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Santa Rosa Post Acute

📍 4650 Hoen Avenue, Santa-rosa, CA 95405 📞 (707) 546-0471 🛏️ 99 beds

Inspection History Overview

Detailed Inspection Reports

Notice: These are official CMS inspection narratives containing detailed regulatory findings. This information is not available in searchable format anywhere else online.

May 2, 2025 Complaint Investigation

Fines and Penalties by Year

2025 1 penalties totaling $10,166

$10,166
Jan 28, 2025

Fine

2022 8 penalties totaling $28,024

$2,818
Jul 11, 2022

Fine

$2,797
Jul 11, 2022

Fine

$8,080
Jun 21, 2022

Fine

$5,284
Jun 21, 2022

Fine

$5,244
Jun 21, 2022

Fine

$1,409
May 16, 2022

Fine

$1,398
May 16, 2022

Fine

$994
Feb 28, 2022

Fine

2021 3 penalties totaling $655

$0
Dec 31, 2021

Payment Denial

$655
Aug 2, 2021

Fine

$0
Jun 18, 2021

Payment Denial

2020 2 penalties totaling $10,165

$5,165
Aug 31, 2020

Fine

$5,000
Aug 31, 2020

Fine

2019 2 penalties totaling $13,904

$13,904
Mar 28, 2019

Fine

$0
Mar 28, 2019

Payment Denial

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Health Violations by Year

2025 8 violations

Tag 0607 F May 2, 2025

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

✓ Corrected: May 12, 2025
Tag 0610 F May 2, 2025

Respond appropriately to all alleged violations.

✓ Corrected: May 12, 2025
Tag 0607 D Apr 25, 2025

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

✓ Corrected: May 16, 2025
Tag 0609 D Apr 25, 2025

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

✓ Corrected: May 16, 2025
Tag 0609 E Apr 9, 2025

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

✓ Corrected: May 2, 2025
Tag 0584 E Mar 24, 2025

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.

✓ Corrected: Apr 7, 2025
Tag 0573 E Feb 24, 2025

Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

✓ Corrected: Mar 11, 2025
Tag 0678 G Jan 28, 2025

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

✓ Corrected: Feb 13, 2025

2024 9 violations

Tag 0692 D Aug 6, 2024

Provide enough food/fluids to maintain a resident's health.

✓ Corrected: Sep 15, 2024
Tag 0655 E Apr 10, 2024

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

✓ Corrected: Jul 12, 2024
Tag 0725 E Apr 10, 2024

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

✓ Corrected: Jul 12, 2024
Tag 0800 D Apr 10, 2024

Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.

✓ Corrected: Jul 12, 2024
Tag 0801 D Apr 10, 2024

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.

✓ Corrected: Jul 12, 2024
Tag 0804 E Apr 10, 2024

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

✓ Corrected: Jul 12, 2024
Tag 0600 E Jan 24, 2024

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

✓ Corrected: Feb 16, 2024
Tag 0656 E Jan 24, 2024

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

✓ Corrected: Feb 16, 2024
Tag 0839 D Jan 3, 2024

Employ staff that are licensed, certified, or registered in accordance with state laws.

✓ Corrected: Jan 13, 2024
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2023 20 violations

Tag 0684 E Dec 22, 2023

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

✓ Corrected: Jan 8, 2024
Tag 0755 D Dec 22, 2023

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

✓ Corrected: Jan 8, 2024
Tag 0880 E Dec 15, 2023

Provide and implement an infection prevention and control program.

✓ Corrected: Dec 31, 2023
Tag 0908 E Dec 14, 2023

Keep all essential equipment working safely.

✓ Corrected: Dec 30, 2023
Tag 0658 E Nov 2, 2023

Ensure services provided by the nursing facility meet professional standards of quality.

✓ Corrected: Nov 14, 2023
Tag 0684 E Sep 28, 2023

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

✓ Corrected: Oct 13, 2023
Tag 0550 D Jun 22, 2023

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

✓ Corrected: Jul 28, 2023
Tag 0657 E Jun 20, 2023

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

✓ Corrected: Aug 5, 2023
Tag 0689 E Jun 20, 2023

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Aug 5, 2023
Tag 0655 E Apr 24, 2023

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

✓ Corrected: May 11, 2023
Tag 0684 D Apr 24, 2023

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

✓ Corrected: May 11, 2023
Tag 0607 D Apr 12, 2023

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

✓ Corrected: Apr 28, 2023
Tag 0558 E Mar 14, 2023

Reasonably accommodate the needs and preferences of each resident.

✓ Corrected: Mar 29, 2023
Tag 0677 D Mar 14, 2023

Provide care and assistance to perform activities of daily living for any resident who is unable.

✓ Corrected: Mar 29, 2023
Tag 0684 G Mar 1, 2023

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

✓ Corrected: Apr 3, 2023
Tag 0880 D Mar 1, 2023

Provide and implement an infection prevention and control program.

✓ Corrected: Apr 3, 2023
Tag 0689 D Feb 28, 2023

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Mar 7, 2023
Tag 0656 D Feb 14, 2023

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

✓ Corrected: Feb 28, 2023
Tag 0676 D Jan 4, 2023

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

✓ Corrected: Jan 18, 2023
Tag 0921 D Jan 4, 2023

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

✓ Corrected: Jan 18, 2023

2022 18 violations

Tag 0584 D Dec 23, 2022

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.

✓ Corrected: Feb 1, 2023
Tag 0584 D Dec 21, 2022

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.

✓ Corrected: Jan 18, 2023
Tag 0684 D Dec 21, 2022

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

✓ Corrected: Jan 18, 2023
Tag 0689 E Dec 19, 2022

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Jan 31, 2023
Tag 0725 E Dec 19, 2022

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

✓ Corrected: Jan 31, 2023
Tag 0921 F Oct 13, 2022

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

✓ Corrected: Nov 17, 2022
Tag 0609 D Oct 5, 2022

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

✓ Corrected: Nov 18, 2022
Tag 0610 D Oct 5, 2022

Respond appropriately to all alleged violations.

✓ Corrected: Nov 18, 2022
Tag 0726 D Oct 5, 2022

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.

✓ Corrected: Nov 18, 2022
Tag 0730 D Oct 5, 2022

Observe each nurse aide's job performance and give regular training.

✓ Corrected: Nov 18, 2022
Tag 0600 D Sep 23, 2022

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

✓ Corrected: Oct 20, 2022
Tag 0677 D Aug 3, 2022

Provide care and assistance to perform activities of daily living for any resident who is unable.

✓ Corrected: Oct 12, 2022
Tag 0689 D Mar 3, 2022

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: May 10, 2022
Tag 0921 D Mar 3, 2022

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

✓ Corrected: May 10, 2022
Tag 0551 D Feb 22, 2022

Give the resident's representative the ability to exercise the resident's rights.

✓ Corrected: Mar 21, 2022
Tag 0558 D Feb 16, 2022

Reasonably accommodate the needs and preferences of each resident.

✓ Corrected: Jun 20, 2022
Tag 0573 D Feb 7, 2022

Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

✓ Corrected: Feb 28, 2022
Tag 0791 D Feb 7, 2022

Provide or obtain dental services for each resident.

✓ Corrected: Feb 28, 2022
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2021 22 violations

Tag 0880 E Dec 31, 2021

Provide and implement an infection prevention and control program.

✓ Corrected: Mar 7, 2022
Tag 0550 D Nov 18, 2021

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

✓ Corrected: Jan 17, 2022
Tag 0732 E Nov 18, 2021

Post nurse staffing information every day.

✓ Corrected: Jan 17, 2022
Tag 0880 E Sep 2, 2021

Provide and implement an infection prevention and control program.

✓ Corrected: Oct 20, 2021
Tag 0842 D Aug 27, 2021

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

✓ Corrected: Sep 15, 2021
Tag 0689 D Jun 18, 2021

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Sep 21, 2021
Tag 0725 E May 17, 2021

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

✓ Corrected: Jun 7, 2021
Tag 0550 D Apr 23, 2021

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

✓ Corrected: May 25, 2021
Tag 0575 D Apr 23, 2021

Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency.

✓ Corrected: May 25, 2021
Tag 0623 E Apr 23, 2021

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

✓ Corrected: May 25, 2021
Tag 0656 D Apr 23, 2021

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

✓ Corrected: May 25, 2021
Tag 0679 D Apr 23, 2021

Provide activities to meet all resident's needs.

✓ Corrected: May 25, 2021
Tag 0755 D Apr 23, 2021

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

✓ Corrected: May 25, 2021
Tag 0761 D Apr 23, 2021

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.

✓ Corrected: May 25, 2021
Tag 0842 D Apr 23, 2021

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

✓ Corrected: May 25, 2021
Tag 0880 D Apr 23, 2021

Provide and implement an infection prevention and control program.

✓ Corrected: May 25, 2021
Tag 0812 D Feb 22, 2021

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Tag 0880 D Feb 5, 2021

Provide and implement an infection prevention and control program.

✓ Corrected: Mar 17, 2021
Tag 0623 E Feb 3, 2021

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

✓ Corrected: Apr 7, 2021
Tag 0725 F Jan 27, 2021

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

✓ Corrected: Jun 1, 2021

2020 4 violations

Tag 0812 D Dec 17, 2020

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Tag 0880 E Dec 17, 2020

Provide and implement an infection prevention and control program.

Tag 0689 D Nov 16, 2020

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Mar 18, 2021
Tag 0880 E Aug 31, 2020

Provide and implement an infection prevention and control program.

✓ Corrected: Oct 15, 2020
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2019 25 violations

Tag 0760 E Jul 11, 2019

Ensure that residents are free from significant medication errors.

✓ Corrected: Aug 6, 2019
Tag 0689 D May 17, 2019

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Jul 29, 2019
Tag 0550 E Mar 28, 2019

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

✓ Corrected: Jul 24, 2019
Tag 0558 D Mar 28, 2019

Reasonably accommodate the needs and preferences of each resident.

✓ Corrected: Jun 3, 2019
Tag 0584 E Mar 28, 2019

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.

✓ Corrected: Jul 24, 2019
Tag 0641 D Mar 28, 2019

Ensure each resident receives an accurate assessment.

✓ Corrected: Jun 3, 2019
Tag 0645 E Mar 28, 2019

PASARR screening for Mental disorders or Intellectual Disabilities

✓ Corrected: Jun 3, 2019
Tag 0655 D Mar 28, 2019

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

✓ Corrected: Jul 24, 2019
Tag 0656 F Mar 28, 2019

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

✓ Corrected: Jun 3, 2019
Tag 0657 G Mar 28, 2019

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

✓ Corrected: Jul 24, 2019
Tag 0677 E Mar 28, 2019

Provide care and assistance to perform activities of daily living for any resident who is unable.

✓ Corrected: Jul 24, 2019
Tag 0688 D Mar 28, 2019

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

✓ Corrected: Jun 3, 2019
Tag 0689 G Mar 28, 2019

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

✓ Corrected: Jul 24, 2019
Tag 0725 F Mar 28, 2019

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

✓ Corrected: Jul 24, 2019
Tag 0741 E Mar 28, 2019

Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.

✓ Corrected: Jul 24, 2019
Tag 0744 D Mar 28, 2019

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

✓ Corrected: Jun 3, 2019
Tag 0755 D Mar 28, 2019

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

✓ Corrected: Jun 3, 2019
Tag 0756 E Mar 28, 2019

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

✓ Corrected: Jun 3, 2019
Tag 0759 D Mar 28, 2019

Ensure medication error rates are not 5 percent or greater.

✓ Corrected: Jun 3, 2019
Tag 0801 D Mar 28, 2019

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.

✓ Corrected: Jun 3, 2019

2018 7 violations

Tag 0550 E Mar 16, 2018

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

✓ Corrected: Apr 20, 2018
Tag 0578 E Mar 16, 2018

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.

✓ Corrected: Apr 20, 2018
Tag 0658 D Mar 16, 2018

Ensure services provided by the nursing facility meet professional standards of quality.

✓ Corrected: Apr 20, 2018
Tag 0690 D Mar 16, 2018

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

✓ Corrected: Apr 20, 2018
Tag 0710 D Mar 16, 2018

Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.

✓ Corrected: Apr 20, 2018
Tag 0760 D Mar 16, 2018

Ensure that residents are free from significant medication errors.

✓ Corrected: Apr 20, 2018
Tag 0761 E Mar 16, 2018

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.

✓ Corrected: Apr 20, 2018
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2017 12 violations

Tag 0283 D Sep 7, 2017

Provide proper discharge planning and communication, of the resident's health status and summary of the resident's nursing home stay.

✓ Corrected: Nov 9, 2017
Tag 0456 D Jul 21, 2017

Keep all essential equipment working safely.

✓ Corrected: Aug 28, 2017
Tag 0314 G Jul 6, 2017

Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.

✓ Corrected: Sep 6, 2017
Tag 0241 D Mar 10, 2017

Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality.

✓ Corrected: Apr 26, 2017
Tag 0279 D Mar 10, 2017

Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

✓ Corrected: Apr 27, 2017
Tag 0323 G Mar 10, 2017

Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.

✓ Corrected: Apr 27, 2017
Tag 0364 E Mar 10, 2017

Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.

✓ Corrected: Apr 27, 2017
Tag 0366 E Mar 10, 2017

Offer other nutritional food to each resident who will not eat the food served.

✓ Corrected: Apr 27, 2017
Tag 0371 F Mar 10, 2017

Store, cook, and serve food in a safe and clean way.

✓ Corrected: Apr 27, 2017
Tag 0441 E Mar 10, 2017

Have a program that investigates, controls and keeps infection from spreading.

✓ Corrected: Apr 27, 2017
Tag 0514 D Mar 10, 2017

Keep accurate, complete and organized clinical records on each resident that meet professional standards.

✓ Corrected: May 15, 2017
Tag 0517 F Mar 10, 2017

Have a detailed, written plan for disasters and emergencies, such as fire, severe weather, and missing residents.

✓ Corrected: Apr 27, 2017
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