Starfile / California

MACLAY HEALTHCARE CENTER

12831 MACLAY STREET, SYLMAR, CA 91342 · CCN 555583

SFF Candidate Abuse icon

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

$297,315

Number of fines

5

Number of penalties

9

Payment denials

4

Chain

Chain

SERRANO GROUP

Facilities in chain

11

Chain avg overall

2.30 / 5

Inspection citations (170)6 immediate jeopardy6 actual harm

1. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2025-09-15 · Health · corrected 2025-10-15

   Potential for more than minimal harm

2. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2025-08-28 · Health · corrected 2025-09-19

   Potential for more than minimal harm

3. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2025-08-28 · Health · corrected 2025-09-19

   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.2025-07-09 · Health · corrected 2025-08-12

   Potential for more than minimal harm

5. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2025-06-03 · Health · corrected 2025-06-27

   Potential for more than minimal harm

6. DF0692Provide enough food/fluids to maintain a resident's health.2025-06-03 · Health · corrected 2025-06-27

   Potential for more than minimal harm

7. DF0825Provide or get specialized rehabilitative services as required for a resident.2025-06-03 · Health · corrected 2025-06-27

   Potential for more than minimal harm

8. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2025-06-03 · Health · corrected 2025-06-27

   Potential for more than minimal harm

9. EF0880Provide and implement an infection prevention and control program.2025-04-28 · Health · corrected 2025-05-09

   Potential for more than minimal harm

10. EF0583Keep residents' personal and medical records private and confidential.2025-03-22 · Health · corrected 2025-04-18

    Potential for more than minimal harm

11. JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2025-03-22 · Health · corrected 2025-04-18

    Immediate jeopardy

12. DF0610Respond appropriately to all alleged violations.2025-03-22 · Health · corrected 2025-04-18

    Potential for more than minimal harm

13. DF0644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.2025-03-22 · Health · corrected 2025-04-18

    Potential for more than minimal harm

14. JF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-03-22 · Health · corrected 2025-04-18

    Immediate jeopardy

15. EF0712Ensure that the resident and his/her doctor meet face-to-face at all required visits.2025-03-22 · Health · corrected 2025-04-18

    Potential for more than minimal harm

16. EF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2025-03-22 · Health · corrected 2025-04-18

    Potential for more than minimal harm

17. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2025-01-28 · Health · corrected 2025-02-12

    Potential for more than minimal harm

18. DF0760Ensure that residents are free from significant medication errors.2025-01-28 · Health · corrected 2025-02-12

    Potential for more than minimal harm

19. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2025-01-16 · Health · corrected 2025-02-04

    Potential for more than minimal harm

20. DF0554Allow residents to self-administer drugs if determined clinically appropriate.2024-12-24 · Health · corrected 2025-01-09

    Potential for more than minimal harm

21. DF0636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.2024-12-24 · Health · corrected 2025-01-09

    Potential for more than minimal harm

22. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2024-12-24 · Health · corrected 2025-01-09

    Potential for more than minimal harm

23. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2024-12-24 · Health · corrected 2025-01-09

    Potential for more than minimal harm

24. DF0760Ensure that residents are free from significant medication errors.2024-12-24 · Health · corrected 2025-01-09

    Potential for more than minimal harm

25. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-12-18 · Health · corrected 2024-12-30

    Potential for more than minimal harm

26. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2024-10-31 · Health · corrected 2024-11-11

    Potential for more than minimal harm

27. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-10-31 · Health · corrected 2024-11-11

    Potential for more than minimal harm

28. EF0584Honor 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.2024-10-24 · Health · corrected 2024-11-08

    Potential for more than minimal harm

29. GF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-10-24 · Health · corrected 2024-11-08

    Actual harm

30. EF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

31. DF0558Reasonably accommodate the needs and preferences of each resident.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

32. DF0561Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

33. EF0604Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

34. DF0641Ensure each resident receives an accurate assessment.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

35. EF0655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

36. EF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

37. EF0658Ensure services provided by the nursing facility meet professional standards of quality.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

38. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

39. DF0685Assist a resident in gaining access to vision and hearing services.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

40. DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

41. EF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

42. EF0698Provide safe, appropriate dialysis care/services for a resident who requires such services.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

43. EF0700Try 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.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

44. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

45. DF0758Implement 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.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

46. EF0760Ensure that residents are free from significant medication errors.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

47. EF0802Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.2024-10-11 · Health · corrected 2024-12-06

    Potential for more than minimal harm

48. 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.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

49. EF0804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

50. EF0805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

51. JF0806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.2024-10-11 · Health · corrected 2024-11-18

    Immediate jeopardy

52. EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

53. EF0813Have a policy regarding use and storage of foods brought to residents by family and other visitors.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

54. EF0814Dispose of garbage and refuse properly.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

55. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

56. EF0880Provide and implement an infection prevention and control program.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

57. EF0887Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

58. DF0908Keep all essential equipment working safely.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

59. EF0925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.2024-10-11 · Health · corrected 2024-11-18

    Potential for more than minimal harm

60. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-09-10 · Health · corrected 2024-09-26

    Potential for more than minimal harm

61. DF0626Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.2024-09-10 · Health · corrected 2024-09-26

    Potential for more than minimal harm

62. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-08-21 · Health · corrected 2024-09-16

    Potential for more than minimal harm

63. DF0576Ensure residents have reasonable access to and privacy in their use of communication methods.2024-08-05 · Health · corrected 2024-09-23

    Potential for more than minimal harm

64. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-08-05 · Health · corrected 2024-08-29

    Potential for more than minimal harm

65. DF0610Respond appropriately to all alleged violations.2024-08-05 · Health · corrected 2024-08-29

    Potential for more than minimal harm

66. DF0880Provide and implement an infection prevention and control program.2024-08-05 · Health · corrected 2024-09-23

    Potential for more than minimal harm

67. DF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-07-18 · Health · corrected 2024-08-20

    Potential for more than minimal harm

68. DF0558Reasonably accommodate the needs and preferences of each resident.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

69. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

70. JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2024-06-07 · Health · corrected 2024-07-15

    Immediate jeopardy

71. DF0610Respond appropriately to all alleged violations.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

72. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

73. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

74. EF0712Ensure that the resident and his/her doctor meet face-to-face at all required visits.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

75. 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.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

76. CF0838Conduct 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.2024-06-07 · Health · corrected 2024-07-15

    Potential for minimal harm

77. EF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-06-07 · Health · corrected 2024-07-15

    Potential for more than minimal harm

78. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2024-04-10 · Health · corrected 2024-04-27

    Potential for more than minimal harm

79. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2024-04-10 · Health · corrected 2024-04-27

    Potential for more than minimal harm

80. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-02-23 · Health · corrected 2024-03-06

    Potential for more than minimal harm

81. DF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

82. DF0580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

83. DF0697Provide safe, appropriate pain management for a resident who requires such services.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

84. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

85. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

86. EF0880Provide and implement an infection prevention and control program.2024-01-25 · Health · corrected 2024-02-16

    Potential for more than minimal harm

87. GF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-12-04 · Health · corrected 2023-12-24

    Actual harm

88. GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-11-14 · Health · corrected 2023-12-14

    Actual harm

89. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2023-10-25 · Health · corrected 2023-11-15

    Potential for more than minimal harm

90. EF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

91. DF0554Allow residents to self-administer drugs if determined clinically appropriate.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

92. EF0558Reasonably accommodate the needs and preferences of each resident.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

93. EF0576Ensure residents have reasonable access to and privacy in their use of communication methods.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

94. 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.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

95. EF0584Honor 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.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

96. DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

97. DF0641Ensure each resident receives an accurate assessment.2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

98. DF0645PASARR screening for Mental disorders or Intellectual Disabilities2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

99. DF0655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted2023-10-06 · Health · corrected 2023-10-30

    Potential for more than minimal harm

100. EF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

101. DF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

102. EF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

103. DF0676Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

104. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

105. DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

106. 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.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

107. DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

108. EF0690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

109. DF0692Provide enough food/fluids to maintain a resident's health.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

110. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

111. DF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

112. DF0758Implement 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.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

113. 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.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

114. DF0804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

115. EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

116. EF0849Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

117. EF0880Provide and implement an infection prevention and control program.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

118. EF0925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.2023-10-06 · Health · corrected 2023-10-30

     Potential for more than minimal harm

119. DF0760Ensure that residents are free from significant medication errors.2023-09-29 · Health · corrected 2023-10-13

     Potential for more than minimal harm

120. GF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2023-09-27 · Health · corrected 2023-10-31

     Actual harm

121. DF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2023-09-27 · Health · corrected 2023-10-31

     Potential for more than minimal harm

122. EF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2023-09-27 · Health · corrected 2023-10-31

     Potential for more than minimal harm

123. EF0757Ensure each resident’s drug regimen must be free from unnecessary drugs.2023-09-27 · Health · corrected 2023-10-31

     Potential for more than minimal harm

124. EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2023-09-27 · Health · corrected 2023-10-31

     Potential for more than minimal harm

125. DF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-09-22 · Health · corrected 2023-10-15

     Potential for more than minimal harm

126. DF0558Reasonably accommodate the needs and preferences of each resident.2023-09-07 · Health · corrected 2023-10-31

     Potential for more than minimal harm

127. JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2023-09-07 · Health · corrected 2023-10-31

     Immediate jeopardy

128. JF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-09-07 · Health · corrected 2023-10-31

     Immediate jeopardy

129. DF0712Ensure that the resident and his/her doctor meet face-to-face at all required visits.2023-09-07 · Health · corrected 2023-10-31

     Potential for more than minimal harm

130. DF0726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.2023-09-07 · Health · corrected 2023-10-31

     Potential for more than minimal harm

131. EF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2023-09-07 · Health · corrected 2023-10-31

     Potential for more than minimal harm

132. EF0880Provide and implement an infection prevention and control program.2023-09-07 · Health · corrected 2023-10-31

     Potential for more than minimal harm

133. DF0880Provide and implement an infection prevention and control program.2023-09-01 · Health · corrected 2023-09-15

     Potential for more than minimal harm

134. DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-08-23 · Health · corrected 2023-09-08

     Potential for more than minimal harm

135. EF0697Provide safe, appropriate pain management for a resident who requires such services.2023-08-23 · Health · corrected 2023-09-08

     Potential for more than minimal harm

136. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2023-08-14 · Health · corrected 2023-08-21

     Potential for more than minimal harm

137. 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.2023-07-27 · Health · corrected 2023-08-10

     Potential for more than minimal harm

138. DF0583Keep residents' personal and medical records private and confidential.2023-07-19 · Health · corrected 2023-08-10

     Potential for more than minimal harm

139. DF0585Honor 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.2023-07-19 · Health · corrected 2023-08-10

     Potential for more than minimal harm

140. DF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2023-06-30 · Health · corrected 2023-07-16

     Potential for more than minimal harm

141. DF0880Provide and implement an infection prevention and control program.2023-06-30 · Health · corrected 2023-07-16

     Potential for more than minimal harm

142. DF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

143. EF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

144. EF0698Provide safe, appropriate dialysis care/services for a resident who requires such services.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

145. EF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

146. DF0838Conduct 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.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

147. EF0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.2023-06-21 · Health · corrected 2023-07-15

     Potential for more than minimal harm

148. DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2023-05-12 · Health · corrected 2023-05-30

     Potential for more than minimal harm

149. DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-05-12 · Health · corrected 2023-05-30

     Potential for more than minimal harm

150. 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.2023-04-27 · Health · corrected 2023-05-12

     Potential for more than minimal harm

151. DF0692Provide enough food/fluids to maintain a resident's health.2023-04-27 · Health · corrected 2023-05-12

     Potential for more than minimal harm

152. DF0925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.2023-04-11 · Health · corrected 2023-05-05

     Potential for more than minimal harm

153. DF0610Respond appropriately to all alleged violations.2023-03-16 · Health · corrected 2023-04-04

     Potential for more than minimal harm

154. EF0550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

155. EF0558Reasonably accommodate the needs and preferences of each resident.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

156. 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.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

157. DF0583Keep residents' personal and medical records private and confidential.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

158. EF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

159. DF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

160. DF0677Provide care and assistance to perform activities of daily living for any resident who is unable.2022-10-28 · Health · corrected 2023-01-17

     Potential for more than minimal harm

161. 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.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

162. GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2022-10-28 · Health · corrected 2022-12-14

     Actual harm

163. DF0690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

164. GF0692Provide enough food/fluids to maintain a resident's health.2022-10-28 · Health · corrected 2022-12-14

     Actual harm

165. DF0755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

166. DF0758Implement 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.2022-10-28 · Health · corrected 2023-01-17

     Potential for more than minimal harm

167. DF0760Ensure that residents are free from significant medication errors.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

168. 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.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

169. EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

170. DF0880Provide and implement an infection prevention and control program.2022-10-28 · Health · corrected 2022-12-14

     Potential for more than minimal harm

Ownership

Other facilities in SYLMAR

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