 2. Record review revealed that O1's last day as the facility manager was June 30, 2024. 3. During an interview, E1 acknowledged that no certified manager had been designated.

Based on documentation review and interview, the manager failed to ensure that a plan is established, documented, and implemented for an ongoing quality management program that, includes a method to make changes or take actions as a result of the identification of a concern about the delivery of services related to resident care. Findings include: 1. Review of the monthly facility quality management reports revealed that the reports did not implement a method to make changes or take actions as a result of the identification of a concern about the delivery of services related to resident care. 2. During an interview, E1 acknowledged the required documentation was not included in the facility quality management reports.

Based on record review and interview, the manager failed to ensure that two of three sample resident records contained documentation of notification to the resident of the availability of vaccinations for influenza. Findings include: 1. The record belonging to R1 contained documentation indicating that the resident was last notified of the availability of the influenza vaccination on October 18, 2022. No additional documentation indicating when the resident had been offered, refused, or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 2. The record belonging to R2 contained documentation indicating that the resident was last notified of the availability of the influenza vaccination on October 18, 2022. No additional documentation indicating when the resident had been offered, refused, or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged that the record did not contain the required documentation.

Based on record review and interview for two of two sample personal care resident records, the manager failed to obtain documentation reflecting that the resident or resident's representative requested that the resident remain in the facility. Findings include: 1. During an interview, E1 indicated that R2 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted. 2. The resident's record did not contain a request from the resident or their representative to remain in the facility. Based on the resident's date of acceptance this documentation was required. 3. During an interview, E1 indicated that R3 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted. 4. The resident's record did not contain a request from the resident or their representative to remain in the facility. Based on the resident's date of acceptance this documentation was required. 5. During an interview, E1 acknowledged that the required documentation was not in the resident's records.

Based on documentation review and interview, the manager failed to ensure that documentation of each evacuation drill included an identification of residents needing assistance for evacuation Findings include: 1. Review of 12 months of facility evacuation drill documentation revealed that the documentation failed to identify the residents needing assistance for evacuation. 2. During an interview, E1 stated, "We do have non-ambulatory and directed care residents here who would need assistance." 3. During an interview, E1 acknowledged the required documentation was not available for review.

Based on documentation review and interview, the manager failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that included annually assessing the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1. Review of facility documentation failed to reveal an annual assessment of the health care institution's risk of exposure to infectious tuberculosis. 2. During an interview, E1 acknowledged that the required documentation was not available for review.