Starfile / California

GRAND OAKS CARE

897 NORTH M STREET, TULARE, CA 93274 · CCN 555861

Inspection history vs California & national averages

Cycle 1 is the most recent standard health inspection. Lower total deficiency counts are better.

Cycle 1 deficiencies by category

Staffing (hours per resident per day)

Fines & penalties

Total fines

$34,492

Number of fines

1

Number of penalties

1

Payment denials

0

Chain

Chain

AJC HEALTHCARE

Facilities in chain

14

Chain avg overall

2.20 / 5

Inspection citations (63)1 actual harm

1. FF0725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.2025-09-02 · Health · corrected 2025-09-03

   Potential for more than minimal harm

2. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2025-07-29 · Health

   Potential for more than minimal harm

3. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2025-07-03 · Health · corrected 2025-07-07

   Potential for more than minimal harm

4. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2025-05-09 · Health · corrected 2025-05-09

   Potential for more than minimal harm

5. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2025-01-29 · Health · corrected 2025-02-13

   Potential for more than minimal harm

6. EF0558Reasonably accommodate the needs and preferences of each resident.2024-10-10 · Health · corrected 2024-10-24

   Potential for more than minimal harm

7. EF0578Honor 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.2024-10-10 · Health · corrected 2024-10-24

   Potential for more than minimal harm

8. DF0584Honor 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.2024-10-10 · Health · corrected 2024-10-24

   Potential for more than minimal harm

9. DF0623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.2024-10-10 · Health · corrected 2024-10-24

   Potential for more than minimal harm

10. EF0658Ensure services provided by the nursing facility meet professional standards of quality.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

11. DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

12. EF0688Provide 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.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

13. EF0726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

14. EF0745Provide medically-related social services to help each resident achieve the highest possible quality of life.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

15. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

16. EF0756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

17. EF0761Ensure 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.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

18. DF0805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

19. DF0806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

20. FF0867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

21. EF0880Provide and implement an infection prevention and control program.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

22. EF0921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.2024-10-10 · Health · corrected 2024-10-24

    Potential for more than minimal harm

23. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2024-06-20 · Health · corrected 2024-06-21

    Potential for more than minimal harm

24. EF0804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.2024-06-20 · Health · corrected 2024-06-21

    Potential for more than minimal harm

25. EF0837Establish 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.2024-06-20 · Health · corrected 2024-06-21

    Potential for more than minimal harm

26. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2024-05-07 · Health · corrected 2024-05-08

    Potential for more than minimal harm

27. DF0919Make sure that a working call system is available in each resident's bathroom and bathing area.2024-05-07 · Health · corrected 2024-05-08

    Potential for more than minimal harm

28. DF0658Ensure services provided by the nursing facility meet professional standards of quality.2024-04-23 · Health · corrected 2024-04-25

    Potential for more than minimal harm

29. DF0658Ensure services provided by the nursing facility meet professional standards of quality.2024-02-13 · Health · corrected 2024-02-29

    Potential for more than minimal harm

30. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2024-02-07 · Health · corrected 2024-02-29

    Potential for more than minimal harm

31. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-02-07 · Health · corrected 2024-02-29

    Potential for more than minimal harm

32. DF0655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted2023-12-22 · Health · corrected 2024-01-22

    Potential for more than minimal harm

33. DF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-12-22 · Health · corrected 2024-01-22

    Potential for more than minimal harm

34. EF0698Provide safe, appropriate dialysis care/services for a resident who requires such services.2023-11-02 · Health · corrected 2023-12-28

    Potential for more than minimal harm

35. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2023-11-02 · Health · corrected 2023-12-28

    Potential for more than minimal harm

36. DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-10-10 · Health · corrected 2023-10-30

    Potential for more than minimal harm

37. GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-05-15 · Health · corrected 2023-06-22

    Actual harm

38. DF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-03-28 · Health · corrected 2023-03-29

    Potential for more than minimal harm

39. DF0578Honor 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.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

40. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

41. EF0676Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

42. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

43. EF0679Provide activities to meet all resident's needs.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

44. DF0688Provide 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.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

45. EF0698Provide safe, appropriate dialysis care/services for a resident who requires such services.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

46. EF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

47. EF0804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

48. DF0806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

49. FF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

50. EF0880Provide and implement an infection prevention and control program.2022-10-13 · Health · corrected 2022-11-17

    Potential for more than minimal harm

51. EF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

52. DF0558Reasonably accommodate the needs and preferences of each resident.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

53. DF0567Honor the resident's right to manage his or her financial affairs.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

54. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

55. EF0658Ensure services provided by the nursing facility meet professional standards of quality.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

56. DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

57. DF0692Provide enough food/fluids to maintain a resident's health.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

58. DF0761Ensure 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.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

59. EF0803Ensure 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.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

60. DF0805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

61. EF0806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

62. EF0880Provide and implement an infection prevention and control program.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

63. EF0908Keep all essential equipment working safely.2019-03-21 · Health · corrected 2019-04-29

    Potential for more than minimal harm

Ownership

Other facilities in TULARE

Source: CMS Provider Data Catalog, Nursing Home Care Compare files (processed 2026-03-01). Citations show the 3 most recent inspection cycles.