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Complaint Investigation

Santa Anita Convalescent Hospital

May 29, 2026 · Temple City, CA · 5522 Gracewood Ave.
Citations 1
CMS Rating 1/5
Beds 391
Provider ID 055293
Healthcare Facility
Santa Anita Convalescent Hospital
Temple City, CA  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

SANTA ANITA CONVALESCENT HOSPITAL in TEMPLE CITY, CA — inspection on May 29, 2026.

Found 1 citation. 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

FF0689
Quality of Life and Care Deficiencies

During a concurrent observation in Resident 338's room and interview in Resident 338's room on 5/26/2026 at 3:02 PM, Certified Nursing Assistant (CNA) 5 stated the resident's bed was not locked and it should have been locked otherwise the bed could have moved and the resident could have fallen.

During an interview on 5/26/2026 at 3:16 PM, Licensed Vocational Nurse (LVN) 18 stated Resident 338's bed was not locked because the bed brake indicator was in a horizontal position. LVN 18 stated the resident's brakes should have always been locked otherwise the resident could have fallen and have an injury or worse.

During an interview on 5/28/2026 at 4:35 PM, the Director of Nursing (DON) stated bed safety features included for the bed to be lowered to the ground, and ensuring the beds were locked.

The DON stated Resident 338's bed did not seem to be locked but should have been to prevent staff and resident injury.

The DON stated if the bed was not locked, Resident 338 could have had a fall or fracture (break in the bone) and the resident could have been scared.

During a concurrent interview and record review on 5/28/2026 at 4:49 PM with the DON, the facility's policy and procedure (P&P) titled Fall Management Program dated 6/1/2017 was reviewed.

The P&P indicated the purpose of the P&P was to prevent resident falls and minimize complications associated with falls through the development of a Fall Management Program.

The P&P also indicated the policy of the facility was to provide the highest quality of care in the safest environment for the residents residing in the facility.

The P&P indicated universal fall prevention measured for all residents included placing the residents bed in the lowest position with the brakes locked.

The DON stated the facility staff were not following the policy but should have been to prevent fall and injury like a fracture.

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 TEMPLE CITY, 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 SANTA ANITA CONVALESCENT HOSPITAL or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.