Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Haven Of Lake Havasu during CMS and state inspections, most recent first.
Two residents with known behavioral issues, one with severe cognitive impairment and one cognitively intact, were involved in a resident-to-resident physical altercation. A resident with a history of behavioral problems, including prior physical altercations, entered another resident’s room and allegedly punched him multiple times in the face and twisted his arm, resulting in a black eye, skin tears, bruising, and minor cuts. Staff later observed the injured resident approaching the nurses’ station with these injuries, and leadership confirmed via camera review that the aggressor had entered the victim’s room and that a physical altercation occurred, despite an existing abuse policy intended to protect residents from abuse.
Two residents with cognitive and behavioral impairments were involved in a physical altercation, including kicking and slapping, after one attempted to pass the other in a wheelchair. Despite care plans addressing supervision and behavioral interventions, staff did not prevent the incident, and documentation confirmed the occurrence of physical aggression between the residents.
A resident with a history of repeated falls and moderate cognitive impairment experienced multiple falls resulting in injuries, despite having a care plan with interventions like frequent safety rounds and a tilt-in-space wheelchair. Documentation and staff interviews revealed gaps in the implementation and monitoring of fall prevention strategies, leading to repeated falls and injuries.
A resident with major depressive disorder expressed suicidal ideation and a plan to overdose on pills during a psychiatric assessment. The facility failed to update the care plan or take action based on the psychiatric notes, which were not communicated to staff. This oversight led to the resident attempting self-harm, resulting in a hospital transfer after being found with wrist lacerations. Staff interviews revealed communication failures and care plan deficiencies.
A resident was discharged from an LTC facility without a comprehensive care plan, leading to an ineffective transition to post-discharge care. The facility failed to coordinate with the IDT to ensure necessary services and equipment were in place, resulting in the resident being discharged without compatible home health services and required medical equipment. The resident's family was not trained in wound care, and the resident had to seek emergency care due to worsening conditions.
A resident with severe cognitive impairment was subjected to abuse by a staff member who intentionally splashed water on their face during a bed bath. The incident was witnessed and reported by another staff member, leading to the responsible staff member being sent home. However, the facility did not report the incident to the Licensing Board, contrary to its policy.
Failure to Prevent Resident-to-Resident Physical Abuse
Penalty
Summary
The deficiency involves the facility’s failure to protect two residents from physical abuse by another resident. Resident #1 had severe cognitive impairment with a BIMS score of 05 and a care plan identifying behavioral problems, including taking others’ belongings, eating other residents’ food, inappropriate contact with other residents’ belongings and clothing, giving food to other residents without permission, refusing medication and care, and initiating a physical altercation with another resident. Despite these identified behaviors and the existence of a care plan focused on behavior problems, Resident #1 was able to enter Resident #2’s room and engage in a physical altercation. Resident #2 was cognitively intact with a BIMS score of 14 and had a care plan for behavior problems related to verbal and physical behaviors, including prior verbal altercations with other residents, use of profanity, striking another resident in the head, spitting water on staff, kicking at staff during care, cursing at staff, and refusing brief checks and changes. On the day of the incident, Resident #2 approached the nurses’ station with a hematoma to the left eye, a large skin tear to the right forearm, minor cuts to the nose, lip, and right hand, and bruising to the left hand. Resident #2 reported that Resident #1 had entered his room, punched him multiple times in the face, grabbed and twisted his arm, and then left the room. Staff interviews and facility documentation confirmed that no staff witnessed any verbal altercation between the two residents prior to the event, and that earlier in the day Resident #2 did not have any injuries. After the incident, staff observed Resident #2 with a swollen eye and face, bruising, and lacerations consistent with his report. The Administrator and DON stated that review of camera footage showed Resident #1 entering Resident #2’s room and that a physical altercation occurred, confirming that Resident #1 went into Resident #2’s room, hit him in the face, and then exited. The facility’s abuse policy stated an objective to provide a safe haven for residents through preventive measures that protect every resident’s right to freedom from abuse, but the documented resident-to-resident physical abuse occurred despite these stated objectives.
Failure to Prevent Resident-to-Resident Abuse Due to Inadequate Supervision
Penalty
Summary
The facility failed to provide adequate supervision to prevent abuse between two residents, resulting in a physical altercation. One resident, with a history of coronary artery disease, hemiplegia, seizure disorder, and schizophrenia, had care plans addressing impaired vision, cognitive impairment, mood problems, and behavioral issues. Interventions included supervision with decision-making, monitoring for behavioral changes, and ensuring safety regarding potential harm to self or others. Despite these interventions, the resident was involved in a physical aggression incident with another resident. The second resident involved had diagnoses including hypertension, diabetes, hemiplegia, anxiety, and depression, with care plans for cognitive impairment and behavioral problems such as physical and verbal aggression. The care plan interventions included anticipating and meeting needs and encouraging appropriate coping and interaction methods. However, this resident was also involved in the incident, which included physical contact such as kicking and slapping between the two residents. Staff interviews confirmed that the altercation occurred when one resident attempted to pass another in a wheelchair, leading to physical contact. The staff member on duty separated the residents, completed incident reports, and notified appropriate parties. Facility documentation and incident reports corroborated the occurrence of the altercation, indicating a failure to ensure adequate supervision and prevent resident-to-resident abuse as required by facility policy and resident rights.
Repeated Falls and Injuries Due to Inadequate Fall Prevention
Penalty
Summary
The facility failed to ensure that a resident did not sustain repeated fall accidents and injuries. The resident, who was admitted with a history of repeated falls and moderate cognitive impairment, experienced multiple falls despite having a care plan in place that included interventions such as anticipating needs, ensuring the call light was within reach, and following the facility's fall protocol. Additional interventions were added over time, including education on safety reminders, frequent safety rounds, and the use of a tilt-in-space wheelchair. Despite these measures, the resident experienced falls on several occasions, resulting in minor injuries and a fracture. The facility's documentation and staff interviews revealed gaps in the implementation and monitoring of fall prevention strategies. There was a lack of consistent documentation regarding the falls, and staff interviews indicated a reliance on standard interventions without a thorough analysis of the root causes of the falls. The facility's policy on monitoring subsequent falls and fall risk was reviewed, highlighting the need for documentation of irreversible risk factors. However, the repeated falls and injuries suggest that the interventions were not effectively preventing falls for this resident.
Failure to Address Suicidal Ideation in Resident
Penalty
Summary
The facility failed to protect a resident from self-harm following an encounter of self-reported suicidal ideation. Resident #135, who was admitted with diagnoses including major depressive disorder and anxiety disorder, expressed suicidal thoughts and a plan to overdose on pills during a psychiatric follow-up assessment. Despite this, the facility did not update the resident's care plan or take any action based on the psychiatric provider's notes, which were not communicated to the facility staff. The resident's care plan, initiated prior to the psychiatric assessment, included monitoring for self-harm risks but was not updated to reflect the new information about the resident's suicidal ideation. Consequently, staff were not informed of the resident's increased risk, and no additional monitoring or interventions were implemented. This lack of action resulted in the resident attempting self-harm, leading to a hospital transfer after the resident was found with lacerations on her wrist. Interviews with facility staff revealed that the lack of communication and failure to update the care plan contributed to the oversight. The Director of Nursing acknowledged that the facility was unaware of the psychiatric notes until after the resident's hospital transfer. The facility's policies on abuse prevention and behavioral health services were not effectively implemented, as the resident's suicidal ideation was not addressed in a timely manner, leading to the resident's self-harm incident.
Inadequate Discharge Planning and Coordination
Penalty
Summary
The facility failed to ensure proper discharge planning for a resident, leading to an ineffective transition to post-discharge care. The resident, who was admitted with conditions including rhabdomyolysis and unstageable pressure ulcers, was discharged without a comprehensive discharge care plan. Despite the resident's expectation to be discharged to the community, the facility did not adequately coordinate with the Interdisciplinary Team (IDT) to ensure necessary services and equipment were in place post-discharge. The discharge process was marred by several issues, including the failure to secure home health services that were compatible with the resident's insurance. The resident and her family expressed concerns about the discharge, particularly regarding wound care, as the resident was not ready to manage her condition independently. The facility's attempt to arrange home health services was unsuccessful, as the agency initially contacted did not accept the resident's insurance, leading to a delay in receiving necessary care. Additionally, the resident's family was not trained in wound care, and the resident was discharged without the required durable medical equipment, such as a wheelchair. The lack of proper coordination and communication resulted in the resident having to seek emergency care shortly after discharge due to worsening wound conditions. Interviews with staff revealed that the facility did not routinely verify the provision of necessary equipment and services post-discharge, contributing to the deficiency.
Failure to Protect Resident from Staff Abuse
Penalty
Summary
The facility failed to protect a resident from abuse by a staff member. The incident involved a resident with severe cognitive impairment, who refused a shower due to pain and requested a bed bath instead. During the bed bath, a staff member intentionally splashed water on the resident's face, which was witnessed by another staff member. The resident expressed discomfort and distrust towards the staff member involved, and the incident was reported to the charge nurse and subsequently to the administrator. The staff member responsible was sent home immediately. The facility's Director of Nursing confirmed that the staff member's contract was canceled, but the incident was not reported to the Licensing Board. Additionally, another staff member failed to properly manage a resident's oxygen, leading to a drop in oxygen saturation. Despite eyewitness accounts, the administrator did not substantiate the abuse incident, citing the staff member's claim that it was accidental. The facility's policy on abuse mandates immediate termination and licensure reporting for employees involved in abuse, which was not fully adhered to in this case.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Lake Havasu City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Havasu Nursing Center | 1.8 mi | — | 0 | 0 |
| Havasu Regional Medical Center | 3.4 mi | — | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.