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Complaint Investigation

Broadway Villa Post Acute

Inspection Date: December 24, 2025
Total Violations 1
Facility ID 055987
Location SONOMA, CA
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Inspection Findings

F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Based on interview and record review the facility failed to report an injury of unknown origin within the required timeframe for one of one resident. The facility was visited by the police for an allegation of abuse related to this injury, and the facility failed to follow up and report the incident to State agencies as required.

This failure of timely reporting had the potential to cause a delayed response by enforcement agencies to ensure resident safetyFindings: On 12/24/25 at 9:16 a.m., the Department received a report from Adult Protective Services (APS) with an allegation of abuse. EMS (Emergency Medical Services) reported to APS they transported a Resident to the hospital with, bruising and pain to his hand, consistent with a grabbing injury.During an interview on 12/24/25 at 3:30 p.m., with the Assistant Director of Nursing (ADON),

the ADON stated she was conducting her investigation first to determine if the facility needed to make a report to the State about this injury of unknown origin. The ADON stated she was aware the police visited

the facility to look into an allegation of abuse. The ADON stated she did not send in a report to the Department because another agency had already reported the allegation of abuse. The ADON confirmed

the allegation had not been reported to the Department by the facility.During a review of the facility's policy titled, Reporting Alleged Violations of Abuse, Neglect, Exploitation or Mistreatment, revised 1/15/25, the policy indicated the facility would ensure that, all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property. All alleged violations are to be reported, immediately but not later than 2 hours if the alleged violation involves abuse or results in serious bodily injury and not later 24 hours if the alleged violation involves neglect, exploitation, mistreatment or misappropriation of property and does not result in serious bodily injury.

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 REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

BROADWAY VILLA POST ACUTE in SONOMA, CA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

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

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 SONOMA, 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 BROADWAY VILLA POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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