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 August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Healdsburg Hospital D/p Snf during CMS and state inspections, most recent first.
The facility failed to label and date food items in the refrigerator and dry storage, risking food-borne illnesses. Observations revealed unlabeled prepared food in the refrigerator and several opened items in dry storage without labels. Kitchen staff acknowledged the lapse in following the facility's policy requiring labeling with received, opened, and use-by dates.
A facility failed to create a person-centered care plan for a resident with a medical condition affecting his eyes, which required specific care to prevent drying. Despite the resident having a gauze dressing and receiving eye drops, the electronic care plan lacked documentation addressing his vision needs, contrary to the facility's policy requiring individualized care plans based on medical and psychosocial needs.
A facility failed to follow professional standards for enteral medication administration for two residents. An LPN did not flush the enteral tubes with the required 15-30 ml of water before and after administering medications, as per facility policy. This was observed during medication administration for residents with complex medical histories, including traumatic brain injury and seizure disorders. The DON confirmed the policy requirements, indicating a deficiency in adherence to established procedures.
Failure to Label and Date Food Items
Penalty
Summary
The facility failed to ensure proper food storage practices, which could lead to food-borne illnesses. During an observation, it was noted that two bowls of prepared food in the walk-in refrigerator were not labeled. Additionally, several food items in the dry storage area, including oatmeal, Nilla wafers, tortilla chips, pasta, and pancake mix, were opened and lacked labels indicating the date they were opened or a use-by date. This lack of labeling could result in the rapid growth of pathogenic microorganisms, posing a risk to the residents. Interviews with kitchen staff revealed that the facility's policy required food items to be labeled with a received date, an opened date, and a use-by date. However, this policy was not followed, as evidenced by the unlabeled items found during the survey. Kitchen Staff E and D acknowledged the labeling requirements and the failure to adhere to them, indicating a lapse in following the facility's food and supply storage policy dated June 2023.
Failure to Develop Individualized Care Plan for Resident's Eye Care
Penalty
Summary
The facility failed to develop a person-centered individualized care plan for a resident, identified as Resident 7, which had the potential to impact the care provided to the resident's eyes. During an observation, it was noted that Resident 7 had his right eye covered with a gauze dressing due to a medical condition that caused swelling, preventing the eyelids from closing. This condition required the use of eye drops and a dressing to prevent the eye from drying out. However, upon review of the electronic care plan, it was found that there was no individualized care plan addressing Resident 7's vision needs. The facility's policy on Person-Centered Care Plans, dated August 2024, mandates that a care plan should be written for each resident based on their medical, functional, and psychosocial needs, which was not adhered to in this case.
Failure to Properly Flush Enteral Tubes During Medication Administration
Penalty
Summary
The facility failed to adhere to professional standards of practice in the administration of medications through enteral tubes for two residents, Resident 16 and Resident 5. During observations, it was noted that Licensed Nurse A did not flush the enteral tubes with the required amount of water before and after administering medications. Specifically, the nurse flushed the tubes with only approximately 5 ml of water between each medication, contrary to the facility's policy which mandates a flush of 15-30 ml of warm water before and after medication administration. Resident 16, who had a history of traumatic brain injury, fecal incontinence, and gastroesophageal reflux disease, was administered several medications through an enteral tube without the proper flushing protocol. Similarly, Resident 5, diagnosed with traumatic brain injury, seizure disorder, and pneumonia, also received medications through an enteral tube without the required flushing before and after the administration. This oversight in following the established protocol could potentially lead to blockages in the enteral tubes, affecting the timely delivery of critical medications. The Director of Nursing confirmed that the facility's policy requires flushing the feeding tube with at least 15-30 ml of warm water before and after medication administration. The failure to comply with this policy was observed during the medication administration process for both residents, highlighting a deficiency in the facility's adherence to its own procedures for enteral medication administration.
What surveyors are citing around you — mapped
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Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 119 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Healdsburg
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Arbol Healthcare Center Of Santa Rosa | 12.6 mi | ★★★★★ | 20 | 0 |
| Cloverdale Healthcare Center | 14.4 mi | ★★★★★ | 5 | 0 |
| Blue Oak Post-acute | 15.3 mi | ★★★★★ | 35 | 0 |
| Park View Post Acute | 15.8 mi | ★★★★★ | 13 | 0 |
| Northvine Postacute Care | 16.1 mi | ★★★★★ | 1 | 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 August 2026) and official state health department websites.