Federal inspection record · CMS data as of October 1, 2026
Grand Terrace Health Care Center
12000 Mount Vernon Ave, Grand Terrace, CA · (909) 825-5221
- CMS high-performer trophy
- Certified beds
- 59
- Residents per day
- 52
- Ownership
- For-Profit
- Chain
- The Ensign Group
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- June 1, 1973
1
How this home got 5 stars
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
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Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in California.
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Staffing
★★★★★no change
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
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Quality measures
★★★★★no change (already 5)
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
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Overall
★★★★★5 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among California homes
Grand Terrace Health Care Center carries 31 inspection points. That is fewer than 91% of California's 1,154 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in California: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–33 pts
- 4★ 33–66 pts
- 3★ 66–96 pts
- 2★ 96–146 pts
- 1★ over 146 pts
Bars show every rated home in California by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
27 health citations on record since 2023. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
No citation on record at the harm or immediate-jeopardy level.
Everything else, by area of care
Resident Assessment and Care Planning6D
- D
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
- D
Ensure each resident receives an accurate assessment.
- D
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Ensure each resident receives an accurate assessment.
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Quality of Life and Care5D
- D
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.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- D
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- D
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Environmental4D
- B
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
- B
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
- D
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
- B
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
Nutrition and Dietary4F
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- D
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- D
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Infection Control3F
- F
Provide and implement an infection prevention and control program.
- F
Provide and implement an infection prevention and control program.
- D
Provide and implement an infection prevention and control program.
Pharmacy Service3E
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- E
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.
- D
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Resident Rights1D
- D
Reasonably accommodate the needs and preferences of each resident.
Administration1D
- D
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
Inspection history
2026-03-05
3 health deficiencies · 2 fire-safety deficiencies
Top issue: Environmental (1 deficiency)
2024-11-22
10 health deficiencies · 4 fire-safety deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
2023-04-07
14 health deficiencies · 5 fire-safety deficiencies
Top issue: Nutrition and Dietary (3 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 4 h 41 min of nursing staff time a day, 27 min of it from a registered nurse.
This home
4 h 41 min
California average
4 h 33 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 30% of nursing staff and 22% of registered nurses left in the past year.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine1.3 pts better | 100.0% | 98.7% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine2.1 pts better | 100.0% | 97.9% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury0.5 pts better | 1.1% | 1.6% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms48.4 pts worse | 56.0% | 7.6% | 13.5% |
| Percentage of long-stay residents who lose too much weight3.6 pts worse | 7.7% | 4.1% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication0.3 pts worse | 14.0% | 13.7% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication6.4 pts better | 5.9% | 12.3% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.3 pts better | 0.0% | 0.3% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened11 pts worse | 19.9% | 8.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased4.6 pts worse | 14.8% | 10.2% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder0.1 pts worse | 0.8% | 0.7% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection1.2 pts better | 0.0% | 1.2% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence5.5 pts better | 4.3% | 9.8% | 18.3% |
| Percentage of long-stay residents with pressure ulcers2.5 pts better | 1.8% | 4.3% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine1.3 pts better | 95.9% | 94.6% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit1.4 pts better | 9.7% | 11.1% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication0.4 pts worse | 1.7% | 1.3% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine4.8 pts better | 97.9% | 93.1% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission3 pts worse | 25.6% | 22.6% | 23.4% |
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Who owns and runs it
8 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Burnam, Soon | Corporate Officer · Individual | 0% | 353 facilities |
| Fitch, Craig | Corporate Officer · Individual | 0% | 9 facilities |
| Haroldsen, Brian | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Sato, Ami | Corporate Officer · Individual | 0% | 151 facilities |
| Scott, Matthew | Corporate Officer · Individual | 0% | 5 facilities |
| Sharobiem, Andro | Adp Of The SNF · Individual | 0% | 3 facilities |
| The Ensign Group Inc | Limited Partnership Interest · Organization | 0% | 135 facilities |
| Willits, Adam | Corporate Director · Individual | 0% | 77 facilities |
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Fire safety
11 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke3F
- D
Provide properly protected cooking facilities.
- F
Inspect, test, and maintain automatic sprinkler systems.
- E
Inspect, test, and maintain automatic sprinkler systems.
Miscellaneous2F
- F
Have simulated fire drills held at unexpected times.
- F
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Emergency Preparedness2F
- F
Implement emergency and standby power systems.
- D
Implement emergency and standby power systems.
Services2D
- D
Have properly installed electrical wiring and gas equipment.
- D
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Gas, Vacuum, and Electrical Systems2D
- D
Have generator or other power source capable of supplying service within 10 seconds.
- D
Ensure proper usage of power strips and extension cords.
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Other homes nearby
-
Meadows Ridge Care Center
Colton, CA · Longwood Management Corporation
★★★★★- Worst citation, 3 yrs
- G
- Nursing / resident / day
- 3 h 54 min
- Fines
- $9,032
-
The Canyons Post-Acute
Colton, CA · Ark Post Acute Network
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 5 h 8 min
- Fines
- $66,158
-
Heritage Gardens Health Care Center
Loma Linda, CA · Progressive Health Care Centers
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 3 h 50 min
- Fines
- $0