Hearth Record

Bay Crest Care Center

A nursing home in Torrance, California 90503

3750 Garnet Street, Torrance, California 90503. (310) 371-2431.

  • A candidate for CMS’s special focus list
  • Cited for abuse (CMS flag)
CMS’s own record, on Care Compare

Watch and the shortlist are kept with a free account, on every device. Your watch list. CMS’s own record is on Care Compare.

The short answer

Record last released by CMS on Oct 28, 2026.

The last 24 months 117 citations in 23 months of the last 36. Last cited Aug 2026. Most serious: immediate jeopardy to health or safety (J). Every month

Each figure’s source sits beside it, in its section below.

What these words mean8
Star ratings
CMS rates some kinds of place from 1 to 5 stars, more stars meaning better on CMS’s own measures for that kind: for a nursing home, its health inspections, staffing and quality measures. A rating is CMS’s summary of those measures; it doesn’t promise good care. Source: CMS, Care Compare and the Five-Star Quality Rating System.
Inspection (survey)
A visit by state inspectors, often unannounced, who check a place against the rules it must meet. For nursing homes and other places Medicare pays, CMS calls these visits surveys: a standard survey of a nursing home comes at least every 15 months, and a complaint survey whenever a complaint calls for one. Source: CMS; 42 CFR 488.308.
Deficiency, citation, violation
What inspectors write up when a place didn’t meet a rule: the rule, what they saw, and when. CMS calls it a deficiency; states may say citation or violation. It is the inspectors’ finding, not a court’s, and the place is usually asked for a plan to correct it. Source: CMS, statement of deficiencies (Form CMS-2567); each state’s licensing agency.
Scope and severity (A to L)
CMS grades each nursing home deficiency with a letter. A to C: no actual harm, with potential for minimal harm. D to F: no actual harm, but potential for more. G to I: actual harm. J to L: immediate jeopardy. Within each band, the letter rises as more residents were affected or could be: one or a few, a pattern, or widespread. Source: CMS, nursing home scope and severity grid (State Operations Manual, chapter 7).
Nurse staffing hours
The hours registered nurses, licensed practical nurses and nurse aides worked, per resident per day, from the payroll records each home sends CMS. Source: CMS, Payroll-Based Journal.
Fines and payment denials
A fine (civil money penalty) is money CMS makes a nursing home pay when it falls short of federal rules. A payment denial means Medicare and Medicaid stop paying for new admissions until the home meets the rules again. Source: CMS; 42 CFR 488.430 and 488.417.
Immediate jeopardy
CMS’s most serious finding: the place’s failure to meet a rule caused, or was likely to cause, serious injury, harm, impairment or death to someone in its care. Source: CMS; 42 CFR 489.3.
Capacity
The most people the licence or certification lets the place care for at once: residents, children, beds or apartments, as the state counts them. It isn’t how many are there now. Source: Each state’s licensing agency.

What did inspectors find?

41 health citations at the latest inspection cycle

The California average is 15.7.

Last standard inspection Mar 13, 2026.

Most serious in three years: immediate jeopardy to health or safety (J), at a complaint inspection on Nov 9, 2025

Source:

CMS, Provider Information, State and US Averages and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

When those citations happened

117 citations in 23 months of the last 36. Last cited Aug 2026. Most serious: immediate jeopardy to health or safety (J). The last 3 years, to Nov 5, 2026.

117 citations by month over the last 3 years. Each cell is one month.
JanFebMarAprMayJunJulAugSepOctNovDec
2023 Dec
2024 JanFebMarAprMayJunJulAugSepOctNovDec
2025 JanFebMarAprMayJunJulAugSepOctNovDec
2026 JanFebMarAprMayJunJulAugSepOctNov

Hover or focus a month to read it.

No visit on record Visited, nothing cited A stronger orange is more serious, on its source’s own levels, read onto four bands: from the least serious it publishes to the most
Source:

Hearth Record drew this from the dates and levels in the source’s own records.

All 118 citations in the last three years

Grouped by inspection, newest first. Each carries , from A, the least serious, to L, the most. 79 came from complaint inspections.

Source:

CMS, Health Deficiencies. Released Oct 28, 2026. Updated monthly.

Aug 25, 2026: complaint inspection3 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. D: no actual harm, potential for more than minimal harm. From a complaint.

  • 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.

    Rule F0726. D: no actual harm, potential for more than minimal harm. From a complaint.

  • Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

    Rule F0943. D: no actual harm, potential for more than minimal harm. From a complaint.

Mar 18, 2026: complaint inspection2 citations
  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Apr 10, 2026.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Apr 10, 2026.

Mar 13, 2026: standard inspection13 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Honor the resident’s right to and the facility must promote and facilitate resident self-determination through support of resident choice.

    Rule F0561. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

    Rule F0604. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Provide the required documentation or notification related to the resident’s needs, appeal rights, or bed-hold policies.

    Rule F0628. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

    Rule F0676. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Provide care and assistance to perform activities of daily living for any resident who is unable.

    Rule F0677. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Provide activities to meet all resident’s needs.

    Rule F0679. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Assist a resident in gaining access to vision and hearing services.

    Rule F0685. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Ensure that residents are free from significant medication errors.

    Rule F0760. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • 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.

    Rule F0803. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Rule F0812. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

    Rule F0849. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

  • Provide and implement an infection prevention and control program.

    Rule F0880. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Mar 20, 2026.

Mar 6, 2026: complaint inspection2 citations
  • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Rule F0689. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 10, 2026.

  • Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

    Rule F0700. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 10, 2026.

Feb 23, 2026: complaint inspection2 citations
  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 2, 2026.

  • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Rule F0657. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 2, 2026.

Jan 30, 2026: complaint inspection1 citation
  • Provide and implement an infection prevention and control program.

    Rule F0880. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 4, 2026.

Dec 17, 2025: complaint inspection1 citation
  • Honor the resident’s right to organize and participate in resident/family groups in the facility.

    Rule F0565. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 24, 2025.

Dec 12, 2025: complaint inspection4 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 13, 2025.

  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 13, 2025.

  • Ensure services provided by the nursing facility meet professional standards of quality.

    Rule F0658. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 13, 2025.

  • Ensure that residents are free from significant medication errors.

    Rule F0760. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 13, 2025.

Nov 9, 2025: complaint inspection5 citations
  • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Rule F0689. J: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Nov 11, 2025.

  • Provide doctor’s orders for the resident’s immediate care at the time the resident was admitted.

    Rule F0635. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 11, 2025.

  • Ensure each resident receives an accurate assessment.

    Rule F0641. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 11, 2025.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 11, 2025.

  • Have a plan that describes the process for conducting QAPI and QAA activities.

    Rule F0865. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 11, 2025.

Nov 3, 2025: complaint inspection3 citations
  • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Rule F0725. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 7, 2025.

  • Ensure that residents are free from significant medication errors.

    Rule F0760. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 7, 2025.

  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 7, 2025.

Oct 17, 2025: complaint inspection2 citations
  • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Rule F0689. G: actual harm. From a complaint. Correction date, as CMS recorded it: Oct 20, 2025.

  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Oct 20, 2025.

Oct 15, 2025: complaint inspection3 citations
  • Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    Rule F0600. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Oct 16, 2025.

  • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Rule F0609. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Oct 16, 2025.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Oct 16, 2025.

Sep 17, 2025: complaint inspection1 citation
  • Let each resident or the resident’s legal representative access or purchase copies of all the resident’s records.

    Rule F0573. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 19, 2025.

Sep 3, 2025: complaint inspection4 citations
  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Have a policy regarding use and storage of foods brought to residents by family and other visitors.

    Rule F0813. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Keep all essential equipment working safely.

    Rule F0908. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

Aug 19, 2025: complaint inspection5 citations
  • Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

    Rule F0678. J: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Rule F0684. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

  • Have a plan that describes the process for conducting QAPI and QAA activities.

    Rule F0865. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 8, 2025.

Jul 11, 2025: complaint inspection5 citations
  • Reasonably accommodate the needs and preferences of each resident.

    Rule F0558. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jul 14, 2025.

  • Provide care and assistance to perform activities of daily living for any resident who is unable.

    Rule F0677. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jul 14, 2025.

  • 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.

    Rule F0688. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jul 14, 2025.

  • Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

    Rule F0690. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jul 14, 2025.

  • Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.

    Rule F0800. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jul 14, 2025.

Jun 3, 2025: complaint inspection1 citation
  • 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.

    Rule F0693. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jun 20, 2025.

May 16, 2025: complaint inspection2 citations
  • Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Rule F0684. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 20, 2025.

  • Ensure that residents are free from significant medication errors.

    Rule F0760. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 20, 2025.

Mar 28, 2025: complaint inspection2 citations
  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Apr 21, 2025.

  • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Rule F0689. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Apr 21, 2025.

Jan 31, 2025: standard inspection18 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Reasonably accommodate the needs and preferences of each resident.

    Rule F0558. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Keep residents’ personal and medical records private and confidential.

    Rule F0583. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

    Rule F0604. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • PASARR screening for Mental disorders or Intellectual Disabilities

    Rule F0645. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Rule F0657. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

    Rule F0676. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Provide care and assistance to perform activities of daily living for any resident who is unable.

    Rule F0677. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Rule F0689. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Provide safe and appropriate respiratory care for a resident when needed.

    Rule F0695. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • 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.

    Rule F0726. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Ensure medication error rates are not 5 percent or greater.

    Rule F0759. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • 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.

    Rule F0761. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Rule F0812. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Provide and implement an infection prevention and control program.

    Rule F0880. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

    Rule F0912. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

  • Develop, implement, and/or maintain an effective training program for all new and existing staff members.

    Rule F0940. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 20, 2025.

Jan 31, 2025: standard and complaint inspection3 citations
  • Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    Rule F0600. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2025.

  • Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.

    Rule F0836. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2025.

  • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

    Rule F0867. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2025.

Dec 30, 2024: complaint inspection1 citation
  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jan 7, 2025.

Oct 30, 2024: complaint inspection1 citation
  • Allow resident to participate in the development and implementation of his or her person-centered plan of care.

    Rule F0553. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 1, 2024.

Sep 30, 2024: complaint inspection1 citation
  • Post nurse staffing information every day.

    Rule F0732. C: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 30, 2024.

Sep 10, 2024: complaint inspection1 citation
  • Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Rule F0684. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 12, 2024.

Aug 21, 2024: complaint inspection2 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 9, 2024.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 9, 2024.

Jul 21, 2024: complaint inspection2 citations
  • 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.

    Rule F0584. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Aug 7, 2024.

  • Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

    Rule F0804. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Aug 7, 2024.

May 6, 2024: complaint inspection5 citations
  • Reasonably accommodate the needs and preferences of each resident.

    Rule F0558. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 24, 2024.

  • Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Rule F0684. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 24, 2024.

  • 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.

    Rule F0688. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 24, 2024.

  • Provide safe, appropriate dialysis care/services for a resident who requires such services.

    Rule F0698. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 24, 2024.

  • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Rule F0725. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: May 24, 2024.

Feb 9, 2024: complaint inspection3 citations
  • Provide safe, appropriate pain management for a resident who requires such services.

    Rule F0697. G: actual harm. From a complaint. Correction date, as CMS recorded it: Mar 5, 2024.

  • Obtain a doctor’s order to admit a resident and ensure the resident is under a doctor’s care.

    Rule F0710. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 5, 2024.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 5, 2024.

Jan 31, 2024: complaint inspection4 citations
  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2024.

  • Provide safe, appropriate pain management for a resident who requires such services.

    Rule F0697. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2024.

  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2024.

  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 20, 2024.

Jan 12, 2024: standard inspection8 citations
  • Provide enough food/fluids to maintain a resident’s health.

    Rule F0692. G: actual harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Allow residents to self-administer drugs if determined clinically appropriate.

    Rule F0554. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Ensure each resident receives an accurate assessment.

    Rule F0641. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Provide for the safe, appropriate administration of IV fluids for a resident when needed.

    Rule F0694. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • 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.

    Rule F0761. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Rule F0812. F: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

  • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

    Rule F0867. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Feb 8, 2024.

Jan 12, 2024: standard and complaint inspection5 citations
  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 8, 2024.

  • Reasonably accommodate the needs and preferences of each resident.

    Rule F0558. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 8, 2024.

  • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Rule F0725. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 8, 2024.

  • Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

    Rule F0802. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 8, 2024.

  • Provide and implement an infection prevention and control program.

    Rule F0880. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Feb 8, 2024.

Dec 21, 2023: complaint inspection1 citation
  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jan 15, 2024.

Dec 7, 2023: complaint inspection1 citation
  • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Rule F0755. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 28, 2023.

Nov 15, 2023: complaint inspection1 citation
  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 5, 2023.

Is it certified, and in good standing?

  • Certified for Medicare and Medicaid since Mar 1, 1980.
  • A candidate for CMS’s special focus list, which CMS keeps for homes with a history of serious problems.
  • CMS marks it with its abuse icon: cited for abuse or neglect that harmed a resident.
  • No change of ownership in the last 12 months.
  • CMS lists its ownership as for profit, limited liability company.
Source:

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

Has it been fined or penalized?

  • 4 fines in the last three years, $124,336 in all.
  • 3 Medicare payment denials in the last three years.
  • 79 citations in the last three years came from complaint inspections.
Source:

CMS, Penalties and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

Fines and payment denials, newest first
DateKindAmount
Nov 3, 2025Medicare payment denialNot given
Nov 3, 2025Fine$44,256
Oct 15, 2025Fine$12,425
Aug 19, 2025Medicare payment denialNot given
Aug 19, 2025Fine$16,149
Dec 7, 2023Medicare payment denialNot given
Dec 7, 2023Fine$51,506

Who does the caring?

3.93 nurse hours per resident per day

The California average is 4.54.

CMS publishes staffing about four months after the fact.

Source:

CMS, Provider Information and State and US Averages. Released Oct 28, 2026. Updated monthly.

Staffing measures
MeasureThis homeCalifornia average
Nurse hours per resident per day3.934.54
Of which registered nurses0.410.68
At weekends3.644.10
Nursing staff turnover56.4%36.6%
Registered nurse turnover80%37.8%
Administrators who left1Not given

Who owns it?

  • Bq Operations Holdings LLC owns 100% directly since Feb 1, 2021.
  • 4 owners or officers are people: Aaron H Robin (owns 5% or more through other companies, 50%); Avrohom L Tress (owns 5% or more through other companies, 25%); Pamela Shaw (runs it (operational or managerial control)); Pamela Shaw (additional disclosable party (controls, leases property to, or provides services to the home)).
  • Part of Genesis Healthcare (183 homes in CMS’s data).
  • No private-equity firm among the owners CMS lists.
  • No real-estate investment trust among the owners CMS lists.
Source:

CMS, All Owners. Checked Nov 5, 2026. Updated monthly.

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

Organisations CMS lists
OrganisationRoleShareSince
Bold Quail Holdings LLCOwns 5% or more through other companies100%Feb 1, 2021
Bq Operations Holdings LLCOwns 5% or more directly100%Feb 1, 2021
9560 Pico LLCOwns 5% or more through other companies50%Feb 1, 2021
Pico AR LLCOwns 5% or more through other companies50%Feb 1, 2021
Newgen LLCOwns 5% or more through other companies50%Feb 1, 2021
An organisation CMS lists without a nameAdditional disclosable party (controls, leases property to, or provides services to the home)Aug 5, 2025

How do residents fare?

  • CMS rates its quality measures 2 of 5 (California average 4.2).
Source:

CMS, Provider Information and State and US Averages. Released Oct 28, 2026. Updated monthly.

CMS’s star ratings, from 1 to 5
MeasureRating
Overall rating1 of 5
Health inspections1 of 5
Staffing2 of 5
Quality measures2 of 5

How does it compare nearby?

  • Among the 12 nearest homes, within 3.6 miles, this one had the 1st most health citations at the latest inspection cycle (41; the middle value was 18).
Source:

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

What the record doesn’t say

  • Complaints that didn’t lead to a citation aren’t published.
  • Inspections reach CMS’s data about six weeks after they happen, and staffing about four months after.
  • CMS publishes the inspectors’ full written findings in a separate monthly file, which isn’t loaded yet.
  • Fines and Medicare payment denials are the only enforcement CMS publishes; state licence actions aren’t included.

Sources

  • Centers for Medicare & Medicaid Services, Provider Information (4pq5-n9py).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, Health Deficiencies (r5ix-sfxw).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, Penalties (g6vv-u9sr).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, All Owners (afe44b85-cc6d-40d7-b5df-00ae8910d1d2).

    Checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, State and US Averages (xcdc-v8bm).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

If you believe something here is wrong, a correction starts with the agency whose record this copies: CMS. CMS’s own record is on Care Compare. If Hearth Record copied something wrongly, it will fix it and log the correction publicly, with its date: how corrections work.

Source:

This copy of the record was made on Nov 5, 2026.

From the home

The public record above comes first. Anything the home adds will appear here, below it, and say who wrote it.

Replies

None. Replies aren’t open yet. When they open, the home will be able to answer any finding for free, and the reply will show beside that finding, unedited and dated.

Paid listing

None. Paid listings aren’t open yet. When they open, anything paid for will say “Paid by the home”, and paying will never change a finding, a rating or the order of results.

How to read a record

Four things every record does, shown on an example record made up for this guide.

An example record, made up for this guide

An example nursing home

Made up for this guide: no real place is shown

Not fully inspected in over two years (CMS flag)

11 health citations at the latest inspection cycle

The state average is 14.3.

Source:

CMS, State and US Averages and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

From the homeNone yet. Replies and paid listings aren’t open, and when they open they will sit here, below the record.

1 of 4

Every fact names its source.

Who published it, when, and how often it changes sit beside each fact, with a link to the agency’s own file.

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