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 June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at California Park Post Acute during CMS and state inspections, most recent first.
A CNA did not demonstrate the required competency to ensure resident safety when a resident entered the dining room and grabbed another resident's arm, resulting in an altercation. The CNA was present but failed to prevent the incident, as confirmed by video review and facility investigation, which found that residents should not be left unsupervised in the dining area.
The facility failed to ensure accurate MDS assessments for two residents regarding medication classes and for two residents regarding weight-loss statuses. A resident with a history of stroke was incorrectly coded for anticoagulant medication instead of antiplatelet, and another resident with atrial fibrillation was similarly miscoded. Additionally, two residents experienced significant weight loss, which was not accurately reflected in their MDS assessments. Staff interviews revealed errors in coding and a lack of accurate documentation.
A resident with intact cognition reported rough care by a CNA during a transfer, but the first CNA informed did not report the incident to management, violating the facility's abuse prevention policy. The Director of Nursing confirmed no complaints were recorded, and the Administrator acknowledged the reporting failure.
A resident, who was cognitively intact and dependent on staff for daily living activities, experienced a violation of privacy and dignity during a shower. Two CNAs rushed the resident and failed to provide privacy when a male CNA entered the room unexpectedly. This incident left the resident feeling embarrassed and anxious, affecting her sleep. The facility's staff, including the DSD, DON, ADON, and Administrator, confirmed the violation of the resident's rights and acknowledged the need for further education for the CNAs involved.
A resident with a history of Parkinson's Disease, high blood pressure, and heart failure experienced worsening edema and severe pain, but the nursing staff failed to report these changes to the physician. Despite the facility's policy, the resident's condition was not communicated, leading to a hospital transfer after family insistence. The DON confirmed the oversight, and the resident received emergent care for multiple severe health issues before returning to the facility.
A resident with Parkinson's, high blood pressure, and heart failure experienced worsening edema and severe pain, which were not reported to a physician by nursing staff. Despite orders to monitor edema and administer Lasix, there was no potassium level monitoring, leading to severe health issues. The resident's family insisted on hospital evaluation, revealing multiple complications. The DON confirmed the failure to report changes, violating facility policy.
CNA Failed to Supervise Residents, Resulting in Resident-to-Resident Altercation
Penalty
Summary
The facility failed to ensure that a Certified Nursing Assistant (CNA) demonstrated the necessary competency and skill set to care for residents as required by federal regulations. Specifically, an incident occurred in which one resident entered the dining room and grabbed another resident's arm, resulting in a resident-to-resident altercation. At the time of the incident, the CNA assigned to the dining room was present but did not prevent the altercation from occurring. Video footage reviewed during the facility's investigation confirmed that the CNA did not fulfill their job duties to maintain resident safety, as residents are not to be left unsupervised in the dining room. The facility's job description for CNAs includes requirements to comply with workplace safety policies and to carry out essential job functions, which encompass ensuring resident safety. The failure of the CNA to supervise and intervene appropriately in the dining room directly led to the incident, placing residents' safety at risk. The deficiency was identified through interviews and record reviews conducted by the facility's Administrator and Director of Nursing.
Plan Of Correction
Signed POC and Evidence is attached: 2567 POC 1DEC1D-H1 How corrective action will be accomplished for those residents found to have been affected by the deficient practice: Two residents were found to be affected by the deficient practice. Care plans have been updated for both residents. Care plan established for Resident 1 to dine in SCU dining room away from Resident 2 dining in DCU. First and Final Write-up will be issued to responsible CNA A for failing to meet job performance standards and not maintaining established care plan for Resident 1. Resident 1 referred to mental health services. Resident 1 underwent medication review with pharmacist. 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: No other residents were found to be affected by the deficient practice. Residents residing in the DCU or those who dine in the DCU had the potential of being affected by the deficient practice. DCU staff were in serviced on Redirecting Residents with Behaviors. What measures will be put into place or what systemic changes the facility will make to ensure that the deficient practice does not recur: Resident 1 will eat all meals in the SCU dining room with supervision. How the facility plans to monitor its performance to ensure that the solutions are sustained: Final Write-up delivered to CNA A, follow-up review scheduled on 1/30/2026, 1:1 education delivered to CNA A. DSD will perform sections of the CAN competency check with CNA A weekly for 1 month, followed by 2 times per month for 2 months. Dates when corrective action will be completed: 1/30/26 No other residents were found to be affected by the deficient practice. Residents residing in the DCU or those who dine in the DCU had the potential of being affected by the deficient practice. DCU staff were in serviced on Redirecting Residents with Behaviors. What measures will be put into place or what systemic changes the facility will make to ensure that the deficient practice does not recur: Resident 1 will eat all meals in the SCU dining room with supervision. How the facility plans to monitor its performance to ensure that the solutions are sustained: Final Write-up delivered to CNA A, follow-up review scheduled on 1/30/2026, 1:1 education delivered to CNA A. DSD will perform sections of the CAN competency check with CNA A weekly for 1 month, followed by 2 times per month for 2 months. Dates when corrective action will be completed: 1/30/26
Inaccurate MDS Assessments for Medications and Weight Loss
Penalty
Summary
The facility failed to ensure that Minimum Data Set (MDS) assessments accurately reflected the classes of medications received during the assessment look-back periods for two residents. Resident #74, who had a medical history of transient cerebral ischemic attack and cerebral infarction, was admitted with an active order for Plavix, an antiplatelet medication. However, the MDS was incorrectly coded to reflect the receipt of an anticoagulant medication instead of an antiplatelet medication. Similarly, Resident #70, with a history of atrial fibrillation and essential hypertension, was administered aspirin, an antiplatelet medication, but the MDS was also incorrectly coded to reflect the receipt of an anticoagulant medication. The facility also failed to ensure that MDS assessments accurately reflected weight-loss statuses for two residents. Resident #8 experienced a 7.9% weight loss in one month, which was documented in the resident's records and noted by the dietitian. However, the MDS assessments did not reflect this significant weight loss. Similarly, Resident #25 experienced a 5.1% weight loss in one week, which was also documented by the dietitian, but the MDS assessment failed to reflect this weight loss. Interviews with facility staff, including the MDS Coordinator, Nurse Consultant, Director of Nursing, and Administrator, revealed that there were errors in coding the MDS assessments. The MDS Coordinator was new to the role, and there were nurse consultants available for assistance. Despite this, the assessments were not accurately coded, leading to discrepancies in the residents' documented conditions. The Director of Dietary was responsible for completing the weight-loss section of the MDS assessments but failed to accurately reflect the residents' weight loss in the assessments.
Failure to Report Allegation of Rough Care
Penalty
Summary
The facility failed to ensure that a certified nursing assistant (CNA) immediately reported an allegation of rough care to facility management, which is a violation of the facility's abuse prevention policy. The policy requires that the first staff member informed of an incident must report it to their immediate supervisor and the Administrator. In this case, a CNA did not report a resident's complaint about another CNA being rough during a transfer using a lift. This omission prevented the facility from initiating its abuse protocol. The resident involved, who had a medical history including type two diabetes mellitus, muscle weakness, difficulty walking, unsteadiness on feet, and a history of falling, had intact cognition as indicated by a Brief Interview for Mental Status (BIMS) score of 15. The resident described the CNA as nice but rough and not taking enough time during care. The Director of Nursing confirmed that no complaints had been reported, and the Administrator acknowledged that the CNA should have reported the resident's statement.
Violation of Resident Privacy and Dignity During Care
Penalty
Summary
The facility failed to ensure that a resident was treated with dignity and respect during direct patient care, specifically during a shower. The resident, who was cognitively intact and made her own decisions, was dependent on staff for activities of daily living due to limited physical mobility and a history of falls. During a shower, the resident was rushed by two CNAs, and privacy was not provided when a male CNA unexpectedly entered the room without the curtain being closed. This incident left the resident feeling embarrassed, violated, and anxious, which affected her sleep. Interviews with the Director of Staff Development, the Director of Nursing, the Assistant Director of Nursing, and the Administrator confirmed the violation of the resident's rights and the loss of dignity. The Director of Staff Development acknowledged that the CNAs involved needed more education, and the resident refused to allow them back into her room for care. The Director of Nursing and Assistant Director of Nursing confirmed that the actions of rushing the resident and not providing privacy were violations of resident rights. The Administrator also confirmed the violation of privacy and dignity, acknowledging the resident's alertness and orientation.
Failure to Report Change in Condition
Penalty
Summary
The facility failed to ensure that licensed nurses reported significant changes in a resident's condition to the physician, resulting in a deficiency. The resident, who was admitted for rehabilitation following a hip replacement and had a history of Parkinson's Disease, high blood pressure, and heart failure, experienced worsening edema and severe pain. Despite the facility's policy requiring prompt assessment and physician notification of changes in condition, the nursing staff did not report the resident's progression from mild to severe pitting edema or the sudden onset of severe pain to the physician. The deficiency was further highlighted when the resident's family insisted on hospital evaluation due to the resident's declining health, which the nursing staff initially resisted. The Director of Nursing confirmed that the changes in the resident's condition should have been reported to the physician, as per the facility's policy. The resident was eventually sent to the hospital, where multiple severe health issues were identified, and received emergent care before returning to the facility eight days later.
Failure to Monitor and Report Resident's Condition
Penalty
Summary
The facility failed to ensure that licensed nursing staff possessed the necessary skills and competencies to meet the medical needs of a resident, leading to a significant deficiency. The resident, who was admitted for rehabilitation following a hip replacement and had underlying conditions such as Parkinson's Disease, high blood pressure, and heart failure, experienced a deterioration in health that was not promptly identified or reported to a physician. Despite orders to monitor edema every shift, the resident's condition worsened from mild to severe pitting edema over several days without any change in condition being reported to the physician. The resident was prescribed Lasix to manage edema, but there was no baseline or ongoing monitoring of potassium levels, which is critical when administering this medication. The lack of monitoring and communication with the physician regarding the resident's condition and medication needs resulted in a low potassium level, severe pain, and multiple health issues, including fluid overload and exacerbated congestive heart failure. The resident's family had to insist on hospital evaluation, which revealed severe health complications requiring emergent care. Interviews with the Director of Nursing confirmed that the nursing staff failed to report significant changes in the resident's condition, such as increased edema and sudden severe pain, to the physician. The facility's policy required prompt assessment and physician notification for any change in a resident's condition, which was not adhered to in this case. This oversight placed the resident at risk for further health complications, highlighting a deficiency in the facility's care practices.
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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 Chico
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Arbor Post Acute | 1.3 mi | ★★★★★ | 2 | 0 |
| Chico Terrace Care Center | 3.7 mi | ★★★★★ | 6 | 0 |
| Oakwood Healthcare Center | 3.7 mi | ★★★★★ | 48 | 0 |
| Autumn Creek Post Acute | 3.8 mi | ★★★★★ | 18 | 0 |
| Feather River Care Center | 20.8 mi | ★★★★★ | 10 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release June 2026) and official state health department websites.