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 | G· | H· | I· |
| Potential harm | D70 | E31 | F2 |
| 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 | |
|---|---|---|---|---|---|---|
| Aug 26, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Aug 14, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 12, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 29, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 24, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 20, 2026 | Fire safety | Fire Safety Standard | 11 | Potential harm | — | Open → |
| Feb 20, 2026 | Health | Health Complaint, Health Standard | 12 | Potential harm | — | Open → |
| Jan 28, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Dec 12, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Dec 10, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jun 20, 2025 | Fire safety | Fire Safety Complaint | 1 | Minimal | — | Open → |
| May 1, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 23, 2025 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Feb 4, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 7, 2024 | Fire safety | Fire Safety Standard | 13 | Potential harm | — | Open → |
| Nov 7, 2024 | Health | Health Standard | 16 | Potential harm | — | Open → |
| Oct 10, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Aug 6, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 12, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 4, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Mar 26, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Mar 22, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Mar 19, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 22, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 16, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 6, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Feb 1, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jan 29, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jan 18, 2024 | Health | Health Complaint | 3 | Potential harm | — | Open → |
| Jan 2, 2024 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Dec 6, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Nov 30, 2023 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Oct 16, 2023 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Sep 14, 2023 | Fire safety | Fire Safety Standard | 17 | Potential harm | — | Open → |
| Sep 14, 2023 | Health | Health Standard | 10 | Potential harm | — | Open → |
| Issued | Class | Type | Category | Final amount | Flags | Record |
|---|---|---|---|---|---|---|
| May 9, 2024 violation Mar 16, 2024 | Class B | Citation Citation B (HSC 1424) | Abuse/Facility Not Self Reported | $2,000 | Closed | 030020136 |
| Mar 29, 2023 violation Oct 12, 2021 | Class B | Citation Citation B (HSC 1424) | Patient Rights | $2,000 | Closed | 030018584 |
| Mar 29, 2023 violation Aug 15, 2019 | Class AA | Citation Citation AA (HSC 1424) | Patient Care | $100,000 | Death related |
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G· | H· | I· |
| Potential harm | D70 | E31 | F2 |
| Minimal | A· | B· | C9 |
| Date | Tag | Deficiency | Scope / severity | Correction | Flags |
|---|---|---|---|---|---|
| Aug 26, 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 Aug 29, 2026 | Complaint |
| Aug 14, 2026 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Sep 4, 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.
14 facilities in 1 states. CMS chain ID 703.
Chain average overall rating (CMS): 3.1
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Spyglass Healthcare LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 50% | Jun 1, 2023 |
| Amm Trust | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 25% | Jun 1, 2023 |
| Joshua Gastwirth | Individual | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 25% | Jun 1, 2023 |
| Ryan Mccormack | Individual | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 20% | Jun 1, 2023 |
| Brady O'shea | Individual | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 5% | Jun 1, 2023 |
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Spyglass Healthcare LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 50% | Jun 1, 2023 |
| Amm Trust | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 25% | Jun 1, 2023 |
| Joshua Gastwirth | Individual | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 25% | Jun 1, 2023 |
| Ryan Mccormack | Individual | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 20% | Jun 1, 2023 |
| Brady O'shea | Individual |
| Facility | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|
| Cedarwood Post Acute 1090 Rio Lane, Sacramento, CA 95822 CCN 0552964 state class AA/A | 51 | Jun 17, 2026 | 76 | — | |
| Camino Ridge Post-Acute 1949 Grant Road, Mountain View, CA 94040 CCN 055315 | 102 |
Coordinates as published by CMS.
| Facility | Distance | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|---|
| Double Tree Post Acute Care Center 7400 24th Street, Sacramento, CA 95822 CCN 0561773 state class AA/AAbuse icon | 1.6 km | 122 | Jan 23, 2026 | 801 IJ | $11k | |
| Bridgewood Post Acute 5901 Lemon Hill Avenue, Sacramento, CA 95824 CCN 0559562 state class AA/AAbuse icon | 3.8 km | 49 | Jul 10, 2026 | 1021 harm | — | |
| City Creek Post Acute 6248 66th Avenue, Sacramento, CA 95823 CCN 5551601 state class AA/A | 4.5 km | 99 | Jul 24, 2026 | 63 | — | |
| Cedarwood Post Acute 1090 Rio Lane, Sacramento, CA 95822 CCN 0552964 state class AA/A | 4.8 km | 51 | Jun 17, 2026 | 76 | — | |
| Acc Care Center 7801 Rush River Drive, Sacramento, CA 95831 CCN 5552611 state class AA/A | 4.8 km | 99 | Aug 13, 2026 | 57 | $24k | |
| Greenhaven Healthcare Center 455 Florin Road, Sacramento, CA 95831 CCN 5550981 state class AA/AAbuse icon | 5.2 km | 148 | Jun 11, 2026 | 1031 harm | — | |
| University Post-Acute Rehab 2120 Stockton Boulevard, Sacramento, CA 95817 CCN 5552651 state class AA/A | 6.4 km | 59 | May 22, 2025 | 50 | — | |
| Bruceville Terrace - D/P SNF of Methodist Hospital 8151 Bruceville Road, Sacramento, CA 95823 CCN 5553445 state class AA/AAbuse icon | 6.9 km | 171 | Aug 18, 2026 | 551 open | — |
| Source | Record | Facts | Evidence | Source release | Retrieved |
|---|---|---|---|---|---|
| CMS Provider Information US-CMS | 555442 | name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 555442 | 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 | 100000962 | 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
| 030018506 |
| Oct 1, 2007 violation Jul 24, 2007 | Class B | Citation Citation B (HSC 1424) | Patient Care | $800 | Closed | 030004294 |
| Dec 13, 2004 violation May 4, 2004 | Class A | Citation Citation AA (HSC 1424) | Patient Care | $100,000 initial $80,000 | Death relatedAppealed Closed | 100002280 |
| Jan 2, 2004 violation Apr 30, 2003 | Class B | Citation Citation B (HSC 1424) | Patient Care | $800 | Closed | 100002250 |
| Jun 4, 2002 violation Mar 29, 2002 | Class A | Citation Citation A (HSC 1424) | Patient Care | $16,238 initial $16,000 | Appealed Closed | 100002163 |
| Jun 12, 2026 | 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 6, 2026 | Complaint |
| Apr 29, 2026 | F-0925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected May 22, 2026 | Complaint |
| Feb 24, 2026 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Mar 13, 2026 | Complaint |
| Feb 20, 2026 | K-0324 | Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 13, 2026 |
| Feb 20, 2026 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 16, 2026 |
| Feb 20, 2026 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2026 |
| Feb 20, 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 Mar 16, 2026 |
| Feb 20, 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 | D · Potential harm Isolated | Corrected Mar 16, 2026 |
| Feb 20, 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 Mar 16, 2026 |
| Feb 20, 2026 | 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 Mar 13, 2026 |
| Feb 20, 2026 | K-0923 | Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 16, 2026 |
| Feb 20, 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 Feb 26, 2026 | Complaint |
| Feb 20, 2026 | F-0603 | Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Feb 26, 2026 |
| Feb 20, 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 Feb 26, 2026 |
| Feb 20, 2026 | 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 26, 2026 |
| Feb 20, 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 Feb 26, 2026 |
| Feb 20, 2026 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Feb 26, 2026 |
| Feb 20, 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 | D · Potential harm Isolated | Corrected Feb 26, 2026 |
| Feb 20, 2026 | F-0806 | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | D · Potential harm Isolated | Corrected Feb 26, 2026 |
| Feb 20, 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 Feb 26, 2026 |
| Feb 20, 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 26, 2026 |
| Feb 20, 2026 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Feb 26, 2026 |
| Feb 20, 2026 | 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 26, 2026 |
| Feb 20, 2026 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | C · Minimal Widespread | Corrected Mar 13, 2026 |
| Feb 20, 2026 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Mar 13, 2026 |
| Feb 20, 2026 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Mar 16, 2026 |
| Jan 28, 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 | E · Potential harm Pattern | Corrected Jan 29, 2026 | Complaint |
| Dec 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 Jan 8, 2026 | Complaint |
| Dec 10, 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 Dec 19, 2025 | Complaint |
| Jun 20, 2025 | K-0711 | Provide a written emergency evacuation plan. Miscellaneous Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Jul 3, 2025 | Complaint |
| May 1, 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 May 9, 2025 | Complaint |
| Apr 23, 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 May 9, 2025 | Complaint |
| Apr 23, 2025 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected May 9, 2025 | Complaint |
| Feb 4, 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 13, 2025 | Complaint |
| Nov 7, 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 Nov 22, 2024 |
| Nov 7, 2024 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0325 | Have properly installed hallway dispensers for alcohol-based hand rub. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Nov 27, 2024 |
| Nov 7, 2024 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0919 | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 22, 2024 |
| Nov 7, 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 Nov 22, 2024 |
| Nov 7, 2024 | F-0583 | Keep residents' personal and medical records private and confidential. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 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 Nov 30, 2024 |
| Nov 7, 2024 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 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 Nov 30, 2024 |
| Nov 7, 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 Nov 30, 2024 |
| Nov 7, 2024 | 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 Nov 30, 2024 |
| Nov 7, 2024 | F-0693 | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 2024 | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Nov 7, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 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 | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Nov 7, 2024 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Nov 7, 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 Nov 30, 2024 |
| Nov 7, 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 | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Nov 7, 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 Nov 30, 2024 |
| Nov 7, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Nov 7, 2024 | E-0015 | Address subsistence needs for staff and patients. Emergency Preparedness Deficiencies · Emergency preparedness | C · Minimal Widespread | Corrected Nov 22, 2024 |
| Nov 7, 2024 | E-0034 | Provide a means of sharing information on occupancy/needs. Emergency Preparedness Deficiencies · Emergency preparedness | C · Minimal Widespread | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0351 | Install an approved automatic sprinkler system. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 22, 2024 |
| Nov 7, 2024 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 22, 2024 |
| Nov 7, 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 | C · Minimal Widespread | Corrected Nov 22, 2024 |
| Oct 10, 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 Oct 21, 2024 | Complaint |
| Aug 6, 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 Aug 27, 2024 | Complaint |
| Apr 12, 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 Apr 22, 2024 | Complaint |
| Apr 4, 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 2, 2024 | Complaint |
| Mar 26, 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 Mar 28, 2024 | Complaint |
| Mar 22, 2024 | F-0573 | Let each resident or the resident's legal representative access or purchase copies of all the resident's records. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Apr 10, 2024 | Complaint |
| Mar 19, 2024 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Apr 17, 2024 | Complaint |
| Feb 22, 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 Mar 11, 2024 | Complaint |
| Feb 16, 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 Mar 11, 2024 | Complaint |
| Feb 6, 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 Feb 19, 2024 | Complaint |
| Feb 1, 2024 | 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 Feb 26, 2024 | Complaint |
| Jan 29, 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 | E · Potential harm Pattern | Corrected Feb 12, 2024 | Complaint |
| Jan 18, 2024 | 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 Feb 8, 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 Feb 8, 2024 | Complaint |
| Jan 18, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Feb 8, 2024 | Complaint |
| Jan 2, 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 Jan 17, 2024 | Complaint |
| Dec 6, 2023 | F-0760 | Ensure that residents are free from significant medication errors. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Dec 20, 2023 | Complaint |
| Nov 30, 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 Dec 10, 2023 | Complaint |
| Oct 16, 2023 | F-0675 | Honor each resident's preferences, choices, values and beliefs. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Oct 23, 2023 | Complaint |
| Oct 16, 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 | E · Potential harm Pattern | Corrected Oct 23, 2023 | Complaint |
| Sep 14, 2023 | K-0161 | Use approved construction type or materials. Construction Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0211 | Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0291 | Install emergency lighting that can last at least 1 1/2 hours. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | 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 Sep 22, 2023 |
| Sep 14, 2023 | K-0324 | Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0344 | Have an alternate power supply for its alarm system. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0347 | Properly provide smoke detection systems in areas open to corridors. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0711 | Provide a written emergency evacuation plan. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 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 | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | K-0919 | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Sep 22, 2023 |
| Sep 14, 2023 | 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 Sep 22, 2023 |
| Sep 14, 2023 | K-0923 | Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Sep 22, 2023 |
| Sep 14, 2023 | F-0583 | Keep residents' personal and medical records private and confidential. Resident Rights Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Oct 9, 2023 |
| Sep 14, 2023 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Oct 9, 2023 |
| Sep 14, 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 Oct 9, 2023 |
| Sep 14, 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 Oct 9, 2023 |
| Sep 14, 2023 | F-0692 | Provide enough food/fluids to maintain a resident's health. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Oct 9, 2023 |
| Sep 14, 2023 | 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 Oct 9, 2023 |
| Sep 14, 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 Oct 9, 2023 |
| Sep 14, 2023 | F-0808 | Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | E · Potential harm Pattern | Corrected Oct 9, 2023 |
| Sep 14, 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 | E · Potential harm Pattern | Corrected Oct 9, 2023 |
| Sep 14, 2023 | F-0925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Environmental Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Oct 9, 2023 |
Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 3.42 (case-mix index 1.63).
| Indirect owner |
| 5% OR GREATER INDIRECT OWNERSHIP INTEREST |
| 5% |
| Jun 1, 2023 |
| Oakwood Health LLC | Organization | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2022 |
| Spyglass Healthcare LLC | Organization | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2022 |
| Christa Bedrin | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2022 |
| Ka'lai Dillon | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Feb 3, 2025 |
| Sergio Gonzalez Ledesma | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2022 |
| Eric Guerrero | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 20, 2024 |
| Eric Lawrence | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Jan 1, 2024 |
| Danett Perkins | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Jan 8, 2024 |
| Elena Santos | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Jun 1, 2023 |
| Gregory Smith | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Nov 1, 2023 |
| Nicole Thornton | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Oct 20, 2023 |
| Remedios Ubaldo | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | May 1, 2022 |
| Nadia Vermeulen | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Apr 29, 2024 |
| Robert Brandi | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jun 1, 2023 |
| Ryan Mccormack | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jun 1, 2023 |
| Joshua Gastwirth | Individual | Trustee | TRUSTEE OF THE SNF | not provided | Jun 1, 2023 |
| Oakwood Health LLC | Organization | Additional disclosable party | ADP OF THE SNF | not provided | May 29, 2025 |
| Spyglass Healthcare LLC | Organization | Additional disclosable party | ADP OF THE SNF | not provided | May 29, 2025 |
| Christa Bedrin | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 1, 2022 |
| Ka'lai Dillon | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Feb 3, 2025 |
| Sergio Gonzalez Ledesma | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 1, 2022 |
| Eric Guerrero | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 20, 2024 |
| Eric Lawrence | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Jan 1, 2024 |
| Danett Perkins | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Jan 8, 2024 |
| Elena Santos | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Jun 1, 2023 |
| Gregory Smith | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Nov 1, 2023 |
| Nicole Thornton | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Oct 20, 2023 |
| Remedios Ubaldo | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 1, 2022 |
| Nadia Vermeulen | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Apr 29, 2024 |
| Aug 12, 2026 |
1082 harm |
| $8,428 |
| Mountain View Healthcare Center 2530 Solace Place, Mountain View, CA 94040 CCN 0553161 state class AA/A | 129 | Jul 15, 2026 | 732 harm | $55k |
| The Win Post-Acute 410 North Winchester Boulevard, Santa Clara, CA 95050 CCN 0556452 state class AA/A | 133 | Mar 24, 2026 | 582 harm1 open | — |
| Palo Alto Post-Acute 911 Bryant Street, Palo Alto, CA 94301 CCN 055646 | 66 | May 30, 2025 | 73 | — |
| Bridgewood Post Acute 5901 Lemon Hill Avenue, Sacramento, CA 95824 CCN 0559562 state class AA/AAbuse icon | 49 | Jul 10, 2026 | 1021 harm | — |
| Pacific Hills Post Acute 370 Noble Court, Morgan Hill, CA 95037 CCN 0560372 state class AA/A | 99 | Jun 16, 2026 | 59 | — |
| Eden Healthcare Center 27350 Tampa Avenue, Hayward, CA 94544 CCN 0560523 state class AA/A | 121 | May 29, 2026 | 971 IJ1 harm | $31k |