Golden Empire
Inspection Findings
F-Tag F0583
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0583 during a standard health inspection conducted on 2025-08-22.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Keep residents' personal and medical records private and confidential.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0600
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0600 during a standard health inspection conducted on 2025-08-22.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
The facility was found deficient in the following area: Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0637
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0637 during a standard health inspection conducted on 2025-08-22.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Assess the resident when there is a significant change in condition
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0641
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0641 during a standard health inspection conducted on 2025-08-22.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Ensure each resident receives an accurate assessment.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0658
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0658 during a standard health inspection conducted on 2025-08-22.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Ensure services provided by the nursing facility meet professional standards of quality.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0684
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0684 during a standard health inspection conducted on 2025-08-22.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0697
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0697 during a standard health inspection conducted on 2025-08-22.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide safe, appropriate pain management for a resident who requires such services.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0755
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0755 during a standard health inspection conducted on 2025-08-22.
Category: Pharmacy Service Deficiencies
The facility was found deficient in the following area: Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0761
F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
During a review of the facility’s P&P titled “Medication Destruction,” undated, the P&P indicated, “…G. All controlled drugs are placed in an approved waste container properly labeled as medication waste or pharmaceutical waste…”
- 2. During a concurrent observation and interview on 8/22/25 at 9:27 a.m. with the DON, an inspection of the
- 2025. The DON stated, “Looks like they [staff] didn’t check it on those days.” The
- 2025. The crash cart log further indicated that the cart should contain three containers of normal saline, but
Station 2 Crash Cart identified that the crash cart log was not checked for multiple days from May to August
crash cart log indicated, “Crash cart will be checked every 24 hours and after each use. Replace any items that do not meet par.” The crash cart log further indicated that the cart should contain three containers of normal saline (a mixture of salt and water), but one container of normal saline and two containers of sterile water were observed inside the crash cart drawer. The DON stated, “Important to make sure everything is ready if there is an emergency…I think they messed up…”
During a concurrent observation and interview on 8/22/25 at 9:40 a.m. with the DON, an inspection of the Station 1 Crash Cart identified that the crash cart log was not checked for multiple days from May to August
two containers of normal saline and one pack of sterile water were observed inside the crash cart drawer.
The crash cart also contained a suction connection tubing that expired on 5/2011. The DON confirmed the
observation and stated, “It could be damaged, it could be compromised…”
During a review of the facility’s P&P titled “Crash Cart/E-carts,” dated 2/20/19, the P&P indicated, “…It is the policy of this facility to organize and maintain the emergency cart (E-cart) to ensure adequate needed equipment for CPR procedures…1. The nursing staff will ensure
the equipment are stocked in the E-cart…3. The E-cart will be inventoried and restocked after each use and checked daily and documented by nursing staff or the pharmacy consultant…6. Once a month the E-cart should be opened and checked for outdated supplies. 7. E-cart checks should be documented on the lists maintained on the E-cart…”
Findings
- 3. During a concurrent observation and interview on 8/22/25 at 9:36 a.m. with a Certified Nursing Assistant
2 (CNA 2) in the memory unit, the residents’ food refrigerator was observed. A medication bottle was stored inside the refrigerator door compartment. CNA 2 confirmed that a bottle containing medication was stored inside the refrigerator meant to be storing only food for residents.
During an interview on 8/22/25 at 9:50 a.m. with a Licensed Nurse 8 (LN 8), LN 8 confirmed a bottle of acidophilus probiotic (live microorganisms consumed for health benefits) was stored inside the resident food refrigerator. LN 8 stated medications stored in the same refrigerator with food posed a risk for cross contamination.
During an interview on 8/22/25 at 1:45 p.m. with the Director of Nursing (DON), the DON stated staff should not be storing any medication in the food refrigerators. DON stated all medications that needed refrigeration should be stored in a secured medication refrigerator in the unit.
During a review of the facility’s policy and procedure titled, “Medication Storage in the Facility, dated March 2018, indicated, “… Refrigerated medications are kept … separate from foods …”
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
F-Tag F0812
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-08-22.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0814
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0814 during a standard health inspection conducted on 2025-08-22.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Dispose of garbage and refuse properly.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0849
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0849 during a standard health inspection conducted on 2025-08-22.
Category: Administration Deficiencies
The facility was found deficient in the following area: Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0868
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0868 during a standard health inspection conducted on 2025-08-22.
Category: Administration Deficiencies
The facility was found deficient in the following area: Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0880
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-08-22.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
F-Tag F0925
Federal health inspectors cited GOLDEN EMPIRE in GRASS VALLEY, CA for a deficiency under regulatory tag F-F0925 during a standard health inspection conducted on 2025-08-22.
Category: Environmental Deficiencies
The facility was found deficient in the following area: Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 15 deficiencies cited during this inspection of GOLDEN EMPIRE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-12.
GOLDEN EMPIRE in GRASS VALLEY, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 GRASS VALLEY, 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 GOLDEN EMPIRE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.