Pasadena Grove Health Center
Inspection Findings
F-Tag F0607
F 0607
Administrator within 5 working days of the initial report. The Facility will submit a follow-up investigative report form or a substantively similar form.
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pasadena Grove Health Center
1470 N Fair Oaks Ave Pasadena, CA 91103
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
and the three State Agencies (CDPH, local PD and Ombudsman). LVN 1 stated it was the facility's policy to report suspected abuse to the abuse coordinator and the three State Agencies right away or within two hours of the incident. During a concurrent interview and record review on 12/19/2025, at 3:02 PM, with Social Services Director (SSD), Resident 1's Progress Note dated 12/18/2025, was reviewed. SSD stated
the Progress Note indicated Resident 1 was assaulted by another resident (Resident 2) (date of assault not indicated) and Resident 1 had called the police and CDPH on 12/18/2025. SSD stated she was not informed that on 12/18/2025, Resident 1 reported getting assaulted by Resident 2 to RNS 1. SSD stated
she was not informed that Resident 1 called the police and the police came and talked to Resident 1 on 12/18/2025SSD stated Resident 1's abuse allegation should have been reported to the State Agencies immediately or within two hours after the allegation was reported. SSD stated it was important to report abuse to the State Agencies to have documentation of what took place and to ensure the safety of the residents involved. During an interview on 12/19/2025, at 3:24 PM, with RNS 1, RNS 1 stated on 12/18/2025, Resident 1 was agitated and upset about her HTN medication. RNS 1 stated that while she was trying to calm Resident 1 down, Resident 1 informed her that she was being harassed in the facility and was assaulted by Resident 2 (unable to provide date of incident). RNS 1 stated the reported incident between Resident 1 and 2 should have been reported to the three State Agencies immediately or within two hours after Resident 1 reported it to her. RNS 1 stated it was important to report the incident to the three state agencies to protect and ensure the safety of the residents and to prevent further abuse. RNS 1 stated she did not follow the facility's abuse policy. During an interview on 12/19/2025, at 4:06 PM, with the Director of Nursing (DON), the DON stated he saw the police arrive at the facility on 12/18/2025. The DON stated he was informed by RNS 1 that Resident 1 was the one who called and spoke to the police. The DON stated he did not know the reason for the police visit and did not ask Resident 1 or RNS 1 for the reason for the police visit. The DON stated RNS 1 did not inform him on 12/18/2025 that Resident 1 reported to RNS 1 the Resident 1 was getting harassed and was assaulted by Resident 2. The DON stated if there is any report of suspected abuse, it should be reported to the State Agencies within two hours. The DON stated it was important to report suspected abuse to the abuse coordinator, CDPH, Ombudsman, and police so an investigation can be started, prevent future abuse in the facility, and for the safety of the residents. During a review of the facility's policy and procedure (P&P), titled, Abuse Prevention and Prohibition Program, revised 8/2023, the P&P indicated the following:To ensure the facility establishes, operationalizes, and maintains an Abuse Prevention and Prohibition Program designed to screen and train employees, protect residents, and to ensure a standardized methodology for prevention, identification, investigation, and reporting of abuse.The Facility will report allegations of abuse immediately but no later than 2 hours after forming the suspicion- if the alleged violation involves abuse or results in serious bodily injury to the state survey agency, adult protective services, law enforcement, and the Ombudsman.
Event ID:
Facility ID:
If continuation sheet
PASADENA GROVE HEALTH CENTER in PASADENA, 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 PASADENA, 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 PASADENA GROVE HEALTH CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.