Cycle 1
Health 2024-07-19 · Fire 2024-07-19
13 health deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Cupertino, CA
Health Care Ctr At The Forum At Rancho San Antonio
5-star overall rating with 4-star inspections with 13 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
23600 Via Esplendor, Cupertino, CA
(650) 944-0200
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
48
Certified beds
Average residents
39
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1992-09-01
CMS approved date
Coverage
Medicare
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
1.23
Registered nurse staffing · state 0.65 · national 0.68
LPN hours / resident day
0.96
Licensed practical nurse staffing · state 1.22 · national 0.87
Aide hours / resident day
3.06
Nurse aide staffing · state 2.64 · national 2.35
Total nurse hours
5.25
All reported nurse hours · state 4.51 · national 3.89
Licensed hours
2.20
RN + LPN hours · state 1.87 · national 1.54
Weekend hours
4.51
Weekend nurse staffing · state 4.08 · national 3.43
Weekend RN hours
0.88
Weekend registered nurse coverage · state 0.50 · national 0.47
Physical therapist
0.35
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
1.27
CMS adjusted RN staffing hours
Adjusted total hours
5.40
CMS adjusted total nurse staffing hours
Case-mix index
1.33
Higher values indicate more complex resident acuity
RN turnover
50%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
36%
Annual nurse turnover · state 38% · national 46%
SNF VBP
Value-based purchasing
Program rank
127
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
83.07
Composite VBP score used to determine payment impact.
Payment multiplier
1.0264
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
10
Baseline 18.82% · Performance 16.00% · Measure score 10 · Achievement 10 · Improvement 9
Healthcare-associated infections
8.71
Baseline 6.37% · Performance 5.23% · Measure score 8.71 · Achievement 8.71 · Improvement 7.78
Total nurse turnover
6.47
Baseline 40.00% · Performance 37.26% · Measure score 6.47 · Achievement 6.47 · Improvement 1.31
Adjusted total nurse staffing
8.05
Performance 5.37 hours · Measure score 8.05 · Achievement 8.05 · This facility did not have sufficient data to calculate a baseline period measure result.
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.52% |
10.72%
1.2 pts better
|
No Different than the National Rate · Eligible stays 196 · Observed rate 6.12% · Lower 95% interval 6.53% |
| Discharge to community | 62.68% |
50.57%
12.1 pts better
|
Better than the National Rate · Eligible stays 181 · Observed rate 60.77% · Lower 95% interval 56.26% |
| Medicare spending per beneficiary | 0.76 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 196 · Denominator 196 |
| Falls with major injury | 12.76% |
0.77%
12 pts worse
|
Numerator 25 · Denominator 196 |
| Discharge self-care score | 46.31% |
53.69%
7.4 pts worse
|
Numerator 69 · Denominator 149 |
| Discharge mobility score | 39.6% |
50.94%
11.3 pts worse
|
Numerator 59 · Denominator 149 |
| Pressure ulcers or injuries, new or worsened | 0.51% |
2.29%
1.8 pts better
|
Numerator 1 · Denominator 196 · Adjusted rate 0.51% |
| Healthcare-associated infections requiring hospitalization | 5.23% |
7.12%
1.9 pts better
|
No Different than the National Rate · Eligible stays 152 · Observed rate 1.97% · Lower 95% interval 3.15% |
| Staff COVID-19 vaccination coverage | 5.2% |
8.2%
3 pts worse
|
Numerator 9 · Denominator 173 |
| Staff flu vaccination coverage | 34.9% |
42%
7.1 pts worse
|
Numerator 67 · Denominator 192 |
| Discharge function score | 44.3% |
56.45%
12.2 pts worse
|
Numerator 66 · Denominator 149 |
| Transfer of health information to provider | 90.32% |
95.95%
5.6 pts worse
|
Numerator 28 · Denominator 31 |
| Transfer of health information to patient | 98.52% |
96.28%
2.2 pts better
|
Numerator 133 · Denominator 135 |
| Resident COVID-19 vaccinations up to date | 53.57% |
25.2%
28.4 pts better
|
Numerator 60 · Denominator 112 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.1 |
2.3
1.2 pts better
|
1.9
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 0.8 · Expected 1.5 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.8 |
1.6
0.8 pts better
|
1.8
1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.8 · Observed 0.6 · Expected 1.3 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.5% |
98.5%
1 pts worse
|
93.4%
4.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 95.0% · Q3 100.0% · Q4 100.0% · 4Q avg 97.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
98.2%
1.8 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 6.2% |
1.6%
4.6 pts worse
|
3.3%
2.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 10.0% · Q3 9.5% · Q4 5.0% · 4Q avg 6.2% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
6.8%
6.8 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 3.0% |
4.1%
1.1 pts better
|
5.4%
2.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q4 5.0% · 4Q avg 3.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 10.3% |
13.7%
3.4 pts better
|
19.6%
9.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q4 5.0% · 4Q avg 10.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 1.8% |
14.2%
12.4 pts better
|
16.7%
14.9 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 1.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.4%
0.4 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 25.6% |
11.0%
14.6 pts worse
|
16.3%
9.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 25.6% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 14.3% |
10.7%
3.6 pts worse
|
14.9%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 14.3% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
1.0%
1 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 5.1% |
1.2%
3.9 pts worse
|
1.7%
3.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 14.3% · Q4 0.0% · 4Q avg 5.1% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 27.3% |
10.9%
16.4 pts worse
|
19.8%
7.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 27.3% |
| Percentage of long-stay residents with pressure ulcers | 11.3% |
4.7%
6.6 pts worse
|
5.1%
6.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 7.4% · Q4 15.8% · 4Q avg 11.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 89.7% |
94.0%
4.3 pts worse
|
81.7%
8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 77.7% · Q2 83.6% · Q3 97.6% · Q4 100.0% · 4Q avg 89.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 3.4% |
11.2%
7.8 pts better
|
12.0%
8.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 3.4% · Observed 2.9% · Expected 9.4% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.5%
1.5 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 83.7% |
93.2%
9.5 pts worse
|
79.7%
4 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 83.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 23.2% |
23.2%
About the same
|
23.9%
0.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 23.2% · Observed 16.9% · Expected 17.4% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-06-09 · Fire 2023-06-09
6 health deficiencies
Top issue: Pharmacy Service (2 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Cycle 3
Health 2019-05-03 · Fire 2019-05-03
3 health deficiencies
Top issue: Infection Control (1 deficiency)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-07-19
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-07-25
D · Potential for more than minimal harm
2024-07-19
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-07-25
D · Potential for more than minimal harm
2024-07-19
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-07-25
D · Potential for more than minimal harm
2023-06-09
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-07-05
D · Potential for more than minimal harm
2023-06-09
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-07-05
C · Minimal harm
2023-06-09
K791 · Miscellaneous Deficiencies
Fire Safety
Ensure that any exit in an area undergoing construction, repair, or improvements shall be inspected daily to ensure its ability to be used instantly in case of emergency.
Corrected 2023-07-05
D · Potential for more than minimal harm
2019-05-03
K223 · Egress Deficiencies
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2019-07-17
Inspection history
Recent health citations
D · Potential for more than minimal harm
2024-09-06
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-09-20
E · Potential for more than minimal harm
2024-07-19
F578 · Resident Rights Deficiencies
Health
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.
Corrected 2024-08-18
E · Potential for more than minimal harm
2024-07-19
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2024-08-18
E · Potential for more than minimal harm
2024-07-19
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-08-18
E · Potential for more than minimal harm
2024-07-19
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F582 · Resident Rights Deficiencies
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F700 · Quality of Life and Care Deficiencies
Health
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.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F732 · Nursing and Physician Services Deficiencies
Health
Post nurse staffing information every day.
Corrected 2024-08-18
D · Potential for more than minimal harm
2024-07-19
F758 · Pharmacy Service Deficiencies
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2024-08-18
E · Potential for more than minimal harm
2023-06-09
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2023-07-09
E · Potential for more than minimal harm
2023-06-09
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-07-09
E · Potential for more than minimal harm
2023-06-09
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-07-09
D · Potential for more than minimal harm
2023-06-09
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2023-07-09
D · Potential for more than minimal harm
2023-06-09
F758 · Pharmacy Service Deficiencies
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2023-07-09
E · Potential for more than minimal harm
2019-05-03
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2019-05-20
D · Potential for more than minimal harm
2019-05-03
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2019-05-20
D · Potential for more than minimal harm
2019-05-03
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2019-05-20
Penalties and ownership
What sits behind the stars
Ownership
Rancho San Antonio Retirement Housing Corporation
5% Or Greater Direct Ownership Interest · Organization
Brauman, Sharon
Corporate Officer · Individual
Brown, Kathy
Corporate Officer · Individual
Bush, Ellyn
Corporate Officer · Individual
Exline, Rick
Corporate Director · Individual
Fishbein, Margery
Corporate Officer · Individual
Jo, Daniel
Operational/Managerial Control · Individual
Johnson, Eiko
Corporate Director · Individual
Kao, Nancy
Operational/Managerial Control · Individual
Life Care Services LLC
Operational/Managerial Control · Organization
Nelson, Mark
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
#1
Los Altos Post-Acute
Los Altos, CA
4-star overall rating with 4-star inspections with 5 recent health deficiencies with 10 fire-safety deficiencies in the latest cycle
#2
Sunny View Manor
Cupertino, CA
5-star overall rating with 4-star inspections with $8,176 in total fines with 4 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
#3
Cupertino Healthcare & Wellness Center
Cupertino, CA
3-star overall rating with 3-star inspections with 14 recent health deficiencies with 10 fire-safety deficiencies in the latest cycle
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