Grand Oaks Care
A nursing home in Tulare, California 93274
897 North M Street, Tulare, California 93274. (559) 687-1340.
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The short answer
Record last released by CMS on Oct 28, 2026.
- 3of 5 CMS’s overall rating
- 7 health citations at the latest inspection cycle California average: 15.7
- 4.37 nurse hours per resident per day California average: 4.54
- 0 fines in the last three years
Each figure’s source sits beside it, in its section below.
What these words mean7
- 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.
- 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?
7 health citations at the latest inspection cycle
The California average is 15.7.
Last standard inspection Feb 12, 2026.
Most serious in three years: D: no actual harm, potential for more than minimal harm.
CMS, Provider Information, State and US Averages and Health Deficiencies. Released Oct 28, 2026. Updated monthly.
When those citations happened
40 citations in 12 months of the last 36. Last cited Mar 2026. Most serious: no actual harm, potential for more than minimal harm (D). The last 3 years, to Nov 5, 2026.
| Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2023 | Dec | |||||||||||
| 2024 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |
| 2025 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |
| 2026 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov |
Hover or focus a month to read it.
Hearth Record drew this from the dates and levels in the source’s own records.
All 40 citations in the last three years
Grouped by inspection, newest first. Each carries 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)., from A, the least serious, to L, the most. 17 came from complaint inspections.
CMS, Health Deficiencies. Released Oct 28, 2026. Updated monthly.
Mar 12, 2026: complaint inspection1 citation
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Ensure services provided by the nursing facility meet professional standards of quality.
Feb 12, 2026: standard inspection6 citations
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Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.
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Ensure services provided by the nursing facility meet professional standards of quality.
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Provide safe, appropriate dialysis care/services for a resident who requires such services.
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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.
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Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
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Provide and implement an infection prevention and control program.
Sep 2, 2025: complaint inspection1 citation
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Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Jul 29, 2025: complaint inspection1 citation
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Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Jul 3, 2025: complaint inspection1 citation
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Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
May 9, 2025: complaint inspection1 citation
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Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Jan 29, 2025: complaint inspection1 citation
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Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.
Oct 10, 2024: standard inspection17 citations
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Reasonably accommodate the needs and preferences of each resident.
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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.
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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.
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Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
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Ensure services provided by the nursing facility meet professional standards of quality.
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Provide appropriate pressure ulcer care and prevent new ulcers from developing.
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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.
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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.
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Provide medically-related social services to help each resident achieve the highest possible quality of life.
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Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
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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.
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Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
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Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
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Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
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Provide and implement an infection prevention and control program.
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Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Jun 20, 2024: complaint inspection3 citations
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Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
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Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
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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.
May 7, 2024: complaint inspection2 citations
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Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
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Make sure that a working call system is available in each resident’s bathroom and bathing area.
Apr 23, 2024: complaint inspection1 citation
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Ensure services provided by the nursing facility meet professional standards of quality.
Feb 13, 2024: complaint inspection1 citation
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Ensure services provided by the nursing facility meet professional standards of quality.
Feb 7, 2024: complaint inspection2 citations
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Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
-
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Dec 22, 2023: complaint inspection2 citations
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Create and put into place a plan for meeting the resident’s most immediate needs within 48 hours of being admitted
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Ensure services provided by the nursing facility meet professional standards of quality.
Is it certified, and in good standing?
- Certified for Medicare and Medicaid since Jun 26, 2009.
- Not on CMS’s special focus list.
- No abuse icon from CMS.
- No change of ownership in the last 12 months.
- CMS lists its ownership as for profit, limited liability company.
- 99 certified beds.
CMS, Provider Information. Released Oct 28, 2026. Updated monthly.
Has it been fined or penalized?
- No fines in the last three years.
- No Medicare payment denials in the last three years.
- 17 citations in the last three years came from complaint inspections.
CMS, Penalties and Health Deficiencies. Released Oct 28, 2026. Updated monthly.
Who does the caring?
4.37 nurse hours per resident per day
The California average is 4.54.
CMS publishes staffing about four months after the fact.
CMS, Provider Information and State and US Averages. Released Oct 28, 2026. Updated monthly.
| Measure | This home | California average |
|---|---|---|
| Nurse hours per resident per day | 4.37 | 4.54 |
| Of which registered nurses | 0.37 | 0.68 |
| At weekends | 3.92 | 4.10 |
| Nursing staff turnover | 46.2% | 36.6% |
| Registered nurse turnover | 37.5% | 37.8% |
| Administrators who left | 0 | Not given |
Who owns it?
- Swc CA Opco 2 LLC owns 100% directly since May 1, 2022.
- 5 owners or officers are people: Aaron Chesley (owns 5% or more through other companies, 50%); James B Gamett (owns 5% or more through other companies, 50%); Michelle Lawrence (managing employee (on the payroll)); Aaron Chesley (corporate officer); James B Gamett (corporate officer).
- Part of Ajc Healthcare (16 homes in CMS’s data).
- No private-equity firm among the owners CMS lists.
- No real-estate investment trust among the owners CMS lists.
CMS, All Owners. Checked Nov 5, 2026. Updated monthly.
CMS, Provider Information. Released Oct 28, 2026. Updated monthly.
| Organisation | Role | Share | Since |
|---|---|---|---|
| Swc CA Opco 2 LLC | Owns 5% or more directly | 100% | May 1, 2022 |
| Ajc Healthcare LLC | Owns 5% or more through other companies | 50% | May 1, 2022 |
| JBG Partners LLC | Owns 5% or more through other companies | 50% | May 1, 2022 |
How do residents fare?
- CMS rates its quality measures 4 of 5 (California average 4.2).
CMS, Provider Information and State and US Averages. Released Oct 28, 2026. Updated monthly.
| Measure | Rating |
|---|---|
| Overall rating | 3 of 5 |
| Health inspections | 3 of 5 |
| Staffing | 2 of 5 |
| Quality measures | 4 of 5 |
How does it compare nearby?
- Among the 12 nearest homes, within 19.0 miles, this one had the 12th most health citations at the latest inspection cycle (7; the middle value was 16.5).
CMS, Provider Information. Released Oct 28, 2026. Updated monthly.
| Place | Miles away | Citations, latest cycle |
|---|---|---|
| Grand Oaks Care This nursing home | 7 | |
| Tulare Healthcare & Wellness Center, LP | 0.1 | 21 |
| Orchards at Tulare | 0.1 | 23 |
| Westgate Gardens Care Center | 6.9 | 14 |
| Sequoia Vista | 6.9 | 28 |
| Linwood Meadows Care Center | 7.0 | 16 |
| Kaweah Health Skilled Nursing Center | 7.2 | 8 |
| Delta Healthcare & Wellness Center, LP | 8.3 | 10 |
| Visalia Post Acute | 9.2 | 24 |
| Lindsay Gardens Nursing & Rehabilitation | 12.8 | 17 |
| Brighton Post Acute | 18.7 | 17 |
| Kings Healthcare & Wellness Center LP | 19.0 | 8 |
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
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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).
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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).
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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).
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Centers for Medicare & Medicaid Services, All Owners (afe44b85-cc6d-40d7-b5df-00ae8910d1d2).
Checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).
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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.
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
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Paid listing
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