North Bay Post Acute
300 Douglas Street, Petaluma, CA 94952Map
Medicare/Medicaid certified98 certified beds~96 residents/dayFor profit - Limited Liability company
What the abuse icon means moreless
CMS flags a facility with its abuse icon when inspectors cited it for abuse that harmed a resident within the past year, or for abuse that could have harmed a resident in each of the last two years. CMS shows this same icon on its own Care Compare site, and caps the facility's ratings while it's flagged. The icon is removed when newer inspections come back clean. The deficiency list below will contain the underlying citations — read them.
What to do with this: read the abuse-related citations below, and ask the facility directly what happened and what changed. Verify the current status at medicare.gov/care-compare.
Last standard health inspection: January 9, 2026
North Bay Post Acute is a 98-bed for-profit, LLC-owned nursing home in Petaluma, Sonoma County, California, serving an average of 96 residents per day. As of CMS data processed June 1, 2026, its overall rating is 1 of 5 stars.
CMS star ratings
CMS scores every nursing home 1–5 stars overall, built from three sub-ratings. moreless
Medicare inspects and measures every certified nursing home, then rolls the results into a 1–5 star overall rating. It combines three parts: health inspections, staffing, and quality measures. Five stars means much better than average — it does not mean perfect. One star means much worse than average — it does not mean every shift is bad. Stars are a screening tool, not a verdict. They can lag reality by months, and they can't see things like how kind the aides are or how the building smells at 7am.
What to do with this: use stars to build a shortlist, then visit in person. Nothing on this site replaces walking the halls.
Health-inspection stars are graded on a curve within each state — never compare stars across state lines. moreless
CMS sets health-inspection star cutoffs separately for each state: roughly the top 10% of homes in a state get 5 stars, the bottom 20% get 1 star, no matter how the state compares to others. That means a 4-star home in one state and a 4-star home in another state may have very different inspection records. The stars tell you how a home compares to its neighbors, not to the whole country. That's why this site shows your state's median next to each star rating — and never a national star comparison.
What to do with this: compare stars only between homes in the same state. To compare across states, use staffing hours — those are real numbers, not curves.
Not all three sub-ratings are equally hard to game: inspections are the most objective, quality measures the least. moreless
The three sub-ratings come from different sources. Health inspections are done on-site by trained state surveyors who show up mostly unannounced — the most objective signal. Staffing comes from payroll records that facilities must submit and CMS audits — quite reliable. Quality measures are partly self-reported by the facility from its own resident assessments — useful, but the facility grades some of its own homework.
What to do with this: when sub-ratings disagree, weigh the inspection star most and the quality-measure star least.
Staffing
Reported hours per resident per day, from payroll records. Hours, unlike stars, can be compared across states.
Hours per resident per day: total staff hours worked, divided by the number of residents. moreless
If a home reports 3.5 total nursing hours per resident per day, that's all nursing staff time across 24 hours — roughly one caregiver-hour every 7 hours per resident, spread across day, evening, and night shifts. On a real floor it decides whether call lights get answered in 5 minutes or 25, whether someone has time to help with dinner, and whether night shift is one aide for a hall or two. Unlike star ratings, hours are actual numbers, so they CAN be compared across state lines.
What to do with this: compare a home's hours to the state and national medians shown, and ask the facility how the hours split across day, evening, and night shifts.
RN (registered nurse) hours
This facility did not submit staffing data.
LPN (licensed practical nurse) hours
This facility did not submit staffing data.
Nurse aide hours
This facility did not submit staffing data.
Total nursing hours
This facility did not submit staffing data.
CMS also adjusts these numbers for how sick each home’s residents are — a home with sicker residents needs more staff for the same star.
CMS also adjusts staffing numbers for how sick each home's residents are. moreless
A home full of short-term rehab patients needs different staffing than a home caring for people with advanced dementia or ventilators. Case-mix adjustment estimates how many hours a home's particular residents need, then scales the reported hours so homes can be compared fairly. A home with sicker residents needs more staff for the same star. This page shows reported (raw payroll) numbers and compares them only to other reported numbers — like with like.
What to do with this: if a home's reported hours look low, check whether its residents may simply need less care — and ask the facility directly.
Staff turnover
Turnover: The facility's staffing data was missing or invalid for calculating turnover, so this measure receives the minimum staffing points.
The share of nursing staff who left within the year. Lower is steadier. moreless
Total nursing staff turnover is the percentage of the home's nurses and aides who stopped working there during the year. Around half of nursing-home staff leaving annually is sadly common in this industry. High turnover means residents are cared for by people who don't know them — which matters enormously for dementia care, pain management, and noticing the small changes that catch problems early. Low turnover usually means staff are treated well enough to stay.
What to do with this: when you visit, ask aides how long they've worked there. Long-tenured aides are the best sign a building has.
Inspections & deficiencies
The last 3 inspection cycles, from CMS’s federal health-survey file. State-only citations and fire-safety surveys are not included — an empty list means nothing federal is in this file, not that nothing ever happened.
Each deficiency gets a letter A–L: how severe it was × how widespread it was. moreless
Surveyors grade every deficiency on a grid. Severity runs from 'potential for minimal harm' up to 'immediate jeopardy to resident health or safety.' Scope runs from isolated (one or a few residents) to pattern to widespread. A and B are paperwork-level; D–F caused no actual harm but had the potential; G–I caused actual harm; J, K, and L mean immediate jeopardy — the most serious finding a surveyor can make. Most citations nationally are D–E.
What to do with this: scan for G or higher. One J/K/L tells you more than ten D's.
Standard surveys are routine; complaint surveys happen because someone reported a problem. moreless
A standard survey is the routine top-to-bottom inspection every home gets on a recurring cycle. A complaint survey happens because a resident, family member, or staff member reported something to the state — surveyors come specifically to investigate it. Infection-control surveys focus on practices like hand hygiene and isolation procedures. A deficiency found during a complaint survey means someone cared enough to report it and a surveyor confirmed enough to cite it.
What to do with this: note which deficiencies came from complaints — they show you what residents and families actually experienced.
The F-number on each deficiency is CMS's code for which federal requirement was violated. moreless
Every federal nursing-home requirement has a tag number. F0686, for example, is the pressure-ulcer requirement; F0600 is freedom from abuse. The tag tells you exactly which rule was broken, and the description next to it is CMS's own plain-language summary of that rule. The same tag appearing across multiple inspections is a pattern worth noticing.
What to do with this: if the same tag repeats across surveys, ask the facility what changed since the last citation.
This data shows federal health surveys only — state-only citations and fire-safety surveys aren't included. moreless
CMS's public deficiency file contains federal health-survey citations. It does not include citations issued under state-only rules, fire-safety (Life Safety Code) surveys, or anything older than three inspection cycles. A facility with no rows here may still have state citations or fire-safety findings. 'No deficiencies in this file' never means 'no violations ever.'
What to do with this: for the full picture, check your state health department's site and medicare.gov/care-compare, which shows fire-safety results separately.
91 deficiencies across the last 3 inspection cycles, in CMS’s federal health-survey file:
- Resident Assessment and Care Planning: 20
- Quality of Life and Care: 14
- Resident Rights: 12
- Pharmacy Service: 10
- Freedom from Abuse, Neglect, and Exploitation: 8
- Nutrition and Dietary: 7
- Environmental: 6
- Infection Control: 5
- Nursing and Physician Services: 5
- Administration: 4
April 14, 2026Complaint surveyTag F0600D — no actual harm, potential for more than minimal harm, isolated
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Deficient, Provider has date of correction · corrected May 1, 2026
April 14, 2026Complaint surveyTag F0657D — no actual harm, potential for more than minimal harm, isolated
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Deficient, Provider has date of correction · corrected May 1, 2026
January 9, 2026Standard surveyTag F0580D — no actual harm, potential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0584D — no actual harm, potential for more than minimal harm, isolated
Honor 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.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0609D — no actual harm, potential for more than minimal harm, isolated
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0641E — no actual harm, potential for more than minimal harm, pattern
Ensure each resident receives an accurate assessment.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0655E — no actual harm, potential for more than minimal harm, pattern
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0677D — no actual harm, potential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0700D — no actual harm, potential for more than minimal harm, isolated
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.
Deficient, Provider has date of correction · corrected February 5, 2026
Show 81 more deficiencies
January 9, 2026Standard surveyTag F0755D — no actual harm, potential for more than minimal harm, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0791D — no actual harm, potential for more than minimal harm, isolated
Provide or obtain dental services for each resident.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0812F — no actual harm, potential for more than minimal harm, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0813D — no actual harm, potential for more than minimal harm, isolated
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0842F — no actual harm, potential for more than minimal harm, widespread
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Deficient, Provider has date of correction · corrected February 5, 2026
January 9, 2026Standard surveyTag F0926D — no actual harm, potential for more than minimal harm, isolated
Have policies on smoking.
Deficient, Provider has date of correction · corrected February 5, 2026
December 30, 2025Complaint surveyTag F0755D — no actual harm, potential for more than minimal harm, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Deficient, Provider has date of correction · corrected January 16, 2026
October 22, 2025Complaint surveyTag F0600G — actual harm, isolated
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Deficient, Provider has date of correction · corrected November 11, 2025
July 15, 2025Complaint surveyTag F0880D — no actual harm, potential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected August 13, 2025
July 15, 2025Complaint surveyTag F0919D — no actual harm, potential for more than minimal harm, isolated
Make sure that a working call system is available in each resident's bathroom and bathing area.
Deficient, Provider has date of correction · corrected August 13, 2025
April 28, 2025Complaint surveyTag F0610D — no actual harm, potential for more than minimal harm, isolated
Respond appropriately to all alleged violations.
Deficient, Provider has date of correction · corrected May 16, 2025
April 25, 2025Complaint surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected May 12, 2025
April 7, 2025Complaint surveyTag F0658G — actual harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected May 1, 2025
January 17, 2025Standard surveyTag F0552D — no actual harm, potential for more than minimal harm, isolated
Ensure that residents are fully informed and understand their health status, care and treatments.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0558D — no actual harm, potential for more than minimal harm, isolated
Reasonably accommodate the needs and preferences of each resident.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0578D — no actual harm, potential for more than minimal harm, isolated
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.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0584F — no actual harm, potential for more than minimal harm, widespread
Honor 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.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0606D — no actual harm, potential for more than minimal harm, isolated
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0607F — no actual harm, potential for more than minimal harm, widespread
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0623D — no actual harm, potential for more than minimal harm, isolated
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0641E — no actual harm, potential for more than minimal harm, pattern
Ensure each resident receives an accurate assessment.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0644D — no actual harm, potential for more than minimal harm, isolated
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0656D — no actual harm, potential for more than minimal harm, isolated
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0657D — no actual harm, potential for more than minimal harm, isolated
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0685D — no actual harm, potential for more than minimal harm, isolated
Assist a resident in gaining access to vision and hearing services.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0712D — no actual harm, potential for more than minimal harm, isolated
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0726F — no actual harm, potential for more than minimal harm, widespread
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.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0742D — no actual harm, potential for more than minimal harm, isolated
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0745D — no actual harm, potential for more than minimal harm, isolated
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0756D — no actual harm, potential for more than minimal harm, isolated
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0758D — no actual harm, potential for more than minimal harm, isolated
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.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0759F — no actual harm, potential for more than minimal harm, widespread
Ensure medication error rates are not 5 percent or greater.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0760D — no actual harm, potential for more than minimal harm, isolated
Ensure that residents are free from significant medication errors.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0761E — no actual harm, potential for more than minimal harm, pattern
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.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0791D — no actual harm, potential for more than minimal harm, isolated
Provide or obtain dental services for each resident.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0812D — no actual harm, potential for more than minimal harm, isolated
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0813D — no actual harm, potential for more than minimal harm, isolated
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0842D — no actual harm, potential for more than minimal harm, isolated
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0865F — no actual harm, potential for more than minimal harm, widespread
Have a plan that describes the process for conducting QAPI and QAA activities.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0867F — no actual harm, potential for more than minimal harm, widespread
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0880F — no actual harm, potential for more than minimal harm, widespread
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0881E — no actual harm, potential for more than minimal harm, pattern
Implement a program that monitors antibiotic use.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0912E — no actual harm, potential for more than minimal harm, pattern
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Deficient, Provider has date of correction · corrected March 13, 2025
January 17, 2025Standard surveyTag F0943F — no actual harm, potential for more than minimal harm, widespread
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Deficient, Provider has date of correction · corrected March 13, 2025
December 23, 2024Complaint surveyTag F0609D — no actual harm, potential for more than minimal harm, isolated
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Deficient, Provider has date of correction · corrected January 3, 2025
December 12, 2024Complaint surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected December 27, 2024
December 3, 2024Complaint surveyTag F0561E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Deficient, Provider has date of correction · corrected December 27, 2024
December 3, 2024Complaint surveyTag F0622E — no actual harm, potential for more than minimal harm, pattern
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Deficient, Provider has date of correction · corrected December 27, 2024
September 16, 2024Complaint surveyTag F0689D — no actual harm, potential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected October 7, 2024
May 15, 2024Complaint surveyTag F0623D — no actual harm, potential for more than minimal harm, isolated
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Deficient, Provider has date of correction · corrected August 14, 2024
April 30, 2024Complaint surveyTag F0725E — no actual harm, potential for more than minimal harm, pattern
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected May 24, 2024
April 30, 2024Complaint surveyTag F0812L — immediate jeopardy to resident health or safety, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected May 24, 2024
April 30, 2024Complaint surveyTag F0814F — no actual harm, potential for more than minimal harm, widespread
Dispose of garbage and refuse properly.
Deficient, Provider has date of correction · corrected May 24, 2024
April 30, 2024Complaint surveyTag F0835F — no actual harm, potential for more than minimal harm, widespread
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Deficient, Provider has date of correction · corrected May 24, 2024
April 30, 2024Complaint surveyTag F0925F — no actual harm, potential for more than minimal harm, widespread
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Deficient, Provider has date of correction · corrected May 24, 2024
August 23, 2023Complaint surveyTag F0686D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Deficient, Provider has date of correction · corrected September 12, 2023
August 11, 2023Complaint surveyTag F0584D — no actual harm, potential for more than minimal harm, isolated
Honor 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.
Deficient, Provider has date of correction · corrected October 28, 2023
August 11, 2023Complaint surveyTag F0656D — no actual harm, potential for more than minimal harm, isolated
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Deficient, Provider has date of correction · corrected October 28, 2023
August 11, 2023Complaint surveyTag F0825D — no actual harm, potential for more than minimal harm, isolated
Provide or get specialized rehabilitative services as required for a resident.
Deficient, Provider has date of correction · corrected October 28, 2023
January 18, 2023Standard surveyTag F0552E — no actual harm, potential for more than minimal harm, pattern
Ensure that residents are fully informed and understand their health status, care and treatments.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0637D — no actual harm, potential for more than minimal harm, isolated
Assess the resident when there is a significant change in condition
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0638F — no actual harm, potential for more than minimal harm, widespread
Assure that each resident’s assessment is updated at least once every 3 months.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0640E — no actual harm, potential for more than minimal harm, pattern
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0641E — no actual harm, potential for more than minimal harm, pattern
Ensure each resident receives an accurate assessment.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0679F — no actual harm, potential for more than minimal harm, widespread
Provide activities to meet all resident's needs.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0689G — actual harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0692D — no actual harm, potential for more than minimal harm, isolated
Provide enough food/fluids to maintain a resident's health.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0699D — no actual harm, potential for more than minimal harm, isolated
Provide care or services that was trauma informed and/or culturally competent.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0725E — no actual harm, potential for more than minimal harm, pattern
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0727D — no actual harm, potential for more than minimal harm, isolated
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0756E — no actual harm, potential for more than minimal harm, pattern
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0759E — no actual harm, potential for more than minimal harm, pattern
Ensure medication error rates are not 5 percent or greater.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0761E — no actual harm, potential for more than minimal harm, pattern
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.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0801F — no actual harm, potential for more than minimal harm, widespread
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0867E — no actual harm, potential for more than minimal harm, pattern
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0880E — no actual harm, potential for more than minimal harm, pattern
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0883E — no actual harm, potential for more than minimal harm, pattern
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0920F — no actual harm, potential for more than minimal harm, widespread
Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture.
Deficient, Provider has date of correction · corrected March 13, 2023
January 18, 2023Standard surveyTag F0926E — no actual harm, potential for more than minimal harm, pattern
Have policies on smoking.
Deficient, Provider has date of correction · corrected March 13, 2023
Fines & penalties
CMS can fine a home or stop paying for new admissions. Shown per CMS's current data window (~3 years) — not all-time. moreless
When deficiencies are serious or aren't fixed, CMS can impose a fine (a civil money penalty) or a payment denial — refusing to pay for new Medicare/Medicaid admissions until the home fixes the problem. Payment denials hit harder than most fines because they stop revenue. CMS's public dataset covers a rolling window of roughly the last three years, so the totals here are recent history, not an all-time record. Many facilities have no penalties in the window — that's common, not remarkable.
What to do with this: a recent large fine deserves a direct question on your visit — what happened, and what changed?
Fines: 2 totaling $142,877 — per CMS data (rolling ~3-year window).
| Date | Type | Amount / length |
|---|---|---|
| April 7, 2025 | Fine | $23,685 |
| April 30, 2024 | Fine | $119,192 |
Ownership & chain
Who actually owns and controls the facility — individuals, companies, and their stakes. moreless
Nursing homes are often owned through layers: an operating company, a property company, management companies, and individual investors with percentage stakes. CMS publishes who holds 5%-or-greater interests and who has operational control. Ownership matters because it sets the budget: research has linked some ownership structures, especially certain chains and investment vehicles, to lower staffing. That's a pattern across the industry, not a verdict on any one building.
What to do with this: know who owns the home before you sign anything, and ask the administrator who actually sets the staffing budget.
CMS lists no chain affiliation for this facility.
| Owner / manager | Role | Stake | Since |
|---|---|---|---|
| Zermatt U.S. Health Services, LLC (Organization) | 5% or greater direct ownership interest | 99% | 01/01/2021 |
| Tanner, Bryan (Individual) | 5% or greater indirect ownership interest | 50% | 01/01/2021 |
| Tanner, Renae (Individual) | 5% or greater indirect ownership interest | 50% | 01/01/2021 |
| Tanner, Bryan (Individual) | Corporate officer | NOT APPLICABLE | 01/01/2021 |
| Moore, Brett (Individual) | Operational/managerial control | NOT APPLICABLE | 01/01/2021 |
| Zermatt U.S. Health Services, LLC (Organization) | Operational/managerial control | NOT APPLICABLE | 01/01/2021 |
Nearby facilities in Sonoma County
Most families compare 2–3 homes. Same county, sorted by overall rating:
Visiting? Go in with questions.
Built from this facility’s own CMS data — bring them on the tour.
- CMS has applied its abuse icon to this facility — ask what happened, what the corrective plan was, and how staff are trained now.
- CMS shows this facility did not submit staffing data — ask to see current staffing schedules for the unit your person would live on.
- CMS data shows 2 fines totaling $142,877 in its current data window — ask what the citations were for and what changed afterward.
- Their last standard health inspection was January 9, 2026 — ask what's improved since then.
- CMS records that this facility has a resident council — ask to speak with a council member before deciding.
- They have 98 certified beds and serve an average of 96 residents per day — ask which unit your person would be on and who staffs it overnight.
- CMS lists no chain affiliation for this facility — ask who owns the home and who sets the staffing budget.
Data: Centers for Medicare & Medicaid Services (data.cms.gov), processing date June 1, 2026. This site is not affiliated with CMS or any government agency.