Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at A Grace Sub Acute & Skilled Care during CMS and state inspections, most recent first.
The facility did not conduct fire drills at varied times as required, with records showing that drills for both PM and NOC shifts repeatedly occurred at the same times. This issue was confirmed through record review and staff interview, affecting all residents and smoke compartments.
A power strip not meeting required UL standards was found in use at a bedside, resulting in an electrical fire. The device had been brought in by a family member for charging a phone, and the facility could not verify its compliance with safety standards. This deficiency affected multiple residents and a smoke compartment.
A resident with a history of traumatic brain injury and epilepsy did not receive prescribed anti-seizure medications as ordered due to delays in pharmacy delivery. The delays were caused by the need for triplicate prescriptions for controlled substances and a lack of timely delivery authorization for a high-cost medication, with required documentation not provided promptly by the facility and physician. Facility policies requiring timely medication receipt and administration were not followed.
The facility failed to follow professional standards for several residents, including incomplete physician orders for insulin and lorazepam, lack of hypoglycemic protocols, and improper blood pressure monitoring on an arm with an AV fistula. Additionally, a resident on fluid restriction due to renal disease was not monitored for fluid intake and output, contrary to facility policy.
The facility failed to attempt alternatives before using side rails for numerous residents, as observed and documented in their care plans and assessments. Despite having physician orders for side rails for positioning and mobility, there was no evidence of alternative measures being considered. Interviews with the DON confirmed that alternatives were not deemed necessary, contradicting the facility's policy requiring less restrictive interventions to be documented and attempted first.
The facility failed to document the administration of controlled drugs for three residents, leading to unaccounted medications and potential errors. The nursing staff signed out medications from the Controlled Drug Record but did not record their administration on the Medication Administration Record, as required by facility policy. This issue was confirmed by the Minimum Data Set Coordinator.
The facility failed to maintain food safety standards, with undated and expired food items found in storage, and improper sanitization practices observed. Spoiled produce and expired test strips were noted, and a dietary supervisor used a contaminated thermometer without sanitizing it, risking foodborne illness for 44 residents.
The facility failed to follow infection prevention protocols, including dirty oxygen concentrator filters, improper PPE use by a nurse during medication administration to a resident with CP-C.R.E, and incorrect placement of a urinary drainage bag by a CNA, risking infection.
A resident with quadriplegia was not provided with an appropriate call device, relying instead on yelling for assistance. Despite the availability of alternative devices, the resident had not been assessed for a suitable option, contrary to the facility's policy on assistive devices.
The facility failed to complete baseline care plans within 48 hours of admission for two residents, as required by policy. Critical information was missing from the care plans, including therapy services, safety details, completion dates, review dates, and necessary signatures. This was confirmed by interviews with the Nurse Supervisor, MDS Coordinator, and DON, who acknowledged the plans should have been completed within 72 hours.
The CP failed to identify and report medication irregularities for two residents. One resident had an unclear and potentially unsafe insulin order, while another resident with CKD received Calcium Acetate at incorrect times, not aligned with meals, affecting its efficacy. The CP did not address these issues during monthly reviews.
Two residents in the facility were affected by medication mismanagement. One resident received warfarin for an incorrect indication, as the orders specified pulmonary edema instead of the correct condition, pulmonary embolism. Another resident had a lidocaine patch applied continuously without the required 12-hour off period, contrary to the manufacturer's instructions. These errors were confirmed by the DON and a Consultant Pharmacist.
A survey found a medication error rate of 5.56% in an LTC facility. One error involved an LVN not allowing the required interval between puffs of an asthma inhaler for a resident, contrary to facility policy. Another error involved an RN failing to flush a gastrostomy tube with water between medications for a resident, as per policy.
The facility did not adhere to the meal preferences of two residents, as observed during a survey. One resident preferred a cheeseburger daily, which was not provided, and another was served rice despite disliking it. The dietary supervisor confirmed these discrepancies, which were against the facility's policy to honor food preferences.
A resident in a room was unable to reach the call button, which was observed hanging on the wall above the bed, out of reach. The resident confirmed the inability to reach the button, and it remained out of reach during multiple observations until an RN handed it to the resident. The facility's policy indicated that call light devices should be accessible to assist with resident safety and independence.
A facility failed to maintain a safe environment for a resident due to cracked walls near the bathroom door and toilet, which were reported but not fully repaired. The resident, who is cognitively intact, confirmed the facility's awareness of the issue since the previous year. The maintenance director acknowledged that repairs were started but incomplete, contrary to the facility's maintenance policy.
A resident with hemiplegia and muscle weakness experienced a witnessed fall in the facility. Despite being at moderate risk for falls, the facility failed to complete a Morse Fall Scale assessment after the incident, as required by their policy. This deficiency was confirmed through interviews and record reviews.
Failure to Conduct Fire Drills at Varied Times
Penalty
Summary
The facility failed to conduct fire drills at varied times as required by regulation. Record review showed that fire drills for both the PM and NOC shifts were conducted at the same times on multiple occasions within the last 12 months, specifically with PM drills at 4:00 p.m. and NOC drills at 2:30 a.m. This deficiency was identified during a review of fire drill records and confirmed in an interview with the Administrator, who stated that the drills were conducted by the Director of Staff Development. The failure to vary the timing of fire drills affected all 116 residents and all four smoke compartments in the facility.
Plan Of Correction
by the deficient practice. Missing Fire Drill was completed on 12/24/2025 and education was provided to The Maintenance Director and designee. What measures will be put into place or what systemic changes the facility will make to ensure that the deficient practice does not recur: A: The Maintenance Director or designee will maintain Fire drills according to regulation quarterly and be held at different times during the day, with a coded announcement being completed instead of audible alarms. Record keeping of quarterly tests to be gathered in a fire drill binder for reference and evidence of completion and compliance. Any updates necessary will be completed timely and reported to the Safety and QA Committee. Include dates when corrective action will be completed. The corrective action completion dates must be acceptable by the State Agency: Completion date: 12/24/25 K0712
Unapproved Power Strip Causes Electrical Fire at Bedside
Penalty
Summary
A deficiency was identified when a power strip was found in use at a patient bedside location that did not meet the required approval standards. During a facility tour, it was observed that a power strip was located approximately one foot away from a resident's bed on the ground in Resident Room 34. The Maintenance Supervisor confirmed that an electrical fire had occurred at this location in the early morning hours, and the resident occupying the bed reported that the power strip had been brought in by a family member for charging a phone. The facility was unable to verify whether the power strip in question met the necessary UL 1363A or UL 60601-1 standards required for use with patient-care-related electrical equipment in a patient care vicinity. This deficiency affected 47 out of 116 residents and one of four smoke compartments, as noted during the survey. The report does not provide additional details regarding the medical history or condition of the resident at the time of the incident.
Plan Of Correction
How corrective actions will be accomplished for those residents found to have been affected by the deficient practice: A: Power strips and extension cords were immediately removed from the rooms. Both family and resident were notified of power cord safety and the importance of using medical-grade approved cords and safety of surroundings around the power cords. How the facility will identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken: A: All residents have the potential to be affected by the deficient practice. Facility-wide audit conducted on 12/08/25 and all other power cords identified were noted and removed. Education was provided on 12/08/25 to the Maintenance Director on appropriate power cords within the facility. Facility-wide audit to be completed weekly for 12 weeks and then PRN as needed. What measures will be put into place or what systemic changes the facility will make to ensure that the deficient practice does not recur: A: 1) Resident education on proper equipment usage (i.e., hospital graded extension cords only) 2) Staff In-Serviced on fire safety and prevention in regards to outlets and proper power cord identification—importance of keeping residents' belongings away from outlets and bringing concerns related to storage of belongings to facility leadership team 3) Daily resident room round sheet updated and to be conducted by assigned department managers. Weekly facility rounds will be conducted and every room and common area checked to ensure approved hospital grade extension cords are in place and outlet integrity is compliant by the maintenance supervisor or designee. How the facility plans to monitor its performance to make sure that solutions are sustained. The facility must develop a plan for ensuring that correction is achieved and sustained. This plan must be implemented, and the corrective action evaluated for its effectiveness. The POC is integrated into the quality assurance system: A: Room round sheets will be turned in weekly. The Maintenance Director or designee will complete a facility-wide audit weekly for 12 weeks and report the results of the audit to the Safety Committee and QA meeting for compliance evaluation x4 months and then PRN as needed. Include dates when corrective action will be completed. The corrective action completion dates must be acceptable by the State Agency: Completion date: 12/11/2025
Failure to Provide Timely Pharmacy Services Resulting in Missed Medication Administration
Penalty
Summary
The facility failed to provide necessary pharmacy services to meet the needs of a resident who was readmitted with diagnoses including traumatic brain injury and epilepsy. Upon review, it was found that the resident had physician orders for multiple anti-seizure medications, including Clobazam, Lacosamide, and Zonisamide, all to be administered via gastrostomy tube. However, the medication administration record showed that these medications were not given on several days following the resident's readmission. Progress notes confirmed that the medications were not available at the facility and were pending delivery from the pharmacy. Interviews with facility staff and the consultant pharmacist revealed that delays occurred due to the need for triplicate prescriptions for controlled substances and a lack of timely delivery authorization for a high-cost medication. The pharmacy had requested the necessary documentation and authorizations from both the physician and the facility, but did not receive them in time to ensure the medications were available as ordered. Facility policies required timely receipt and administration of medications, but these were not followed, resulting in the resident not receiving prescribed anti-seizure medications as ordered.
Incomplete Physician Orders and Improper Monitoring in LTC Facility
Penalty
Summary
The facility failed to ensure professional standards of practice were followed for several residents, leading to potential unsafe implementation of medical orders and unmonitored medical conditions. For Residents 25, 35, 93, and 98, there were incomplete physician orders. Resident 93 had an unclear insulin order with an incorrect dosage and no specified frequency or parameters for administration. Resident 35's lorazepam orders lacked dosing frequency, yet the medication was administered multiple times without clarification from the physician. Resident 98's insulin orders referenced a hypoglycemic protocol that was not present in the clinical record, leaving staff without guidance for managing low blood sugar levels. Resident 25 also had insulin orders that referred to non-existent hypoglycemia orders, which were only clarified with the physician shortly before the surveyor's interview. These deficiencies in medication orders and protocols could lead to inappropriate medication administration and inadequate response to residents' medical needs. The facility's policies required medication orders to include dosage, frequency, and clinical conditions, but these were not consistently followed. Additionally, Resident 75, who had an AV fistula for dialysis, had blood pressure readings taken on the arm with the fistula, contrary to care plan instructions and facility policy. This practice could cause injury or bleeding. Furthermore, Resident 75 was on a fluid restriction due to end-stage renal disease, but there was no monitoring of fluid intake and output, which is crucial for dialysis patients. The facility's policy required monitoring of fluid balance, but this was not implemented for Resident 75.
Failure to Attempt Alternatives Before Using Side Rails
Penalty
Summary
The facility failed to offer and/or attempt alternatives before using side rails for 18 of 22 sampled residents and 77 non-sampled residents. This deficiency was identified through observations, interviews, and record reviews. The residents involved had physician orders for side rails for positioning, mobility, or postural support, but there was no documentation that alternatives were considered or attempted prior to their use. The facility's policy required less restrictive interventions to be incorporated into care planning, but this was not followed. During observations, it was noted that residents had side rails or grab bars in use without documented attempts of alternative measures. For instance, Resident 66 had side rails for positioning and mobility, but the care plan and assessments lacked evidence of alternative attempts. Similar findings were noted for other residents, such as Resident 38, Resident 75, and Resident 77, among others. Informed consents for the use of bed rails indicated that alternatives were not attempted, and in some cases, were deemed not appropriate due to the use of specific mattresses like low air loss mattresses. Interviews with the Director of Nursing (DON) revealed that the facility did not consider alternatives necessary, as side rails were used for support, mobility, and positioning. The DON confirmed that most residents had side rails and that the facility used them if deemed beneficial. The facility's policy on the proper use of side rails, revised in 2016, stated that less restrictive interventions should be documented and attempted before considering side rails, but this was not adhered to, leading to the deficiency.
Failure to Document Controlled Drug Administration
Penalty
Summary
The facility failed to ensure accurate accountability and documentation of controlled drug administration for three residents, leading to potential medication errors and drug diversion. During an interview with the Director of Nursing (DON), it was explained that the facility's policy requires nurses to assess residents, review physician orders, sign out medications from the Controlled Drug Record (CDR), administer the medication, document the administration on the Medication Administration Record (MAR), and reassess the resident within one hour. However, discrepancies were found in the records of three residents, indicating that the nursing staff signed out medications from the CDR but failed to document their administration on the MAR. For Resident 39, there were five occasions where diazepam was signed out but not documented on the MAR. Resident 35 had nine instances where lorazepam was signed out without documentation on the MAR. Similarly, Resident 85 had four instances where oxycodone was removed without proper documentation. The Minimum Data Set Coordinator (MDSC) confirmed these findings and acknowledged that the medications were unaccounted for, as the nursing staff did not document the administration as required by the facility's policy.
Food Safety Deficiencies in LTC Facility
Penalty
Summary
The facility failed to adhere to professional standards for food safety, as evidenced by several observations in the kitchen. Undated food items, food past their use-by date, and spoiled produce such as bananas with black spots, partially soft tomatoes, and dry green onions were found in the refrigerator and on the shelves. Additionally, a tube of Auto-Chlor test strips, essential for ensuring proper chemical concentration in cleaning solutions, was expired. The dietary supervisor confirmed these findings and acknowledged that expired food should not be on the shelves and should have been discarded. The facility's policies on labeling, dating, and storing produce were not followed, contributing to these deficiencies. Furthermore, during a tray line observation, the dietary supervisor failed to sanitize a contaminated thermometer before using it to check the temperature of lemonade. The thermometer was handled improperly, touching the bin several times before being dipped into the lemonade. This action was contrary to the facility's policy on thermometer use and calibration, which requires cleaning and sanitizing the thermometer before use. These lapses in food safety practices had the potential to cause foodborne illness and cross-contamination, affecting the 44 residents eating at the facility.
Infection Control Deficiencies in LTC Facility
Penalty
Summary
The facility failed to maintain proper infection prevention techniques in several instances. Two oxygen concentrators in different rooms were observed with dirty filters, indicating a lack of adherence to the facility's policy for weekly cleaning by the assigned environmental services staff. The Assistant Director of Nursing acknowledged the need for cleaning and checking the policy for frequency, while the Administrator later confirmed the filters had been cleaned. A registered nurse did not follow enhanced barrier precautions while administering medication to a resident who tested positive for CP-C.R.E, a multi-drug resistant organism. Despite clear signage indicating the need for gowns and gloves during high-contact care activities, the nurse entered the resident's room twice without wearing a gown, although gloves and a mask were used. The nurse admitted to the oversight after being shown the precautionary posters. Additionally, a certified nursing assistant placed a urinary drainage bag on a resident's bed during personal care, causing urine to flow back toward the resident. This action was confirmed by the treatment nurse and the infection preventionist, who both stated that the drainage bag should be kept below the bladder to prevent infection. The facility's policy also supports this practice, emphasizing the need to position the drainage bag lower than the bladder at all times.
Failure to Provide Appropriate Call Device for Resident with Quadriplegia
Penalty
Summary
The facility failed to accommodate the needs of a resident with quadriplegia by not providing an appropriate staff call device. The resident, who was admitted with diagnoses including respiratory failure and quadriplegia, was observed with hand splints and a call button placed next to her on the bed. However, due to her condition, she was unable to use the call button effectively and instead had to yell out for assistance. Interviews with staff, including a registered nurse and the maintenance director, revealed that the resident had not been assessed for an appropriate call device, despite the availability of alternative devices that could be activated by other means, such as a head-activated call device. The facility's policy on assistive devices and equipment indicated that call light devices should be appropriate for the resident's condition. Despite this, the resident's needs were not adequately assessed or met, as confirmed by the nurse supervisor and the Director of Nursing. Both acknowledged the availability of other call devices that could be more suitable for the resident's condition, yet no action had been taken to provide such a device. This oversight had the potential to delay necessary care and services for the resident.
Failure to Complete Baseline Care Plans Within Required Timeframe
Penalty
Summary
The facility failed to complete baseline care plans within 48 hours of admission for two residents, Resident 66 and Resident 25, as required by their policy. For Resident 66, the baseline care plan was missing critical information such as therapy services, completion date, review date with the resident or representative, and signatures from both staff and the resident or representative. Similarly, Resident 25's baseline care plan lacked details on safety, completion date, review date, and necessary signatures. These omissions were confirmed during interviews with the Nurse Supervisor, MDS Coordinator, and Director of Nursing, who all acknowledged that the baseline care plans should have been completed within 72 hours of admission. The facility's policy, dated December 2016, mandates that a baseline care plan be developed within 72 hours to ensure the resident's immediate care needs are met. This includes reviewing healthcare practitioner orders and implementing a plan covering initial goals, physician orders, dietary needs, therapy services, and social services. The policy also requires that a summary of the baseline care plan be provided to the resident and their representative. The failure to adhere to this policy resulted in the potential for residents and their responsible parties to be unaware of the care plan, as evidenced by the incomplete documentation for Residents 66 and 25.
Consultant Pharmacist Fails to Identify Medication Irregularities
Penalty
Summary
The consultant pharmacist (CP) failed to identify and report medication irregularities during the monthly drug regimen review for two residents. For one resident, an order for Admelog insulin was issued without specifying the frequency or parameters for administration, and the dose was incorrectly set at 3 ml, equating to 300 units, which is excessively high. Despite the order being unclear and potentially unsafe, the CP did not identify or report this irregularity during the monthly reviews since July 2024. For another resident with chronic kidney disease, the CP did not ensure that the medication Calcium Acetate was administered in accordance with the manufacturer's specifications, which require it to be taken with meals. The facility's administration schedule did not align with meal times, resulting in the medication being given at incorrect times on 35 out of 39 occasions. The resident's phosphorous levels were high, indicating the medication was not optimally effective. The CP did not make any recommendations to correct the administration timing after June 2024.
Medication Mismanagement for Two Residents
Penalty
Summary
The facility failed to ensure that two residents were free from unnecessary medications, leading to a deficiency in medication management. Resident 35 was administered warfarin, a blood thinner, for an incorrect indication. The resident's clinical record showed a diagnosis of chronic embolism and thrombosis, as well as a saddle embolus of the pulmonary artery with acute cor pulmonale. However, the physician's orders incorrectly indicated that warfarin was prescribed for pulmonary edema, rather than the appropriate condition of pulmonary embolism. This error was confirmed during an interview with the Director of Nursing, who acknowledged the incorrect diagnosis in the warfarin orders. Resident 98 was affected by improper administration of a lidocaine patch, which was not used according to the manufacturer's specifications. The resident's physician's orders specified the application of a lidocaine patch for back pain management, but the patch was applied continuously without the required 12-hour off period. The Licensed Vocational Nurse confirmed the incorrect application schedule, and the Director of Nursing verified that the facility's template for lidocaine patch application was not followed. The Consultant Pharmacist also confirmed the correct usage instructions for the lidocaine patch, highlighting the deviation from proper medication administration practices.
Medication Administration Errors in LTC Facility
Penalty
Summary
The facility was found to have a medication error rate of 5.56% during a survey, with two errors occurring out of 36 opportunities. One error involved a Licensed Vocational Nurse (LVN) administering an asthma medication, Alvesco, to a resident without allowing the recommended 1-2 minute interval between puffs. The LVN was unaware of the need to space out inhalations, which was contrary to the facility's policy and procedures that required a minimum of one minute between inhalations of the same medication. The second error involved a Registered Nurse (RN) administering medications via a gastrostomy tube to another resident. The RN failed to flush the tube with water between administering each of the ten medications, as required by the facility's policy. The policy specified that the tube should be flushed with 10 mL of water between medications and a final flush of 50 mL after the last medication. The RN acknowledged the oversight during an interview, confirming that he did not follow the correct procedure.
Failure to Honor Resident Meal Preferences
Penalty
Summary
The facility failed to provide meals according to the preferences and dislikes of two residents, which was identified during a survey. Resident 55, who was admitted to the facility on an unspecified date, preferred to have a cheeseburger every day, but this preference was not honored during a lunch service observed on October 15, 2024. Similarly, Resident 67, admitted on an unspecified date, was served rice despite her documented dislike for it. These discrepancies were confirmed during an interview with the dietary supervisor, who acknowledged that meals should have been served according to the residents' preferences and dislikes. The facility's 2023 policy on food preferences states that residents' food preferences will be adhered to within reason, and substitutes for disliked foods will be provided from the appropriate food group.
Resident's Call Button Out of Reach
Penalty
Summary
The facility failed to ensure that a resident had access to a staff call device, which is essential for requesting help or in case of an emergency. During multiple observations in Room R3, the call button for bed A was found hanging on the wall above the head of the bed, out of reach of the resident. The resident confirmed that she could not reach the call button and expressed a desire to be able to call for assistance. Despite being observed at different times throughout the day, the call button remained out of reach until a registered nurse noticed the issue and handed the call button to the resident. The facility's policy and procedure on assistive devices and equipment, revised in January 2020, indicated that call light devices should be provided to assist with resident mobility, safety, and independence.
Facility Fails to Repair Cracked Walls in Resident's Bathroom
Penalty
Summary
The facility failed to maintain a safe, functional, and sanitary environment for one of the sampled residents due to cracked walls near the bathroom door and at the bottom left side of the toilet in the bathroom. This issue was observed during an interview with the resident, who confirmed that the facility was aware of the damage since the previous year. The resident, who was cognitively intact with a BIMS score of 15, expressed that the walls were damaged and needed repair. During a review of the maintenance log with the maintenance director, it was confirmed that the maintenance staff had started repairs but missed the areas near the bathroom door and the bottom of the toilet. The facility's policy on maintenance service, revised in 2009, indicates that the maintenance department is responsible for maintaining the building in good repair and free from hazards. However, the failure to address the cracked walls in a timely manner represents a deficiency in maintaining a safe environment for residents.
Failure to Complete Morse Fall Scale After Resident Fall
Penalty
Summary
The facility failed to complete a Morse Fall Scale assessment after a witnessed fall involving a resident, which is a requirement according to the facility's policy. The resident, who had diagnoses including hemiplegia, disorientation, and muscle weakness, was admitted on an unspecified date and was identified as being at moderate risk for falls based on a previous Morse Fall Scale assessment. On a specific date, the resident was seen scooting out of bed by a licensed nurse (LN A) and another staff member. Despite attempts to assist, the resident slid onto the ground, which was documented as a witnessed fall. Upon review of the resident's medical record, it was found that there was no documentation of a Morse Fall Scale assessment being completed after the fall. This was confirmed during an interview with another licensed nurse (LN B), who acknowledged that the facility's protocol required a Morse Fall Scale assessment to be completed after each fall. The facility's policy and an undated fall checklist both indicated the necessity of conducting a Morse assessment following a fall, highlighting the deficiency in adhering to established procedures.
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Illustrative
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near San Jose
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Creekside Post-acute | 0.6 mi | ★★★★★ | 2 | 0 |
| Empress Care Center, Llc | 1.1 mi | ★★★★★ | 0 | 0 |
| White Blossom Care Center | 1.2 mi | ★★★★★ | 22 | 0 |
| Baywood Post Acute | 1.5 mi | ★★★★★ | 0 | 0 |
| Courtyard Care Center | 1.7 mi | ★★★★★ | 2 | 0 |
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