Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around January 2027
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 Grossmont Gardens Healthcare Center during CMS and state inspections, most recent first.
A facility failed to provide written advance directive information to 10 of 12 sampled residents, and there was no documentation that the residents or their representatives received it. The SSD, DON, and ADM all confirmed the omission, and the facility policy stated that the resident or representative is to be given written information about the right to formulate an advance directive.
The facility failed to develop or implement resident-specific care plans for a resident’s personal belongings preferences, two residents’ LAL mattress settings, a resident’s clip alarm use, and a resident’s continuous O2 therapy. Staff observed belongings moved out of view for a resident with stroke-related aphasia, found LAL mattresses set inconsistently with weight-based orders, saw a clip alarm in use without being care planned, and confirmed a resident on continuous O2 had no care plan for that treatment. The DON and other staff acknowledged the missing or unimplemented care plan elements.
Food Safety Failures in Kitchen Food Cooling, Glove Use, and Facial Hair Coverage: A Cook did not monitor the cooling of TCS foods and the kitchen had no cooling log, while glove use during tray line preparation was inappropriate, including failure to change gloves or wash hands after contamination events and between tasks. A Server/Kitchen Aide was also observed with uncovered facial hair, despite facility expectations for beard restraints.
A resident with stroke-related hemiplegia and aphasia was upset after a CNA entered her room while she was sleeping and rearranged her personal belongings without permission, including moving her dentures and other items into a nightstand drawer. The resident and her husband reported that important personal items were no longer where she could find them, and staff acknowledged that the belongings should not have been moved without her consent.
A resident had an active PRN lorazepam order for end of life anxiety written for 6 months with no stop date. The DON confirmed the order was for 180 days, but no prescriber documentation was provided to justify extending the PRN psychotropic beyond the 14-day limit required by facility policy.
Low Air Loss Mattress Settings Not Followed: Two residents with pressure injury risk had LAL mattresses observed set above the ordered weight-based range. One resident with adult failure to thrive and palliative care was on a mattress set between 180 and 210 lbs despite weighing 138 lbs, and another resident with a stroke was on a mattress set at 410 lbs despite weighing 285 lbs. An LPN and the DON both acknowledged the settings were too high and that no documented resident preference explained the settings.
Controlled meds were not consistently documented on both the CDR and MAR, with some doses signed out but not charted and one dose charted but not signed out. In addition, diabetes meds were given without following ordered timing and hold parameters, including insulin lispro given when blood sugars were below the hold threshold, and BP meds were administered despite a low SBP and explicit hold instructions. The DON confirmed the record discrepancies and the medication administration entries.
Medication error rate exceeded the allowed threshold when surveyors observed multiple medication administration errors involving an LPN. One resident received crushed medications that included EC and ER tablets that should not have been crushed, another resident’s morning meds included crushed EC and ER tablets, and a third resident was given an inhaler that had exceeded its beyond-use date. The facility’s medication administration policy required checking medication labels and beyond-use dates before administration.
An LN administered fluticasone/vilanterol to a resident using an inhaler mouthpiece that had no label attached, even though the box had the pharmacy label. Another LN confirmed the mouthpiece was unlabeled, and the DON stated staff were expected to label devices such as inhaler mouthpieces with the resident's name and open date.
The FSM who shared oversight of the kitchen serving the SNF was not qualified to manage day-to-day food service operations and did not hold the Certified Dietary Manager or DSS credential. The FSD and ADM confirmed there was no dedicated full-time qualified person for the SNF, and surveyors also observed kitchen issues including no cool down process for time and temperature control, improper glove use, and uncovered facial hair.
Fortified Diet Recipes Not Followed: The facility failed to prepare fortified foods according to standardized recipes. A cook stated he added gravy or butter to foods and planned to add butter to all lunch items, while the FSD said cooks decide how much calorie booster to add and when. The RDN stated cooks should follow the recipes to ensure the Fortified Diet is correct, but the Mexican Roasted Vegetables recipe did not list a Fortified Diet instruction.
Missing Adaptive Eating Equipment on Meal Tray: A resident's meal tray ticket listed a plate guard, but the adaptive utensil was not delivered with the tray during observed meals. The resident stated the plate guard was not present, and the FSD confirmed it was missing even though facility records showed the resident required a plate guard for all meals.
A resident’s MAR contained the wrong indication for Namenda after the diagnosis was incorrectly entered into the EMR. During record review, an LN confirmed the handwritten order listed unspecified dementia, while the electronic record documented the medication for unconsolable crying. The facility’s documentation policy required medical record entries to be objective, complete, and accurate.
The facility's QAA/QAPI committee did not identify, develop, or implement action plans related to advance directives. The DON and ADM stated advance directives were not completed according to regulation for many residents and acknowledged this should have been done. The ADM also stated advance directives should have been identified as a QAPI project.
Infection control practices were not properly implemented in the medication room and during medication administration for a resident with a G-tube. The soap dispenser at the sink was not working, and an LPN used the same gloves to move a bedside table and then administer medications through the resident’s feeding tube without changing gloves, despite EBP being in place and facility policies requiring hand hygiene and glove changes after touching the resident’s environment.
Loose Bed Side Rails Not Properly Secured: A resident with dementia had an unpadded half side rail that was raised and loose, with the rail moving side to side and back and forth. Staff observed the resident going to the edge of the bed, attempting to climb over the rail, and hanging her legs over the side rails. An LN stated the rails were very loose and should have been fixed to the bed, while the MD and DON stated the rails were not securely attached.
Failure to Provide Written Advance Directive Information
Penalty
Summary
The facility failed to ensure that written information regarding advance directives was provided to 10 of 12 sampled residents, including Residents 14, 8, 12, 19, 15, 7, 20, 5, 6, and 2. A review of the clinical records on 2/10/2026 found no documentation that these residents or their representatives were given advance directive information, which is the legal document indicating resident preferences for end-of-life treatment decisions. During an interview and record review on 2/10/2026, the SSD stated the facility did not provide written information regarding advance directives to residents or their representatives and that they should have. On 2/11/2026, the DON and ADM also stated the facility did not provide written information about advance directives and that there was no documentation in the clinical record showing it had been provided. The facility policy titled Advanced Directives, revised September 2022, stated that the resident or representative is provided with written information concerning the right to formulate an advance directive if he or she chooses to do so.
Care plans missing or not followed for belongings, LAL mattress use, fall alarm, and oxygen therapy
Penalty
Summary
The facility failed to develop and/or implement resident-specific written care plans for five residents involving personal belongings, low air loss (LAL) mattress use, a clip alarm, and continuous oxygen therapy. The report states that these failures had the potential to cause confusion in the delivery of care and that residents’ preferences and goals could be unmet. The facility policy titled Care Plans, Comprehensive Person-Centered required a comprehensive, person-centered care plan with measurable objectives and timetables to meet the resident’s physical, psychosocial, and functional needs. For one resident with hemiplegia, hemiparesis, and aphasia following a stroke, staff observed that personal belongings had been moved and placed out of view or access, including dentures, hygiene items, and a mirror. The resident became upset and had difficulty expressing that items were missing or rearranged. The resident’s husband stated the belongings were important to help the resident communicate needs to staff. Staff interviews confirmed the resident was particular about belongings, preferred them within view and organized to her liking, and that this preference should have been care planned and communicated to all staff. The DON also stated that the resident’s preferred location of personal belongings and use of belongings as a means to communicate should have been developed into a care plan. For two residents with physician orders for LAL mattresses, the care plans did not reflect the mattress use or were not implemented as written. One resident was at high risk for pressure injury, weighed 138 lbs., and was observed on a LAL mattress set between 180 and 210 lbs. Staff stated the mattress was set too high and should have been set by weight, but the care plan was not implemented because the mattress was not set according to the resident’s weight. Another resident with stroke and pressure injury risk weighed 285 lbs. and was observed on a LAL mattress set at 410 lbs.; staff stated the setting was too high and that no documentation explained why it was set there. Staff and the DON stated the resident’s LAL use and any preference for the setting should have been documented in the care plan when the mattress was first used. Another resident with dementia was observed using a clip alarm while seated in a wheelchair, but there was no physician order for the device and the fall care plan did not include it. The resident had multiple documented falls over several months. Staff stated the clip alarm was a current intervention to help prevent falls and should have been included in the care plan. A different resident with acute respiratory failure with hypoxia and asthma was receiving continuous oxygen at 3 L/min by nasal cannula, but there was no care plan for continuous oxygen at the time of the survey. Staff and the DON confirmed the care plan was missing and stated it should have reflected the resident’s current oxygen therapy.
Food Safety Failures in Kitchen Food Cooling, Glove Use, and Facial Hair Coverage
Penalty
Summary
Food safety and sanitation guidelines were not followed in the kitchen when the cool down process for time/temperature control for safety (TCS) foods was not monitored. During a concurrent kitchen observation and interview, ground beef labeled with the day's date and prepared at 8:00 AM was found in the reach-in refrigerator, and the Food Services Director stated there was no cool down log to monitor the product's temperature during cooling. The Cook confirmed he did not monitor cooled foods for time or temperature and stated the kitchen did not maintain a cooling log to track the cooling process for TCS foods. The Food Services Manager also stated that chicken would be cooked and cooled for use in chicken salad, but no cooling log or other documentation was maintained. The Registered Dietitian Nutritionist stated that proper cool down requires monitoring temperatures and using a cooling log, and the facility's policy identified temperature limits for food in the danger zone and cooling requirements for potentially hazardous food. Gloves were not used appropriately during food preparation, and facial hair was not covered in the kitchen. During lunch tray line observation, the Cook wiped his hands on a used cleaning cloth and did not change his gloves or wash his hands before preparing a sandwich, picked up a meal tray ticket off the floor and did not change his gloves or wash his hands before preparing a sandwich, used gloved hands to open an oven door and then touched a tortilla on a plate, and touched the handle of a bin of dishes in the dish room before picking up a hamburger bun and placing it on a plate. In a separate kitchen observation, a Server/Kitchen Aide was observed with uncovered facial hair. The Food Services Director stated that gloves should be worn and changed between tasks and that beard restraints should be worn by those with facial hair, and the Registered Dietitian Nutritionist stated that gloves should be changed between tasks and beard restraints were available and should be used by staff in the kitchen.
Resident’s Personal Belongings Moved Without Permission
Penalty
Summary
The facility failed to ensure Resident 20 was treated with dignity and respect when CNA 1 moved the resident’s personal belongings without permission. Resident 20 was admitted with diagnoses including hemiplegia and hemiparesis following a stroke and aphasia, and on observation she appeared upset and stated that all of her belongings were gone without her knowledge. She pointed to her dresser and said someone had entered her room and moved her belongings. During the investigation, Resident 20’s husband and staff reported that the resident’s belongings had been rearranged and placed where she could not easily find or access them. LN 12 stated the resident’s food had been put in the nightstand drawer, and the husband reported that items such as dentures, deodorant, shampoo, oral care products, and a mirror were moved from their usual places. CNA 1 stated she entered the room while the resident was sleeping and rearranged the belongings to make the room look cleaner, including moving the dentures from the dresser into the nightstand drawer, and acknowledged she should have asked before moving the items. LN 11 and the DON stated it was disrespectful to move or rearrange a resident’s personal belongings without consent, and facility policies stated residents are to be treated with dignity and respect and staff do not handle or move personal belongings without permission.
Unnecessary PRN Psychotropic Medication Order Exceeded 14 Days
Penalty
Summary
The facility failed to ensure that one sampled resident was free from unnecessary psychotropic medication use when the resident had an active order for lorazepam 0.5 mg every six hours as needed for end of life anxiety, with the order written for 6 months and no stop date for end of life management. The record review showed the order was dated 12/18/25 and was intended for use as needed for agitation with shortness of breath and fear. During an interview, the DON stated that the lorazepam as-needed order was for 180 days, or 6 months. When asked for documentation showing the prescriber’s rationale for extending the psychotropic as-needed order beyond 14 days, the DON did not provide any documentation. The facility policy on psychotropic medication use stated that PRN psychotropic orders are limited to 14 days unless the prescriber documents the rationale for extending the order and includes the duration.
Low Air Loss Mattress Settings Not Followed
Penalty
Summary
The facility failed to ensure pressure redistribution low air loss mattresses were set according to physician orders for two residents. One resident was admitted with adult failure to thrive and palliative care diagnoses and was assessed as high risk for pressure injury development. Although the physician ordered the low air loss mattress to be set per weight range or resident preference and the resident weighed 138 lbs., the mattress was observed set between 180 and 210 lbs. on two separate observations while the resident was in bed receiving care. A second resident was admitted with a stroke diagnosis and was also assessed as at risk for pressure injury development. The physician ordered the low air loss mattress to be set per weight range or resident preference, and the resident weighed 285 lbs. The mattress was observed set at 410 lbs. on two separate observations. During interview, the resident stated he did not have a preference for the setting and said nurses were responsible for setting the mattress. A licensed nurse reviewed the record and stated the mattress was set too high, that the resident’s preference was not documented, and that the mattress should have been set by weight. The DON stated that if the resident had a preference for a setting of 410 lbs., it should have been documented in the clinical record, and that it was the expectation for the mattresses to be set by weight and for the physician’s order to be followed. The DON also stated the charge nurse was responsible for monitoring the mattress settings and acknowledged that both residents’ mattresses were not set by weight and were set too high. The facility policy on prevention of pressure injuries stated support surfaces should be selected based on the resident’s risk factors in accordance with current clinical practice.
Medication Administration and Controlled Substance Documentation Errors
Penalty
Summary
Safe and effective pharmaceutical services were not maintained when controlled medications were documented as signed out of the controlled drug record (CDR) but were not documented on the Medication Administration Record (MAR) for four administrations of morphine sulfate for one resident, two administrations of oxycodone for another resident, and two administrations of morphine sulfate for a third resident. In one additional case, hydrocodone-acetaminophen was documented on the MAR for a resident, but the dose was not signed out on the CDR. The DON reviewed the records and confirmed the missing documentation. The facility policy for controlled substances required a resident-specific controlled substance record with the date and time of administration and the nurse’s signature. Medication administration for diabetes was not carried out in accordance with orders and medication directions for two residents. One resident had active orders for glipizide three times daily and metformin twice daily; the glipizide package label directed administration 30 minutes before a meal, and the metformin label directed administration with food. The nurse confirmed the scheduled administration times and the meal times, and the facility-provided drug references stated glipizide should be given about 30 minutes before meals and metformin with meals. Another resident had an active order for insulin lispro before meals and at bedtime with a hold parameter for blood sugar less than 150, yet doses were documented and given when blood sugars were 146, 100, and 132. The DON acknowledged the MAR entries for those administrations. Blood pressure medications were also administered despite hold parameters for one resident. The resident had orders for carvedilol twice daily and losartan daily, both with instructions to hold for systolic blood pressure less than 110. On the morning reviewed, the resident’s blood pressure was 100/60, yet both medications were documented as given. The DON verified the MAR entries, the blood pressure reading, and the hold parameters. The facility’s medication administration policy stated medications are to be administered in accordance with prescriber orders.
Medication Error Rate Exceeded Allowed Threshold
Penalty
Summary
The facility failed to ensure the medication error rate remained below 5 percent. Surveyors found 6 medication errors out of 40 opportunities during medication administration observations for three residents, resulting in a 15% error rate. The errors were identified during direct observation, interview, and record review. For one resident, an LPN prepared and administered seven medications by crushing all tablets together in one bag and mixing them with pudding. The medications included levetiracetam 500 mg, ferrous sulfate 325 mg EC, and acetaminophen 650 mg ER. During record review and interview, the LPN confirmed the ferrous sulfate was enteric-coated and the acetaminophen was extended-release, and stated she was unaware not to crush levetiracetam, ferrous sulfate EC, and acetaminophen ER. Facility-provided drug information stated these medications should not be crushed. For another resident, an LPN crushed each of five morning medications separately and mixed them with pudding, including aspirin 81 mg EC and potassium chloride 10 mEq ER. The LPN later confirmed she had crushed all of the resident’s morning medications and acknowledged aspirin EC should not be crushed. For a third resident, an LPN administered a fluticasone/vilanterol inhaler that had been opened on 12/01 and was labeled to be discarded six weeks after opening. During interview, another LPN stated the inhaler was no good, and the DON stated it should have been taken out of circulation immediately and reordered. The facility’s medication administration policy required checking the expiration or beyond-use date before administering medications.
Unlabeled Inhaler Mouthpiece Administered
Penalty
Summary
Safe medication labeling was not ensured when an LN administered an opened and unlabeled inhaler mouthpiece to Resident 16 during medication administration. During observation, the LN prepared and gave 13 medications, including fluticasone/vilanterol for the resident's asthma or COPD, from an inhaler that was inside a pharmacy-labeled box, but the inhaler mouthpiece itself had no label attached. During a later interview, another LN stated the inhaler mouthpiece had no label but normally should have a label affixed in addition to the box label. The DON stated that nursing staff were expected to label the resident's name and open date on devices such as inhaler mouthpieces. The facility policy on Medication Labeling and Storage stated that labeling of medications is consistent with currently accepted pharmaceutical practices.
Unqualified Food Services Oversight
Penalty
Summary
The facility failed to ensure that the Food Services Manager (FSM), who shared responsibility with the Food Services Director (FSD) for overseeing the kitchen serving the Skilled Nursing Facility, was qualified to manage the day-to-day operations of the food services department. During interviews, the FSM stated that she did not have the Certified Dietary Manager or Dietary Services Supervisor credential, and the FSD agreed with the stated division of responsibilities. The Administrator confirmed that the current kitchen structure had the FSD and FSM overseeing the entire community, and that the facility did not have a dedicated full-time qualified person for the SNF. During the recertification survey, surveyors also observed multiple kitchen issues, including the absence of a cool down process for time and temperature control for food safety, improper use of gloves, and uncovered facial hair. Review of facility documents did not show evidence that the FSM met the qualifications required under California Health and Safety Code HSC 1265.4 for supervision of dietetic service operations. The report states that this affected 21 residents who received food prepared in the kitchen.
Fortified Diet Recipes Not Followed
Penalty
Summary
The facility failed to prepare foods in a form designed to meet individual needs when fortified foods were not prepared according to the facility's standardized recipes. During observation, interview, and document review, a cook stated he used 2 oz of gravy or butter to fortify foods and said it was listed on the recipe, but when shown the Mexican Roasted Vegetable Recipe he could not locate where gravy or butter was listed. He also stated he planned to add butter to all items on the lunch menu. The Food Services Director stated that cooks use the Calorie Boosters listed on the document, but the cooks decide how much of the calorie boosters to add and when. The Registered Dietitian Nutritionist stated that the menus use additions listed on the recipes and that cooks should follow the recipes to ensure the Fortified Diet is correct. She stated the fortified diet is recommended for residents with weight loss or poor meal intake. Review of the facility policy titled Standardized Recipes indicated only tested, standardized recipes will be used to prepare food. Review of the Mexican Roasted Vegetables standardized recipe showed special diet instructions for Diabetic, Mechanical Soft Ground, Puree, and Finger Food, but Fortified Diet was not listed on the recipe.
Missing Adaptive Eating Equipment on Meal Tray
Penalty
Summary
The facility failed to provide special required adaptive eating equipment for Resident 22 during meals. During a concurrent observation and interview on 02/09/2026 at 1:02 PM, Resident 22 had a meal tray at bedside, and the tray ticket indicated a plate guard, but the plate guard was not delivered on the meal tray. Resident 22 stated that there was not a plate guard on the tray. During a concurrent observation and interview on 02/10/2026 at 12:15 PM with the Food Service Director during the lunch meal tray line, Resident 22's tray ticket again listed a plate guard, and the resident still did not have one on the meal tray. The Food Service Director confirmed that the plate guard was missing from Resident 22's meal tray and stated that it should have been included. Facility records titled Order Summary Report, Food Preparation and Service, dated 02/10/26, indicated that Resident 22 was on a CCHO diet and required a plate guard for all meals.
Inaccurate Medication Indication Documented on MAR
Penalty
Summary
The facility failed to maintain accurately documented records when the wrong indication for Namenda was electronically transcribed on the MAR for one resident. During a concurrent interview and record review, the resident’s medical record showed Namenda 5 mg twice a day for unconsolable crying, started 12/17/25. When asked where the diagnosis came from, the LN reviewed the original handwritten order, which stated "Dx unspecified dementia," and stated that the incorrect diagnosis had been entered into the electronic medical record. The facility’s drug review for Namenda identified it as a medication used for moderate to severe Alzheimer dementia, and the facility’s Charting and Documentation policy stated that documentation in the medical record must be objective, complete, and accurate.
QAA/QAPI Committee Failed to Address Advance Directives
Penalty
Summary
The facility's QAA/QAPI committee failed to identify, develop, and implement action plans related to advance directives, as cross referenced with F 578. During interview, the DON and ADM stated that advance directives were not completed according to regulation for many residents and both acknowledged that this should have been completed. The ADM stated the QAPI committee reviewed facility issues affecting a high number of residents and that advance directives should have been identified as a QAPI project. Review of the facility's undated QAPI policy stated that information about the quality of care and services delivered to residents is evaluated and monitored by the QAPI committee to identify problems, high risk issues, and opportunities for improvement, including resident choice.
Infection Control Lapses in Medication Room and G-Tube Medication Administration
Penalty
Summary
The facility failed to implement proper infection control practices in the Medication Room and during medication administration for one resident with a G-tube. During a tour of the Medication Room, the soap dispenser at the sink was observed not working; the motion-activated dispenser had a blinking light and no soap came out when hands were placed underneath it. The Infection Preventionist stated there should have been soap at all sinks for handwashing to prevent staff who had touched medical waste from walking around the facility potentially contaminating things. The facility policy on hand hygiene stated that hand hygiene products and supplies are to be readily accessible and convenient for staff use. During a medication administration observation for a resident with Enhanced Barrier Precautions posted outside the room, an LPN wore gown and gloves into the room, moved a bedside table while wearing the same gloves, and then administered medications through the resident’s G-tube without changing gloves. The LPN acknowledged using the same gloves to move the table and for medication administration and stated she should have changed them after moving the table to avoid cross-contamination. The Infection Preventionist stated nursing staff were to change gloves after moving furniture to avoid touching the G-tube with contaminated gloves. The facility’s EBP policy identified feeding tube care or use as a high-contact resident care activity requiring gown and gloves, and the hand hygiene policy stated hand hygiene is indicated after touching the resident’s environment and before performing an aseptic task.
Loose Bed Side Rails Not Properly Secured
Penalty
Summary
The facility failed to ensure that the side rails for Resident 14 were properly maintained. Resident 14 was admitted with a diagnosis of unspecified dementia. During observation, the resident’s bed had an unpadded half side rail that was raised, and the side rail was loose and easily moved from side to side and back and forth. The side rail had vertical bars with approximately 3-4-inch gaps between them. Interview and observation findings showed that Resident 14 liked to go to the edge of the bed, attempted to get out of bed by climbing over the side rail, and would hang her legs over the side rails. A LN observed both side rails moving back and forth and side to side and stated they were very loose and should have been fixed to the bed. The Maintenance Director stated the side rails were loose and that she tightened them, and also stated side rails were not routinely inspected after installation. The DON stated side rails should be firmly attached and secured to the bed and that loose side rails were not safe.
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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 La Mesa
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Grossmont Hospital D/p Snf | 0.6 mi | ★★★★★ | 0 | 0 |
| Grossmont Post Acute Care | 0.6 mi | ★★★★★ | 3 | 0 |
| Arbor Hills Nursing Center | 0.6 mi | ★★★★★ | 8 | 0 |
| Parkway Hills Nursing & Rehabilitation | 0.6 mi | ★★★★★ | 34 | 0 |
| Country Manor La Mesa Healthcare Center | 0.7 mi | ★★★★★ | 0 | 0 |
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