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Complaint Investigation

Fortuna Rehabilitation And Wellness Center, Lp

January 29, 2026 · Fortuna, CA · 2321 Newburg Road
Citations 2
CMS Rating 2/5
Beds 104
Provider ID 056361
Healthcare Facility
Fortuna Rehabilitation And Wellness Center, Lp
Fortuna, CA  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

FORTUNA REHABILITATION AND WELLNESS CENTER, LP in FORTUNA, CA — inspection on January 29, 2026.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0600
Freedom from Abuse, Neglect, and Exploitation Deficiencies

During a review of the facility's policy titled, Abuse Prevention and Management, effective 2024, the policy stipulated, The facility does not condone any form of resident abuse., include[ing] verbal abuse.

Verbal abuse is defined as any use of oral, written, gestured communication, or sounds that willfully includes despairing and derogatory terms directed to resident.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

056361 01/29/2026

Fortuna Rehabilitation and Wellness Center, LP 2321 Newburg Road Fortuna, CA 95540

assessment and conduct 72-hour monitoring for Resident 1 after an alleged abuse incident.This failure

nursing needs for the resident.A review of Resident 1's admission record indicated he was admitted in October 2025 with the diagnosis of encounter for palliative care (specialized medical care for individuals living with serious, chronic or life threatening illness that focuses on providing relief from the symptoms, pain and stress), acute chronic systolic (congestive) heart failure (a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling), muscle weakness, hearing loss and absence of left leg, below the knee.A review of Resident 1's Minimum Data Set (MDS- a federally mandated resident assessment tool), dated 1/10/26, indicated Resident 1 had slight memory impairment.In an interview on 1/29/26 at 10:41 p.m. with the Director of Nursing (DON), the DON confirmed she was aware of the allegation of abuse that occurred on 1/9/26.

The DON stated she expected licensed nurses to have charted a Change of Condition (COC) on the resident's chart, documented when the MD and family were notified, updated the residents' care plan and monitor the residents for 72 hours after the alleged abuse incident.

The DON further stated she also expected the Social Services Director (SSD) to follow-up with the resident and document what occurred during the conversation.In a concurrent interview and record review on 1/29/26 at 10:25 a.m., the DON confirmed the social services 72-hour checks were lacking and there was no assessment documented or progress notes.A review of the facility's undated Abuse Reporting and Documentation lesson plan indicated LNs were to, complete assessment. and skin assessment of alleged victim.notify MD. add to alert charting x [for] 72 hours with appropriate monitors in place for increased distress. LN to document psychosocial q [every] shift and Social Services to document psychosocial q [every] day. IDT [Interdisciplinary Team, a group of healthcare professionals from different fields who collaborate and coordinate a resident's care needs] to review allegations promptly. A review of the facility's policy titled, Abuse Prevention and Management, revised 5/30/24, indicated, the resident will be assessed by the licensed nurse for any physical injuries or emotional distress.

Notify the physician and provide treatment as ordered.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in FORTUNA, CA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from FORTUNA REHABILITATION AND WELLNESS CENTER, LP or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.