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California CDPH state citations and administrative penalties, 1997 to early 2024 (archived dataset). Separate from federal CMS deficiencies.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G1 | H· | I· |
| Potential harm | D67 | E19 | F10 |
| Minimal | A· | B1 |
CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.
Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.
| Date | Domain | Survey types | Citations | Most severe | Open | |
|---|---|---|---|---|---|---|
| Jun 11, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| May 5, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 2, 2026 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Mar 12, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 26, 2026 | Fire safety | Fire Safety Standard | 8 | Potential harm | — | Open → |
| Feb 26, 2026 | Health | Health Standard | 13 | Potential harm | — | Open → |
| Dec 16, 2025 | Health | Health Complaint | 1 | Actual harm | — | Open → |
| Nov 24, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jul 18, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| May 12, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 24, 2025 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Apr 10, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 3, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 26, 2025 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Feb 4, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Dec 26, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 27, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 8, 2024 | Fire safety | Fire Safety Standard | 18 | Potential harm | — | Open → |
| Nov 8, 2024 | Health | Health Complaint, Health Standard | 16 | Potential harm | — | Open → |
| Sep 5, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 18, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 6, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 26, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 24, 2024 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Jan 20, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 29, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 14, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Oct 30, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Oct 29, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 9, 2023 | Fire safety | Fire Safety Standard | 6 | Potential harm | — | Open → |
| Jun 9, 2023 | Health | Health Standard | 13 | Potential harm | — | Open → |
| Issued | Class | Type | Category | Final amount | Flags | Record |
|---|---|---|---|---|---|---|
| May 17, 2024 violation Apr 20, 2024 | Class B | Citation Citation B (HSC 1424) | Abuse/Facility Not Self Reported | $3,000 | Closed | 030020196 |
| Sep 5, 2018 violation Jul 29, 2018 | Class B | Citation Citation B (HSC 1424) | Abuse/Facility Not Self Reported | $2,000 | Closed | 030014381 |
| Mar 15, 2018 violation Dec 22, 2015 | Class B | Citation Citation A (HSC 1424) | Patient Care | $15,000 | Death related |
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G1 | H· | I· |
| Potential harm | D67 | E19 | F10 |
| Minimal | A· | B1 | C5 |
| Date | Tag | Deficiency | Scope / severity | Correction | Flags |
|---|---|---|---|---|---|
| Jun 11, 2026 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jun 25, 2026 | Complaint |
| May 5, 2026 | F-0850 | Hire a qualified full-time social worker in a facility with more than 120 beds. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected May 20, 2026 | Complaint |
“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.
CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.
CMS legal business name of the certified provider. Operates this facility only.
13 facilities in 1 states. CMS chain ID 175.
Chain average overall rating (CMS): 4
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Dyan Agbunag | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Jan 27, 2025 |
| Chandandeep Cheema | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2023 |
| Matthew Jackson | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Sep 29, 2023 |
| Robert Jackson | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Sep 29, 2023 |
| Benjamin Tuifua | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Sep 29, 2023 |
| Matthew Jackson | Individual |
| Facility | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|
| Sherwood Healthcare Center 4700 Elvas Ave, Sacramento, CA 95819 CCN 055305 | 62 | May 9, 2025 | 47 | — | |
| Saylor Lane Healthcare Center 3500 Folsom Boulevard, Sacramento, CA 95816 CCN 055417 | 42 |
Coordinates as published by CMS.
| Facility | Distance | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|---|
| Acc Care Center 7801 Rush River Drive, Sacramento, CA 95831 CCN 5552611 state class AA/A | 2.6 km | 99 | Aug 13, 2026 | 57 | $24k | |
| Cedarwood Post Acute 1090 Rio Lane, Sacramento, CA 95822 CCN 0552964 state class AA/A | 3.4 km | 51 | Jun 17, 2026 | 76 | — | |
| Capital Post Acute 6821 24th Street, Sacramento, CA 95822 CCN 5554423 state class AA/AAbuse icon | 5.2 km | 121 | Aug 26, 2026 | 112 | — | |
| Double Tree Post Acute Care Center 7400 24th Street, Sacramento, CA 95822 CCN 0561773 state class AA/AAbuse icon | 5.6 km | 122 | Jan 23, 2026 | 801 IJ | $11k | |
| River Bend Nursing Center 2215 Oakmont Way, West Sacramento, CA 95691 CCN 0558875 state class AA/A | 7.8 km | 99 | Jul 30, 2026 | 691 harm | $22k | |
| Pioneer House 415 P Street, Sacramento, CA 95814 CCN 5555424 state class AA/A | 8.5 km | 50 | Jun 3, 2026 | 921 harm4 open | — | |
| Bridgewood Post Acute 5901 Lemon Hill Avenue, Sacramento, CA 95824 CCN 0559562 state class AA/AAbuse icon | 8.8 km | 49 | Jul 10, 2026 | 1021 harm | — | |
| University Post-Acute Rehab 2120 Stockton Boulevard, Sacramento, CA 95817 CCN 5552651 state class AA/A | 9.1 km | 59 | May 22, 2025 | 50 | — |
| Source | Record | Facts | Evidence | Source release | Retrieved |
|---|---|---|---|---|---|
| CMS Provider Information US-CMS | 555098 | name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 555098 | ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only. | Verified | Oct 1, 2026 | Nov 7, 2026 |
| California CDPH Licensed Facility Listing CA | 100000057 | state_license, licensed_beds, licensee Linked to the CMS record by exact CCN. | Verified | Oct 16, 2026 | Nov 7, 2026 |
First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction
| 030013908 |
| Oct 27, 2017 violation Oct 15, 2015 | Class B | Citation Citation B (HSC 1424) | Patient Care | $2,000 | Closed | 030013565 |
| Mar 12, 2013 violation May 13, 2010 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 030009780 |
| Feb 16, 2012 violation May 13, 2009 | Class B | Citation Citation B (HSC 1424) | Abuse/Facility Not Self Reported | $800 | Closed | 030009010 |
| Feb 16, 2012 violation May 1, 2009 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $1,000 | Closed | 030009009 |
| Apr 1, 2010 violation Mar 13, 2008 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 030007099 |
| Jun 2, 2005 violation Mar 6, 2005 | Class B | Citation Citation B (HSC 1424) | Patient Care | $800 | Closed | 100002294 |
| Dec 17, 2003 violation Nov 16, 2003 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $900 | Appealed Closed | 100002247 |
| Apr 3, 2003 violation Oct 31, 2002 | Class B | Citation Citation B (HSC 1424) | Patient Care | $250 initial $800 | Appealed Closed | 100002212 |
| Feb 15, 2002 violation Nov 3, 2001 | Class A | Citation Citation A (HSC 1424) | Patient Care | $0 initial $18,000 | Appealed Closed | 100002134 |
| Feb 1, 2002 violation Jul 15, 2000 | Class B | Citation Citation B (HSC 1424) | Patient Care | $900 | Closed | 100002133 |
| Jan 17, 2002 violation Dec 29, 2001 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $800 | Closed | 100002131 |
| Sep 6, 2001 violation Jul 28, 2000 | Class B | Citation Citation B (HSC 1424) | Patient Care | $600 initial $800 | Appealed Closed | 100002103 |
| Jun 6, 2001 violation Jan 3, 2001 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 100002079 |
| Aug 23, 2000 violation Jun 6, 2000 | Class B | Citation Citation A (HSC 1424) | Other · NEGLECT/ABUSE | $6,000 initial $8,000 | Appealed Closed | 100002034 |
| Jun 29, 2000 violation Dec 3, 1999 | Class B | Citation Citation B (HSC 1424) | Patient Care | $500 initial $1,000 | Appealed Closed | 100002028 |
| Jun 29, 2000 violation Dec 1, 1999 | Class B | Citation Citation A (HSC 1424) | Patient Care | $1,000 initial $10,000 | Appealed Closed | 100002027 |
| May 17, 2000 violation Apr 9, 2000 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 100002018 |
| Apr 2, 2026 | F-0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 23, 2026 | Complaint |
| Apr 2, 2026 | F-0694 | Provide for the safe, appropriate administration of IV fluids for a resident when needed. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 23, 2026 | Complaint |
| Mar 12, 2026 | F-0627 | Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Apr 1, 2026 | Complaint |
| Feb 26, 2026 | K-0161 | Use approved construction type or materials. Construction Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 25, 2026 |
| Feb 26, 2026 | K-0211 | Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 11, 2026 |
| Feb 26, 2026 | K-0342 | Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 6, 2026 |
| Feb 26, 2026 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 25, 2026 |
| Feb 26, 2026 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 25, 2026 |
| Feb 26, 2026 | K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 25, 2026 |
| Feb 26, 2026 | K-0521 | Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Services Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Apr 6, 2026 |
| Feb 26, 2026 | K-0920 | Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 25, 2026 |
| Feb 26, 2026 | F-0578 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0600 | 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 · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0685 | Assist a resident in gaining access to vision and hearing services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0760 | Ensure that residents are free from significant medication errors. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0805 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0813 | Have a policy regarding use and storage of foods brought to residents by family and other visitors. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Feb 26, 2026 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Mar 20, 2026 |
| Dec 16, 2025 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | G · Actual harm Isolated | Corrected Jan 14, 2026 | Complaint |
| Nov 24, 2025 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 18, 2025 | Complaint |
| Jul 18, 2025 | F-0600 | 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 · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Aug 19, 2025 | Complaint |
| May 12, 2025 | F-0600 | 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 · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected May 27, 2025 | Complaint |
| Apr 24, 2025 | F-0600 | 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 · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected May 20, 2025 | Complaint |
| Apr 24, 2025 | F-0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected May 20, 2025 | Complaint |
| Apr 10, 2025 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 11, 2025 | Complaint |
| Apr 3, 2025 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 15, 2025 | Complaint |
| Feb 26, 2025 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 14, 2025 | Complaint |
| Feb 26, 2025 | F-0688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 14, 2025 | Complaint |
| Feb 4, 2025 | F-0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Feb 6, 2025 | Complaint |
| Dec 26, 2024 | F-0551 | Give the resident's representative the ability to exercise the resident's rights. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jan 24, 2025 | Complaint |
| Nov 27, 2024 | F-0610 | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 3, 2024 | Complaint |
| Nov 8, 2024 | E-0009 | Include a process for Emergency Preparedness collaboration. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Dec 10, 2024 |
| Nov 8, 2024 | E-0024 | Establish policies and procedures for volunteers. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Nov 23, 2024 |
| Nov 8, 2024 | E-0026 | Establish roles under a Waiver declared by secretary. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Nov 16, 2024 |
| Nov 8, 2024 | E-0034 | Provide a means of sharing information on occupancy/needs. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Nov 16, 2024 |
| Nov 8, 2024 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Nov 25, 2024 |
| Nov 8, 2024 | K-0211 | Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 22, 2024 |
| Nov 8, 2024 | K-0223 | Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 14, 2024 |
| Nov 8, 2024 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 19, 2024 |
| Nov 8, 2024 | K-0321 | Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Nov 8, 2024 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Dec 4, 2024 |
| Nov 8, 2024 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Dec 5, 2024 |
| Nov 8, 2024 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Nov 8, 2024 | K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Nov 14, 2024 |
| Nov 8, 2024 | K-0920 | Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 13, 2024 |
| Nov 8, 2024 | F-0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0600 | 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 · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 6, 2024 | Complaint |
| Nov 8, 2024 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0676 | 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 · Clinical care | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0805 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Administration Deficiencies · Administration & records | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Dec 6, 2024 |
| Nov 8, 2024 | F-0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Dec 6, 2024 |
| Nov 8, 2024 | E-0015 | Address subsistence needs for staff and patients. Emergency Preparedness Deficiencies · Emergency preparedness | C · Minimal Widespread | Corrected Nov 17, 2024 |
| Nov 8, 2024 | E-0032 | Provide primary/alternate means for communication. Emergency Preparedness Deficiencies · Emergency preparedness | C · Minimal Widespread | Corrected Nov 16, 2024 |
| Nov 8, 2024 | K-0324 | Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 16, 2024 |
| Nov 8, 2024 | K-0351 | Install an approved automatic sprinkler system. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 21, 2024 |
| Sep 5, 2024 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Sep 6, 2024 | Complaint |
| Jun 18, 2024 | F-0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jun 27, 2024 | Complaint |
| Jun 6, 2024 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jun 25, 2024 | Complaint |
| Apr 26, 2024 | F-0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected May 23, 2024 | Complaint |
| Apr 24, 2024 | F-0557 | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected May 15, 2024 | Complaint |
| Apr 24, 2024 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected May 15, 2024 | Complaint |
| Jan 20, 2024 | F-0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jan 25, 2024 | Complaint |
| Nov 29, 2023 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Dec 7, 2023 | Complaint |
| Nov 14, 2023 | F-0607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Nov 28, 2023 | Complaint |
| Oct 30, 2023 | F-0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Nov 8, 2023 | Complaint |
| Oct 29, 2023 | F-0741 | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 10, 2023 | Complaint |
| Jun 9, 2023 | K-0161 | Use approved construction type or materials. Construction Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jun 26, 2023 |
| Jun 9, 2023 | K-0222 | Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jun 26, 2023 |
| Jun 9, 2023 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jun 26, 2023 |
| Jun 9, 2023 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jun 26, 2023 |
| Jun 9, 2023 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jun 26, 2023 |
| Jun 9, 2023 | F-0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0637 | Assess the resident when there is a significant change in condition Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0802 | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Jul 12, 2023 |
| Jun 9, 2023 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Jul 12, 2023 |
| Jun 9, 2023 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Jun 26, 2023 |
| Jun 9, 2023 | F-0847 | Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Administration Deficiencies · Administration & records | B · Minimal Pattern | Corrected Jul 12, 2023 |
Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 4.89 (case-mix index 1.30).
| Corporate officer / director |
| CORPORATE OFFICER |
| not provided |
| Sep 29, 2023 |
| Robert Jackson | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Sep 29, 2023 |
| Jack Sanofsky | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Sep 29, 2023 |
| Dyan Agbunag | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Jan 27, 2025 |
| Chandandeep Cheema | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 1, 2023 |
| Matthew Jackson | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Sep 29, 2023 |
| Robert Jackson | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Sep 29, 2023 |
| Benjamin Tuifua | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Sep 29, 2023 |
| May 8, 2025 |
80 |
| — |
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