15 health deficiencies
Top issue: Quality of Life and Care (5 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fullerton, CA
5-star overall rating with 4-star inspections with 15 recent health deficiencies
201 East Bastanchury, Fullerton, CA
(714) 870-0060
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Beds
59
Certified beds
Average residents
52
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Nahs
Operator or chain grouping
Approved since
1996-07-24
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
12 facilities
Chain averages 4 overall / 3 health / 3 staffing / 5 quality stars
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
RN hours / resident day
0.66
Registered nurse staffing · state 0.65 · national 0.68
LPN hours / resident day
1.50
Licensed practical nurse staffing · state 1.22 · national 0.87
Aide hours / resident day
2.54
Nurse aide staffing · state 2.64 · national 2.35
Total nurse hours
4.70
All reported nurse hours · state 4.51 · national 3.89
Licensed hours
2.17
RN + LPN hours · state 1.87 · national 1.54
Weekend hours
4.25
Weekend nurse staffing · state 4.08 · national 3.43
Weekend RN hours
0.42
Weekend registered nurse coverage · state 0.50 · national 0.47
Physical therapist
0.39
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.54
CMS adjusted RN staffing hours
Adjusted total hours
3.87
CMS adjusted total nurse staffing hours
Case-mix index
1.66
Higher values indicate more complex resident acuity
RN turnover
14%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
32%
Annual nurse turnover · state 38% · national 46%
SNF VBP
Program rank
1,291
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
57.94
Composite VBP score used to determine payment impact.
Payment multiplier
1.0131
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
8.36
Baseline 20.04% · Performance 17.56% · Measure score 8.36 · Achievement 8.36 · Improvement 7.74
Healthcare-associated infections
5.02
Baseline 8.69% · Performance 6.65% · Measure score 5.02 · Achievement 3.95 · Improvement 5.02
Total nurse turnover
6.94
Baseline 29.23% · Performance 35.29% · Measure score 6.94 · Achievement 6.94 · Improvement 0
Adjusted total nurse staffing
2.85
Baseline 3.95 hours · Performance 3.89 hours · Measure score 2.85 · Achievement 2.85 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.04% |
10.72%
1.7 pts better
|
No Different than the National Rate · Eligible stays 423 · Observed rate 7.57% · Lower 95% interval 6.57% |
| Discharge to community | 70.5% |
50.57%
19.9 pts better
|
Better than the National Rate · Eligible stays 431 · Observed rate 66.59% · Lower 95% interval 65.45% |
| Medicare spending per beneficiary | 1.13 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 37.23% |
95.27%
58 pts worse
|
Numerator 86 · Denominator 231 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 231 |
| Discharge self-care score | 88% |
53.69%
34.3 pts better
|
Numerator 154 · Denominator 175 |
| Discharge mobility score | 73.14% |
50.94%
22.2 pts better
|
Numerator 128 · Denominator 175 |
| Pressure ulcers or injuries, new or worsened | 0.43% |
2.29%
1.9 pts better
|
Numerator 1 · Denominator 231 · Adjusted rate 0.27% |
| Healthcare-associated infections requiring hospitalization | 6.65% |
7.12%
0.5 pts better
|
No Different than the National Rate · Eligible stays 242 · Observed rate 5.79% · Lower 95% interval 4.57% |
| Staff COVID-19 vaccination coverage | 9.8% |
8.2%
1.6 pts better
|
Numerator 15 · Denominator 153 |
| Staff flu vaccination coverage | 38.82% |
42%
3.2 pts worse
|
Numerator 59 · Denominator 152 |
| Discharge function score | 84% |
56.45%
27.5 pts better
|
Numerator 147 · Denominator 175 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 55 · Denominator 55 |
| Transfer of health information to patient | 99.39% |
96.28%
3.1 pts better
|
Numerator 162 · Denominator 163 |
| Resident COVID-19 vaccinations up to date | 0.88% |
25.2%
24.3 pts worse
|
Numerator 1 · Denominator 114 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
98.5%
1.5 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · 4Q avg 100.0% |
| 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 | 0.0% |
1.6%
1.6 pts better
|
3.3%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 10.6% |
6.8%
3.8 pts worse
|
11.4%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.5% · 4Q avg 10.6% |
| Percentage of long-stay residents who lose too much weight | 3.2% |
4.1%
0.9 pts better
|
5.4%
2.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · 4Q avg 3.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 20.6% |
13.7%
6.9 pts worse
|
19.6%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 21.7% · 4Q avg 20.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 0.0% |
14.2%
14.2 pts better
|
16.7%
16.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · 4Q avg 0.0% · 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 · Q1 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 6.6% |
11.0%
4.4 pts better
|
16.3%
9.7 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 6.6% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 9.5% |
10.7%
1.2 pts better
|
14.9%
5.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · 4Q avg 9.5% · 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 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
1.2%
1.2 pts better
|
1.7%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 7.7% |
10.9%
3.2 pts better
|
19.8%
12.1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 7.7% |
| Percentage of long-stay residents with pressure ulcers | 5.3% |
4.7%
0.6 pts worse
|
5.1%
0.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.1% · 4Q avg 5.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
94.0%
6 pts better
|
81.7%
18.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 9.1% |
11.2%
2.1 pts better
|
12.0%
2.9 pts better
|
Short Stay · 20240701-20250630 · Adjusted 9.1% · Observed 8.7% · Expected 10.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.3% |
1.5%
1.2 pts better
|
1.6%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.6% · Q3 0.5% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.0% |
93.2%
4.8 pts better
|
79.7%
18.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 98.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 15.8% |
23.2%
7.4 pts better
|
23.9%
8.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 15.8% · Observed 15.3% · Expected 23.1% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (5 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Top issue: Pharmacy Service (4 deficiencies)
2 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Top issue: Resident Rights (5 deficiencies)
3 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Fire safety
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-04-12
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2024-04-12
Fire Safety
Conduct testing and exercise requirements.
Corrected 2023-06-06
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-06-06
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-06-06
Inspection history
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-11-21
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-11-21
Health
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected 2025-10-25
Health
Respond appropriately to all alleged violations.
Corrected 2025-10-25
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-10-25
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-03-17
Health
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Corrected 2025-03-17
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-03-17
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-03-17
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 2025-03-17
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-03-17
Health
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
Corrected 2025-03-17
Health
Provide and implement an infection prevention and control program.
Corrected 2025-03-17
Health
Ensure each resident receives an accurate assessment.
Corrected 2025-03-17
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2025-03-17
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2025-01-09
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-01-09
Health
Respond appropriately to all alleged violations.
Corrected 2025-01-09
Health
Provide and implement an infection prevention and control program.
Corrected 2024-04-19
Health
Implement a program that monitors antibiotic use.
Corrected 2024-04-19
Health
Keep all essential equipment working safely.
Corrected 2024-04-19
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2024-04-19
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2024-04-19
Health
Keep residents' personal and medical records private and confidential.
Corrected 2024-04-19
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2024-04-19
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-04-19
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2024-04-19
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2024-04-19
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-04-19
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-04-19
Health
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.
Corrected 2024-04-19
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2024-04-19
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 2024-04-19
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2024-04-19
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 2024-04-19
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2024-04-19
Health
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected 2024-04-19
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-06-12
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-06-12
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2023-06-12
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 2023-06-12
Health
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Corrected 2023-06-12
Health
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected 2023-06-12
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-06-12
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2023-06-12
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-06-12
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-06-12
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-06-12
Health
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.
Corrected 2023-06-12
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2023-06-12
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-06-12
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 2023-06-12
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2023-06-12
Health
Provide and implement an infection prevention and control program.
Corrected 2023-06-12
Health
The resident has the right to receive notices in a format and a language he or she understands.
Corrected 2023-06-12
Health
Dispose of garbage and refuse properly.
Corrected 2023-06-12
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
Operational/Managerial Control · Individual
Corporate Director · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
Corporate Officer · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
Fullerton, CA
5-star overall rating with 4-star inspections with 12 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
Fullerton, CA
2-star overall rating with 2-star inspections with 32 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
Fullerton, CA
3-star overall rating with 3-star inspections with 23 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
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