Haven Of Sedona
Inspection Findings
F-Tag F0559
F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
unhappy and losing their right to choose or decline a roommate, as the form includes that option. During
the interview, the RRM reviewed the clinical record and stated that there was no documentation of a roommate change notification for Resident #11; and, staff should have completed the notification but failed to do so in this case.During an interview with the DON (Staff #120) conducted on August 19, 2025 at 2:32 p.m., the DON stated that best practice would be to have nursing staff document room changes in the clinical record as a progress note. The DON further stated that her expectation was for social services to complete their documentation for roommate changes and upload the completed form into the record.
Review of the facility policy titled, Resident Rights - Room Change/Roommate Assignment, was revised in January of 2024 revealed that resident room or roommate assignments may change if the facility deemed it necessary, but that resident preferences were taken into account when such changes were considered. The policy further revealed that prior to changing a room or roommate assignment, residents should have been given advance written notice of such change, and advance written notice of a roommate change would include why the change was being made. The policy also revealed that documentation of a room change should be recorded in the resident's medical record.
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Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
08/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haven of Sedona
505 Jacks Canyon Road Sedona, AZ 86351
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0607
F 0607 Level of Harm - Minimal harm or potential for actual harm
Rights/Dignity: Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, was revised
in January of 2024 and revealed that all reports of abuse, neglect, or exploitation needed to be thoroughly investigated by facility management, and needed to be reported immediately, but within two hours to the state agency, ombudsman, resident's representative, Adult Protective Services (APS), law enforcement, the physician, and the medical director.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
08/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haven of Sedona
505 Jacks Canyon Road Sedona, AZ 86351
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
stated that the CNA who intended to shower her left early that day, and by the end of the night they realized that Resident #11 had not gotten her shower yet, so they decided to set her up for one. Staff #46 said that
they left the resident in the shower for 30 minutes, and at some point she thought that the nurse went into
the shower room because the resident dropped something. Staff #46 further stated that after 30 minutes,
they returned to the shower room because the resident was screaming, and they got her dressed and in her wheelchair before the resident told them she was going to report them. Staff #46 said that the resident immediately wheeled herself back to her room and sent an email to report them; and, the charge nurse texted the ED (staff #29), to report it immediately. In an interview with the other CNA (staff #34) conducted
on [DATE REDACTED] at 1:30 p.m., staff #34 stated that allegations of abuse or neglect must be reported within two hours. Staff #34 stated that she reported the resident's allegations to the nurse immediately, who then notified the supervising nurse and the oncoming shift. She also noted that she was not suspended until [DATE REDACTED], at 11:00 a.m. An interview was conducted with a Registered Nurse (RN/Staff#58) on [DATE REDACTED] at 2:24 p.m. The RN said that per the facility's policy, the timeframe for reporting was immediately to the administrator; and, if an allegation were made outside of business hours, they would leave a message, try to reach the Director of Nursing (DON), and make sure the residents were safe. During an interview with
the DON (Staff #120) and ED (Staff #29) conducted on [DATE REDACTED] at 2:32 p.m. both the DON and the ED stated that the timeframe for reporting was 2 hours. Regarding the incident, the ED stated that they were notified over email on [DATE REDACTED] at 10:16 p.m., the ED did not check her email immediately, and she did not see the email until around 10 a.m. on [DATE REDACTED]. The ED stated that she read it, reviewed it, and the facility did
the initial 2 hours of making sure the resident was safe before sending the aide home and suspending the other. The ED stated that they did a skin assessment and concluded that it was not substantial for abuse and neglect. The ED stated that she did not click the verification link sent to her email to submit the report to the State Agency, and when she attempted to click the link it expired. The ED further stated that they would fix their reporting processes moving forward. Review of a policy titled, Resident Rights/Dignity: Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, was revised in January of 2024 and revealed that all reports of abuse, neglect, or exploitation needed to be thoroughly investigated by facility management, and needed to be reported immediately, but within two hours to the state agency, ombudsman, resident's representative, Adult Protective Services (APS), law enforcement, the physician, and the medical director.
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HAVEN OF SEDONA in SEDONA, AZ inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SEDONA, AZ, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from HAVEN OF SEDONA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.