Loading facility…
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 | G4 | H· | I· |
| Potential harm | D62 | E27 | F25 |
| Minimal | A· | B· |
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 | |
|---|---|---|---|---|---|---|
| Jul 9, 2026 | Fire safety | Fire Safety Standard | 9 | Potential harm | — | Open → |
| Jul 9, 2026 | Health | Health Standard | 7 | Potential harm | — | Open → |
| Feb 4, 2026 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Jul 14, 2025 | Health | Health Complaint | 3 | Actual harm | — | Open → |
| Mar 13, 2025 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Mar 12, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jan 24, 2025 | Fire safety | Fire Safety Standard | 17 | Potential harm | — | Open → |
| Jan 24, 2025 | Health | Health Complaint, Health Standard | 19 | Actual harm | — | Open → |
| Jan 15, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 21, 2024 | Health | Health Complaint | 3 | Potential harm | — | Open → |
| Aug 27, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 3, 2024 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| May 28, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 9, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jan 30, 2024 | Fire safety | Fire Safety Standard | 17 | Potential harm | — | Open → |
| Jan 30, 2024 | Health | Health Standard | 22 | Potential harm | — | Open → |
| Jan 18, 2024 | Health | Health Complaint | 6 | Potential harm | — | Open → |
| Nov 29, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 28, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Oct 9, 2023 | Health | Health Complaint | 1 | Actual harm | — | Open → |
| Oct 6, 2023 | Health | Health Complaint | 7 | Potential harm | — | Open → |
| Date | Type | Amount | Payment denial | Record |
|---|---|---|---|---|
| Jul 14, 2025 | Civil money penalty (fine) | $12,438 | — | 555304|Fine|134997 |
| Jan 15, 2025 | Denial of payment for new admissions | — | Feb 21, 2025 · 27 days | 555304|Payment Denial|2025-02-21 |
| Jan 15, 2025 | Civil money penalty (fine) | $49,387 | — | 555304|Fine|131095 |
| Issued | Class | Type | Category | Final amount | Flags | Record |
|---|---|---|---|---|---|---|
| Feb 7, 2023 violation Nov 29, 2020 | AP NHPPD | Administrative Penalty AP - 3.2 Nursing-Hours-per-Patient-Day AP (HSC 1276.5) | DHPPD: 1 Day (No Penalty) | $0 | Closed | 810018475 |
| Dec 15, 2021 violation Oct 1, 2019 | AP NHPPD | Administrative Penalty AP - 3.2 Nursing-Hours-per-Patient-Day AP (HSC 1276.5) | DHPPD: 12 - 24 Days | $30,000 | Closed | 810017163 |
| Aug 13, 2019 violation Oct 1, 2017 | AP NHPPD | Administrative Penalty AP - 3.2 Nursing-Hours-per-Patient-Day AP (HSC 1276.5) | DHPPD: 2 - 11 Days | $15,000 | Closed | 170015279 |
| Jun 15, 2015 |
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G4 | H· | I· |
| Potential harm | D62 | E27 | F25 |
| Minimal | A· | B· | C6 |
| Date | Tag | Deficiency | Scope / severity | Correction | Flags |
|---|---|---|---|---|---|
| Jul 9, 2026 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jul 15, 2026 | |
| Jul 9, 2026 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jul 22, 2026 | |
| Jul 9, 2026 | K-0353 |
“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.
277 facilities in 16 states. CMS chain ID 690.
Chain average overall rating (CMS): 3
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Lakeport Chico Master Tenant LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | Apr 1, 2018 |
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Lakeport Chico Master Tenant LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | Apr 1, 2018 |
| Frederick Apt | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jan 1, 2024 |
| Mark Hancock | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jan 1, 2024 |
| Joshua Jergensen | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jan 1, 2024 |
| John Mitchell |
| Facility | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|
| Redlands Healthcare Center 1620 W Fern Ave, Redlands, CA 92373 CCN 0550011 state class AA/A | 78 | Apr 23, 2026 | 23 | — | |
| Pleasant Hill Post Acute 1625 Oak Park Boulevard, Pleasant Hill, CA 94523 CCN 055049 |
Coordinates as published by CMS.
| Facility | Distance | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|---|
| California Park Post Acute 2850 Sierra Sunrise Terrace, Chico, CA 95928 CCN 5556252 state class AA/A | 2.1 km | 90 | Jul 13, 2026 | 551 harm | — | |
| Chico Terrace Care Center 188 Cohasset Lane, Chico, CA 95926 CCN 055516 | 4.6 km | 76 | Jan 21, 2026 | 72 | $35k | |
| Oakwood Healthcare Center 375 Cohasset Rd, Chico, CA 95926 CCN 0556561 state class AA/AAbuse icon | 4.7 km | 99 | Aug 10, 2026 | 1301 IJ3 harm | $56k | |
| Autumn Creek Post Acute 587 Rio Lindo Avenue, Chico, CA 95926 CCN 0560746 state class AA/AAbuse icon | 4.8 km | 184 | Aug 11, 2026 | 1084 harm | $107k |
| Source | Record | Facts | Evidence | Source release | Retrieved |
|---|---|---|---|---|---|
| CMS Provider Information US-CMS | 555304 | name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 555304 | 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 | 230000255 | 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
| Class A |
| Citation Citation A (HSC 1424) |
| Patient Care |
| $10,000 |
| Death related Closed |
| 230010660 |
| Jun 15, 2015 violation Feb 3, 2014 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $2,000 | Closed | 230010658 |
| Mar 28, 2014 violation Dec 30, 2012 | Class B | Citation Citation B (HSC 1424) | Patient Care | $2,000 | Closed | 230009692 |
| Apr 8, 2013 violation May 13, 2011 | Class B | Citation Citation B (HSC 1424) | Patient Care | $2,000 | Closed | 230009415 |
| Jun 7, 2012 violation Apr 12, 2012 | Class B | Citation Citation B (HSC 1424) | Problem Transfer | $1,000 | Closed | 230009230 |
| Jun 29, 2011 violation May 13, 2011 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 230008331 |
| Apr 26, 2011 violation Feb 15, 2009 | Class B | Citation Citation B (HSC 1424) | Patient Care | $650 initial $1,000 | Appealed Closed | 230008191 |
| Apr 12, 2011 violation Nov 7, 2010 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,000 | Closed | 230008132 |
| Nov 9, 2010 violation Apr 6, 2010 | Class A | Citation Citation A (HSC 1424) | Patient Care | $10,000 initial $20,000 | Appealed Closed | 230007702 |
| May 19, 2010 violation Apr 1, 2010 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $1,000 | Appealed Closed | 230007222 |
| May 28, 2009 violation Mar 30, 2009 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $1,950 initial $1,000 | Appealed Closed | 230006218 |
| May 28, 2009 violation Feb 19, 2009 | Class B | Citation Citation B (HSC 1424) | Patient Care | $1,950 initial $1,000 | Appealed Closed | 230006217 |
| Jan 30, 2009 violation Dec 17, 2008 | Class B | Citation Citation B (HSC 1424) | Patient Care | $650 initial $1,000 | Appealed Closed | 230005832 |
| Dec 29, 2008 violation Nov 9, 2008 | Class B | Citation Citation B (HSC 1424) | Patient Care | $500 initial $1,000 | Appealed Closed | 230005731 |
| Aug 7, 2008 violation Jul 6, 2008 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $650 initial $1,000 | Appealed Closed | 230005301 |
| Jun 13, 2008 violation May 30, 2008 | Class B | Citation Citation B (HSC 1424) | Other · REPORTING | $2,000 initial $1,000 | Appealed Closed | 230005134 |
| Feb 21, 2008 violation Dec 7, 2007 | Class AA | Citation Citation AA (HSC 1424) | Patient Care | $65,000 initial $100,000 | Death relatedAppealed Closed | 230004700 |
| Dec 5, 2007 violation Nov 1, 2007 | Class B | Citation Citation B (HSC 1424) | Administration | $500 initial $750 | Appealed Closed | 230004474 |
| Dec 5, 2007 violation Aug 17, 2007 | Class B | Citation Citation B (HSC 1424) | Patient Care | $500 initial $750 | Appealed Closed | 230004473 |
| Jul 11, 2007 violation Jun 2, 2006 | Class B | Citation Citation B (HSC 1424) | Staffing | $500 initial $1,000 | Appealed Closed | 230004069 |
| Jun 6, 2007 violation Feb 5, 2007 | Class B | Citation Citation B (HSC 1424) | Administration | $600 initial $750 | Appealed Closed | 230004000 |
| Jun 7, 2006 violation May 8, 2006 | Class B | Citation Citation B (HSC 1424) | Staffing | $650 initial $1,000 | Appealed Closed | 230003138 |
| Feb 22, 2005 violation Jun 17, 2004 | Class B | Citation Citation B (HSC 1424) | Staffing | $500 initial $1,000 | Appealed Closed | 230001127 |
| Feb 22, 2005 violation Jun 18, 2004 | Class B | Citation Citation B (HSC 1424) | Patient Care | $600 initial $1,000 | Appealed Closed | 230001126 |
| Oct 8, 2003 violation Jul 18, 2003 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $750 initial $1,000 | Appealed Closed | 230001060 |
| Mar 28, 2002 violation Nov 26, 2001 | Class A | Citation Citation A (HSC 1424) | Patient Care | $0 initial $20,000 | Appealed Closed | 230000979 |
| Mar 28, 2002 violation Nov 7, 2001 | Class A | Citation Citation A (HSC 1424) | Patient Care | $25,000 initial $18,000 | Appealed Closed | 230000978 |
| Mar 27, 2002 violation Dec 21, 2001 | Class A | Citation Citation A (HSC 1424) | Patient Care | $15,300 initial $18,000 | Appealed Closed | 230000977 |
| Jan 17, 2002 violation Nov 10, 2001 | Class A | Citation Citation A (HSC 1424) | Patient Care | $15,300 initial $18,000 | Appealed Closed | 230000964 |
| Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety |
| D · Potential harm Isolated |
| Corrected Jul 22, 2026 |
| Jul 9, 2026 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jul 22, 2026 |
| Jul 9, 2026 | K-0741 | Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jul 22, 2026 |
| Jul 9, 2026 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jul 22, 2026 |
| Jul 9, 2026 | K-0919 | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jul 22, 2026 |
| Jul 9, 2026 | K-0920 | Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jul 22, 2026 |
| Jul 9, 2026 | 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 Jul 27, 2026 |
| Jul 9, 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 | D · Potential harm Isolated | Corrected Jul 28, 2026 |
| Jul 9, 2026 | F-0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Jul 16, 2026 |
| Jul 9, 2026 | 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 | D · Potential harm Isolated | Corrected Jul 24, 2026 |
| Jul 9, 2026 | F-0803 | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Jul 22, 2026 |
| Jul 9, 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 Jul 22, 2026 |
| Jul 9, 2026 | F-0814 | Dispose of garbage and refuse properly. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Jul 24, 2026 |
| Jul 9, 2026 | K-0712 | Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Jul 22, 2026 |
| Feb 4, 2026 | F-0558 | Reasonably accommodate the needs and preferences of each resident. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Feb 6, 2026 | Complaint |
| Feb 4, 2026 | F-0825 | Provide or get specialized rehabilitative services as required for a resident. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Feb 6, 2026 | Complaint |
| Jul 14, 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 Aug 2, 2025 | Complaint |
| Jul 14, 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 2, 2025 | Complaint |
| Jul 14, 2025 | 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 Aug 2, 2025 | Complaint |
| Mar 13, 2025 | 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 18, 2025 | Complaint |
| Mar 13, 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 | E · Potential harm Pattern | Corrected Mar 18, 2025 | Complaint |
| Mar 12, 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 18, 2025 | Complaint |
| Jan 24, 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 Mar 18, 2025 |
| Jan 24, 2025 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | G · Actual harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 2025 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Feb 27, 2025 |
| Jan 24, 2025 | K-0352 | Properly install and monitor supervisory attachments on automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Feb 14, 2025 |
| Jan 24, 2025 | 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 Feb 14, 2025 |
| Jan 24, 2025 | 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 Feb 27, 2025 |
| Jan 24, 2025 | K-0781 | Have restrictions on the use of portable space heaters. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 27, 2025 |
| Jan 24, 2025 | K-0919 | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 12, 2025 |
| Jan 24, 2025 | 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 Feb 27, 2025 |
| Jan 24, 2025 | 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 Feb 21, 2025 |
| Jan 24, 2025 | F-0558 | Reasonably accommodate the needs and preferences of each resident. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 2025 | 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 | E · Potential harm Pattern | Corrected Feb 21, 2025 |
| Jan 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 Feb 21, 2025 |
| Jan 24, 2025 | 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 Feb 21, 2025 |
| Jan 24, 2025 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 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 Feb 21, 2025 |
| Jan 24, 2025 | F-0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 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 Mar 18, 2025 |
| Jan 24, 2025 | 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 Mar 20, 2025 |
| Jan 24, 2025 | F-0730 | Observe each nurse aide's job performance and give regular training. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 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 | E · Potential harm Pattern | Corrected Feb 21, 2025 | Complaint |
| Jan 24, 2025 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 2025 | 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 Feb 21, 2025 |
| Jan 24, 2025 | 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 | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 2025 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Feb 21, 2025 |
| Jan 24, 2025 | F-0926 | Have policies on smoking. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 21, 2025 |
| Jan 24, 2025 | K-0291 | Install emergency lighting that can last at least 1 1/2 hours. Egress Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Feb 14, 2025 |
| Jan 24, 2025 | K-0346 | Follow proper procedures when the fire alarm was out of service for more than 4 hours. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Feb 6, 2025 |
| Jan 24, 2025 | K-0354 | Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Feb 6, 2025 |
| Jan 24, 2025 | K-0712 | Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Feb 14, 2025 |
| Jan 15, 2025 | F-0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Jan 28, 2025 | Complaint |
| Nov 21, 2024 | F-0552 | Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 13, 2024 | Complaint |
| Nov 21, 2024 | F-0559 | Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 13, 2024 | Complaint |
| Nov 21, 2024 | F-0576 | Ensure residents have reasonable access to and privacy in their use of communication methods. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Nov 29, 2024 | Complaint |
| Aug 27, 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 | E · Potential harm Pattern | Corrected Sep 27, 2024 | Complaint |
| Jun 3, 2024 | F-0552 | Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jun 23, 2024 | Complaint |
| Jun 3, 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 Jun 23, 2024 | Complaint |
| May 28, 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 | E · Potential harm Pattern | Corrected Jun 10, 2024 | Complaint |
| Apr 9, 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 Apr 18, 2024 | Complaint |
| Jan 30, 2024 | E-0004 | Develop and maintain an Emergency Preparedness Program (EP). Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | E-0015 | Address subsistence needs for staff and patients. Emergency Preparedness Deficiencies · Emergency preparedness | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | E-0030 | List the names and contact information of those in the facility. Emergency Preparedness Deficiencies · Emergency preparedness | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | E-0032 | Provide primary/alternate means for communication. Emergency Preparedness Deficiencies · Emergency preparedness | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0161 | Use approved construction type or materials. Construction Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0211 | Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | 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 20, 2024 |
| Jan 30, 2024 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0347 | Properly provide smoke detection systems in areas open to corridors. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0741 | Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Miscellaneous Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 20, 2024 |
| Jan 30, 2024 | K-0919 | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 20, 2024 |
| Jan 30, 2024 | 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 20, 2024 |
| Jan 30, 2024 | F-0559 | Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0565 | Honor the resident's right to organize and participate in resident/family groups in the facility. Resident Rights Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 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 | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 2024 | 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 | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 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 | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0679 | Provide activities to meet all resident's needs. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 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 Feb 21, 2024 |
| Jan 30, 2024 | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Feb 21, 2024 |
| Jan 30, 2024 | 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 Feb 21, 2024 |
| Jan 30, 2024 | F-0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Nursing and Physician Services Deficiencies · Staffing & supervision | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0727 | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Feb 21, 2024 |
| Jan 30, 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 | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Feb 21, 2024 |
| Jan 30, 2024 | 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 | F · Potential harm Widespread | Corrected Feb 21, 2024 |
| Jan 30, 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 Feb 21, 2024 |
| Jan 30, 2024 | 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 Feb 21, 2024 |
| Jan 30, 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 Feb 21, 2024 |
| Jan 30, 2024 | F-0865 | Have a plan that describes the process for conducting QAPI and QAA activities. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0908 | Keep all essential equipment working safely. Environmental Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Feb 21, 2024 |
| Jan 30, 2024 | F-0919 | Make sure that a working call system is available in each resident's bathroom and bathing area. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 21, 2024 |
| Jan 18, 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 Jan 30, 2024 | Complaint |
| Jan 18, 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 Jan 30, 2024 | Complaint |
| Jan 18, 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 Jan 30, 2024 | Complaint |
| Jan 18, 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 | E · Potential harm Pattern | Corrected Feb 20, 2024 | Complaint |
| Jan 18, 2024 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Feb 5, 2024 | Complaint |
| Jan 18, 2024 | F-0745 | Provide medically-related social services to help each resident achieve the highest possible quality of life. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Feb 20, 2024 | Complaint |
| Nov 29, 2023 | F-0660 | Plan the resident's discharge to meet the resident's goals and needs. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 14, 2023 | Complaint |
| Nov 28, 2023 | 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 13, 2023 | Complaint |
| Oct 9, 2023 | 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 | G · Actual harm Isolated | Corrected Oct 9, 2023 | Complaint |
| Oct 6, 2023 | 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 | E · Potential harm Pattern | Corrected Oct 6, 2023 | Complaint |
| Oct 6, 2023 | F-0727 | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Nursing and Physician Services Deficiencies · Staffing & supervision | E · Potential harm Pattern | Corrected Oct 20, 2023 | Complaint |
| Oct 6, 2023 | 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 Oct 20, 2023 | Complaint |
| Oct 6, 2023 | F-0835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Oct 6, 2023 | Complaint |
| Oct 6, 2023 | F-0837 | Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Oct 17, 2023 | Complaint |
| Oct 6, 2023 | F-0865 | Have a plan that describes the process for conducting QAPI and QAA activities. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Oct 20, 2023 | Complaint |
| Oct 6, 2023 | F-0908 | Keep all essential equipment working safely. Environmental Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Oct 6, 2023 | Complaint |
Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 3.24 (case-mix index 1.75).
| Individual |
| Corporate officer / director |
| CORPORATE OFFICER |
| not provided |
| Jan 1, 2024 |
| Charles Garretson | Individual | Managing employee | CONTRACTED MANAGING EMPLOYEE | not provided | Nov 20, 2023 |
| Jessica Johnson | Individual | Managing employee | W-2 MANAGING EMPLOYEE | not provided | Jul 11, 2024 |
| 51 |
| Jul 6, 2026 |
51 |
| — |
| Cottonwood Canyon Healthcare Center 1391 Madison Avenue, El Cajon, CA 92021 CCN 055064 | 96 | Aug 26, 2026 | 781 harm | $9,255 |
| Moraga Post Acute 348 Rheem Boulevard, Moraga, CA 94556 CCN 055085 | 49 | Apr 13, 2026 | 501 harm | — |
| Yuba City Post Acute 1220 Plumas St, Yuba City, CA 95991 CCN 0550921 state class AA/A | 59 | Apr 1, 2026 | 62 | — |
| Diablo Valley Post Acute 3806 Clayton Road, Concord, CA 94521 CCN 0551502 state class AA/AAbuse icon | 190 | Aug 13, 2026 | 763 harm | $102k |
| Garden City Healthcare Center 1310 West Granger, Modesto, CA 95350 CCN 0551852 state class AA/A | 104 | Aug 11, 2026 | 751 IJ2 harm | $35k |
| Oakwood Gardens Care Center 3510 East Shields, Fresno, CA 93726 CCN 055204 | 103 | Jul 2, 2026 | 71 | — |