Inspection Reports for Mystic Haven
3421 Camsore Point Lane, Las Vegas, NV 89129, NV, 89129
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Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Jul 8, 2025
Visit Reason
This inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A with no regulatory deficiencies identified. Five resident files and four employee files were reviewed, and no further action is necessary.
Report Facts
Resident files reviewed: 5
Employee files reviewed: 4
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 6
Jun 25, 2024
Visit Reason
The inspection was an annual State Licensure survey initiated on 06/25/24 and completed on 06/27/24 to assess compliance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility was found to have multiple regulatory deficiencies including water temperatures exceeding acceptable limits, unsanitary food preparation areas, failure to obtain medical exemption waivers for residents with wounds, lack of administrator review of medication, absence of an emergency preparedness plan, and inadequate infection control training for designated staff.
Severity Breakdown
Severity: 2: 6
Deficiencies (6)
| Description | Severity |
|---|---|
| Water temperatures in bathroom sinks and showers exceeded the acceptable range of 100 to 110 degrees Fahrenheit. | Severity: 2 |
| Food storage and meal preparation area on the patio was not clean and sanitary, with dusty appliances and exposed food items. | Severity: 2 |
| Failure to obtain a medical exemption waiver for a resident with Stage 4 wounds receiving hospice care. | Severity: 2 |
| Medication reviews for all four residents were not reviewed and initialed by the Administrator as required. | Severity: 2 |
| No documented emergency preparedness plan was available for the facility. | Severity: 2 |
| Primary and secondary infection control staff did not complete the required 15 hours of infection control training. | Severity: 2 |
Report Facts
Number of beds: 6
Resident census: 4
Water temperature readings: 7
Residents reviewed: 4
Employee files reviewed: 5
Residents with medication review deficiencies: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frederick Brown | Administrator | Named as the Administrator who acknowledged deficiencies and signed the report |
| Employee #1 | Administrator and primary infection control staff | Identified as lacking required infection control training |
| Employee #4 | Caregiver and secondary infection control staff | Identified as lacking required infection control training |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 3
Jun 14, 2023
Visit Reason
This inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A but had several deficiencies including poor maintenance of the premises, failure to submit a required bedfast waiver for one resident, and missing annual activities of daily living (ADL) assessment for another resident.
Severity Breakdown
Severity: 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility premises were not clean or well maintained, including rusty bed frame, weeds up to eight inches, broken walker, and clutter on the patio. | Severity: 2 |
| Failure to submit a bedfast waiver for one resident who was unable to turn in bed without assistance. | Severity: 2 |
| Failure to ensure annual activities of daily living (ADL) assessment was completed for one resident; initial assessment was present but annual update was missing. | Severity: 2 |
Report Facts
Resident census: 6
Total licensed capacity: 6
Employee files reviewed: 5
Resident files reviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frederick Brown | Administrator | Signed the report and named in plan of correction |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jun 3, 2022
Visit Reason
This inspection was conducted as an annual state licensure and infection control survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
No regulatory deficiencies were identified. The facility received a grade of A and was provided guidance on nondiscrimination, privacy, cultural competency training, complaint policy, and gender identity/expression policy requirements.
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 3
Aug 3, 2021
Visit Reason
The inspection was conducted as an annual state licensure and infection control survey in accordance with Nevada Administrative Code Chapter 449 for a Residential Facility for Groups.
Findings
The facility received a grade of A but had several deficiencies including failure to re-evaluate a resident with cognitive changes, failure to have medications available on site for two residents, and failure to properly destroy discontinued medication for one resident. Corrective actions were planned and initiated by the administrator.
Severity Breakdown
Level 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to ensure a resident was re-evaluated by a physician due to change in cognition (Resident #4). | Level 2 |
| Failure to ensure medication was available on site for 2 of 6 residents (Residents #2 and #3). | Level 2 |
| Failure to ensure medication was destroyed after discontinuation for 1 of 6 residents (Resident #1). | Level 2 |
Report Facts
Residents present: 6
Licensed capacity: 6
Deficiencies cited: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frederick D Brown | Administrator | Named as the facility administrator responsible for corrective actions |
Inspection Report
Routine
Census: 5
Capacity: 10
Deficiencies: 0
Oct 21, 2020
Visit Reason
The inspection was a COVID-19 focused infection control State Licensure survey conducted to assess compliance with infection control measures related to COVID-19 at the facility.
Findings
The facility implemented multiple infection control measures including signage, screening, hand hygiene, PPE use, resident distancing, and cleaning protocols. No residents or staff were positive for COVID-19 at the time, and no regulatory deficiencies were identified.
Report Facts
Hand sanitizer bottles: 5
Gloves: 400
Disposable masks: 50
Licensed beds: 10
Residents present: 5
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 1
Jun 13, 2019
Visit Reason
This inspection was conducted as a State Licensure annual survey of the facility in accordance with Chapter 449, Residential Facility for Groups.
Findings
The facility received an annual survey grade of A. One deficiency was identified related to failure to document administration of a second tuberculin test for one resident.
Severity Breakdown
2: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to document administration of a second tuberculin test for Resident #5. | 2 |
Report Facts
Resident files reviewed: 5
Employee files reviewed: 6
Annual survey grade: A
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| NEVARRIE P DELEON | RFA | Signed as Laboratory Director's or Provider/Supplier Representative |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Jun 5, 2018
Visit Reason
The inspection was conducted as an annual survey initiated at the facility on 06/05/18 in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A with no regulatory deficiencies identified at the time of the survey. Four resident files and eight employee files were reviewed.
Inspection Report
Complaint Investigation
Census: 4
Deficiencies: 0
Oct 16, 2017
Visit Reason
The inspection was conducted as a complaint investigation initiated on 10/09/2017 and completed on 10/16/2017, triggered by one complaint with two allegations regarding level of care and pressure sore precautions.
Findings
The complaint allegations could not be substantiated. The investigation included observation, interviews, and record reviews. No regulatory deficiencies were identified and no further action was necessary.
Complaint Details
One complaint (NV00050312) with two allegations was investigated and both allegations were not substantiated.
Report Facts
Sample size: 5
Number of complaints investigated: 1
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Aug 29, 2017
Visit Reason
This inspection was conducted as an annual State Licensure survey of the facility.
Findings
The facility received a grade of A with no regulatory deficiencies identified at the time of the survey.
Inspection Report
Complaint Investigation
Census: 5
Deficiencies: 0
May 31, 2016
Visit Reason
The inspection was conducted as a result of a complaint investigation at the facility on 5/31/16.
Findings
The investigation included observation of grooming and physical appearance of five residents, meal observation, a tour of the facility, interviews with the Administrator and Caregiver, and review of files including the employee of concern. No regulatory deficiencies were identified and the complaint allegations could not be substantiated.
Complaint Details
Complaint #NV00045762 with allegations related to State Licensure was investigated but could not be substantiated.
Report Facts
Sample size: 7
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Jan 20, 2016
Visit Reason
This Statement of Deficiencies was generated as a result of an annual State Licensure survey conducted in the facility on 1/20/16 by the Division of Public and Behavioral Health.
Findings
The facility received a grade of A with no regulatory deficiencies identified. Five resident files and four employee files were reviewed during the survey.
Report Facts
Resident files reviewed: 5
Employee files reviewed: 4
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 16, 2015
Visit Reason
This document reports the results of an annual State Licensure survey conducted at the facility on 2015-01-16 by the Division of Public and Behavioral Health.
Findings
The facility was found to be in substantial compliance with regulations, receiving a grade of A, with no deficiencies identified during the survey.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 7
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Jan 9, 2014
Visit Reason
This report documents a State Licensure annual grading survey conducted on 1/9/14 to assess compliance with regulatory requirements for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of A but had several deficiencies related to personnel files, including incomplete pre-employment physicals and CPR certification, as well as medication administration and storage issues. Some deficiencies were repeat findings from a prior survey.
Severity Breakdown
Level 1: 1
Level 2: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Personnel file did not include a current pre-employment physical for Employee #5. | Level 2 |
| Personnel file did not include certification for first aid and CPR for Employee #5. | Level 2 |
| Medication administration records (MAR) were inaccurate or incomplete for 2 of 6 residents inspected. | Level 1 |
| Medication storage was not secure; medications were found in resident bathroom without proper labeling or locked storage. | Level 2 |
Report Facts
Residents present: 6
Licensed capacity: 6
Deficiencies cited: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #5 | Named in deficiencies related to pre-employment physical and CPR certification |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Jan 9, 2014
Visit Reason
This inspection was conducted as a State Licensure annual grading survey of the facility Mystic Haven on 1/9/2014 to assess compliance with state regulations.
Findings
The facility received a grade of A but had several deficiencies including incomplete or outdated employee health and training records, inaccurate medication administration records for residents, and unsecured medications found in resident bathrooms. Some deficiencies were repeat findings from a prior survey.
Severity Breakdown
Severity: 1: 1
Severity: 2: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 6 employees had a current pre-employment physical examination; physical dated 7/12/12 for an employee hired 6/1/13. | Severity: 2 |
| Failed to ensure 1 of 6 caregivers was currently certified in first aid and CPR; training was done online. | Severity: 2 |
| Medication administration records (MAR) were inaccurate for 2 of 6 residents; missing signatures, medications not listed, and incorrect dosage instructions. | Severity: 1 |
| Medications were not stored securely; antifungal cream and lubricating jelly found unsecured in resident bathroom. | Severity: 2 |
Report Facts
Number of residents: 6
Total licensed capacity: 6
Number of employees reviewed: 6
Number of resident files reviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #5 | Named in deficiencies related to pre-employment physical and first aid/CPR certification |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Jan 8, 2013
Visit Reason
The inspection was an annual State Licensure inspection conducted on 1/8/13 to assess compliance with state regulations for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of A but had deficiencies related to medication administration, PRN medication availability, medication storage, and securing medications. Specific issues included unavailable PRN medications for some residents, failure to prescribe maintenance level medications properly, and unsecured medications in resident rooms.
Severity Breakdown
Severity: 2 Scope: 3: 3
Severity: 2 Scope: 2: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Medication/change order not properly administered as prescribed by physician. | Severity: 2 Scope: 3 |
| Failure to administer PRN medications as prescribed for 3 of 5 residents due to unavailability. | Severity: 2 Scope: 3 |
| Failure to ensure medications were prescribed for maintenance level administration for 1 of 4 residents. | Severity: 2 Scope: 2 |
| Failure to ensure medications were kept secured; unsecured medications found in resident rooms. | Severity: 2 Scope: 3 |
Report Facts
Resident census: 6
Licensed capacity: 6
Residents reviewed: 6
Employee files reviewed: 5
Residents with unavailable PRN medications: 3
Residents with maintenance medication not prescribed: 1
Residents with unsecured medications: 1
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 3
Jan 8, 2013
Visit Reason
This document is an annual State Licensure inspection conducted on 1/8/2013 to assess compliance with state regulations for Mystic Haven, a residential facility for group beds for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A but was found deficient in medication administration and storage practices, including failure to have PRN medications available for some residents, improper administration instructions, and unsecured medications in resident rooms.
Severity Breakdown
Level 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility unable to administer PRN medications as prescribed for 3 of 5 residents due to unavailability of medications. | Level 2 |
| Failure to ensure medications were not prescribed for maintenance level administration for 1 of 4 residents. | Level 2 |
| Medications were not stored securely; unsecured medications found in resident rooms including pre-poured medication cups and unsecured medication bottles. | Level 2 |
Report Facts
Residents present: 6
Total licensed capacity: 6
Residents with unavailable PRN medications: 3
Residents reviewed: 6
Employee files reviewed: 5
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 5
Jan 4, 2012
Visit Reason
This document is the result of an annual State Licensure survey conducted at the facility on 01/04/2012 to assess compliance with regulatory requirements.
Findings
The facility received a grade of A. Several deficiencies were identified including uncovered garbage containers, failure to prohibit smoking in oxygen storage areas, unsecured oxygen tanks, and failure to keep resident files locked securely.
Severity Breakdown
1: 2
2: 2
Deficiencies (5)
| Description | Severity |
|---|---|
| Containers used to store garbage outside of the facility were not kept reasonably clean and covered, allowing potential rodent access. | 1 |
| The facility failed to prohibit smoking in areas where oxygen is in use or being stored, including the garage used as a storage room for oxygen tanks and designated smoking area. | 2 |
| The facility failed to secure 2 of 8 oxygen tanks in a rack or to the wall. | 2 |
| The facility failed to ensure the files for 5 of 5 residents were kept in a locked place; the file cabinet lock was left unlocked. | 1 |
| The caregivers failed to monitor resident ability to operate oxygen equipment as required. | — |
Report Facts
Census: 5
Total Capacity: 6
Severity 1 Deficiencies: 2
Severity 2 Deficiencies: 2
Scope 3 Deficiencies: 2
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 4
Jan 4, 2012
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at the facility on 1/4/12.
Findings
The facility received a grade of A but was found deficient in several areas including uncovered garbage containers, failure to prohibit smoking in oxygen storage areas, unsecured oxygen tanks, and unlocked resident files.
Severity Breakdown
1: 2
2: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure that garbage containers were covered. | 1 |
| Failed to prohibit smoking in areas of the facility where oxygen is in use or being stored (garage used as storage and smoking area). | 2 |
| Failed to secure 2 of 8 oxygen tanks in a rack or to the wall. | 2 |
| Failed to ensure the files for 5 of 5 residents were kept in a locked place (file cabinet left unlocked). | 1 |
Report Facts
Resident files reviewed: 5
Employee files reviewed: 3
Oxygen tanks observed: 8
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 3
Feb 15, 2011
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at the facility on 02/15/2011.
Findings
The facility received a grade of A. Deficiencies were identified related to personnel background checks, use of restraints, and medication storage, with severity levels noted for each deficiency.
Severity Breakdown
Severity: 2: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Personnel File - Background Check: Facility failed to ensure 1 of 3 employees met background check requirements (missing complete set of fingerprints). | — |
| Restriction on Use of Restraints: Facility failed to ensure 1 of 5 residents was not restrained with full side bed rails as required. | Severity: 2 |
| Medication Storage: Facility failed to keep medications for 1 of 5 residents in a locked area; Resident #3 had medications not stored in a lock box. | Severity: 2 |
Report Facts
Residents reviewed: 5
Employee files reviewed: 3
Licensed capacity: 6
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