Windsor The Ridge Rehabilitation Center
WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA — inspection on November 25, 2025.
Found 7 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
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0552 during a standard health inspection conducted on 2025-11-25.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Ensure that residents are fully informed and understand their health status, care and treatments.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0605 during a standard health inspection conducted on 2025-11-25.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
The facility was found deficient in the following area: Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0676 during a standard health inspection conducted on 2025-11-25.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.
During further interview, RN 1 stated that Resident 23 had his wander guard (a technology system used in facilities like hospitals and senior living homes to prevent residents at risk of wandering from leaving a secure area) on his left wrist but nobody heard the alarm when resident left. RN 1 also stated that they did not find Resident 23's wander guard in the facility. RN 1 further stated that Resident 23 was high risk for elopement thus, he was placed on one-on-one (1:1) supervision in July 2025 but was discontinued in mid-August 2025. RN 1 also stated that Resident 23 had episodes of leaving the facility prior to this incident.
During an interview on 9/25/25 at 3:58 PM, Certified Nursing Assistant (CNA) 2 stated that Resident 23 had left the facility more than once and placed a designated CNA to provide 1:1 supervision. CNA 2 also stated that an order and intervention to check resident every 15-20 minutes was in place.Review of Resident 23's active orders for September 2025 indicated, Monitor episode of exit seeking the facility every shift for episode of elopement.
Monitor wander guard placement #36 to left wrist for function and location every shift.
Monitor wander guard for placement and functioning hourly.Review of Resident 23's elopement care plan revised on 9/11/25 indicated, [Resident 23] has increase supervision-initiated r/t leaving the facility without staff knowledge . [Resident 23] noted removing wander guard using metal utensils.
The care plan indicated interventions including, Ensure bedroom screen door is locked at all times.
Initiated increased supervision and monitoring .
Monitor and document behaviors and triggers that may lead to elopement.
Monitor wander guard #36 placement and functioning.
Provide plastic utensils in all meals.During a concurrent interview and record review on 9/25/25 at 4:53 PM with the DON Resident 23's care plan was reviewed.
The DON stated that the new intervention they added on 9/11/25 was to provide plastic utensils in all meals to resident.
The DON also stated that increased supervision and monitoring was continued.
Review of the facility's policy and procedure titled, Elopement, revised 2/21/25, indicated, .The facility shall establish and utilize
Facility ID:
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0755 during a standard health inspection conducted on 2025-11-25.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0756 during a standard health inspection conducted on 2025-11-25.
Category: Pharmacy Service Deficiencies
The facility was found deficient in the following area: Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.
Federal health inspectors cited WINDSOR THE RIDGE REHABILITATION CENTER in SALINAS, CA for a deficiency under regulatory tag F-F0757 during a standard health inspection conducted on 2025-11-25.
Category: Pharmacy Service Deficiencies
The facility was found deficient in the following area: Ensure each resident’s drug regimen must be free from unnecessary drugs.
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 7 deficiencies cited during this inspection of WINDSOR THE RIDGE REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-26.