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Linwood Meadows Care Center

4444 West Meadow, Visalia, CA 93277 · Tulare County · (559) 627-1241

98 certified beds, about 93 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1980

Certified for Medicaid Certified for Medicare
Overall
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 555125 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on May 22, 2025, inspectors cited 16 health deficiencies (the California average is 15.6, the national average 9.2).

None of its 54 health citations since July 2021 was rated as actual harm or immediate jeopardy.

CMS lists no fines against this home in the last three years.

Nurses and nurse aides worked 4.03 hours per resident per day, against 4.52 across California and 3.86 nationally. Registered nurses accounted for 0.25 of those hours.

36.4% of nursing staff left within the year CMS measured (California average 36.7%).

CMS links it to PACS Group, an affiliated group of 275 nursing homes.

Health inspections

Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.

Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.

Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit

Where its citations fall on CMS's grid

CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 54 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
0G
0H
0I
Potential for more than minimal harm
27D
22E
5F
Potential for minimal harm
0A
0B
0C
August 5, 2025Complaint inspection · 1 citation
  1. D
    Ensure services provided by the nursing facility meet professional standards of quality.
    F658 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 2, 2025
    Inspectors wroteBased on interview and record review, the facility failed to ensure the physician was notified when one of three sampled residents (Resident 1) medication was not administered per physician's orders. This failure resulted in Resident 1 not receiving enoxaparin sodium (medication used to prevent blood clots) and had the potential for Resident 1 to experience health complications.
May 23, 2025Complaint inspection · 1 citation
  1. E
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    F609 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) May 24, 2025
    Inspectors wroteBased on interview and record review, the facility failed to report allegations of physical abuse to the California Department of Public Health (CDPH) within 24 hours for three of four sampled residents (Resident 1, Resident 2, and Resident 3). This failure had the potential for abuse allegations not being investigated and residents experiencing continued physical abuse.
May 22, 2025Standard inspection · 16 citations
  1. E
    Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
    F578 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to offer, obtain, and complete advance directives (AD- a written statement of a person's wishes regarding medical treatment when one is unable to make decisions for themselves) for 10 of 26 sampled residents (Resident 14, Resident 20, Resident 12, Resident 75, Resident 5, Resident 142, Resident 29, Resident 86, Resident 71, and Resident 243). This failure had the potential to result in a failure to provide care in accordance with the resident's treatment wishes.
  2. E
    Provide activities to meet all resident's needs.
    F679 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure activities of interest were provided for four of 11 sampled residents (Resident 86, Resident 14, Resident 56, and Resident 29). This failure had the potential to affect Resident 86, Resident 14, Resident 56, and Resident 29's physical, mental, social, emotional health and well-being, which could diminish quality of life and /or potentially cause depression (feeling of sadness).
  3. E
    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
    F727 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to ensure a Registered Nurse (RN) worked at least eight hours a day, seven days a week on 11 of 21 sampled days. This failure had the potential to negatively affect residents care, clinical outcomes, and assessments.
  4. E
    Observe each nurse aide's job performance and give regular training.
    F730 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to have an effective Certified Nurse Assistant (CNA) performance evaluation (PE- a process to give employees feedback on their job performance) and annual in-service program when: 1. Three of six sampled CNA's (CNA 1, CNA 3,and CNA 4) had not received 12 hours of annual in-service education. This failure had the potential to result in CNA's not having appropriate knowledge to care for residents. 2. Two of eight sampled CNAs (CNA 1, CNA 2, CNA 3) had not received a performance evaluation every 12 months. This failure had the potential for the facility to not be able to validate the CNA's had the knowledge and skills to perform their job duties, which could negativly affect resident care.
  5. E
    Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
    F807 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Honor two of 25 sampled residents (Resident 31, Resident 73) food preferences. 2. Follow physician diet orders for one of 25 sampled residents (Resident 59). These failures had the potential to result in a decreased oral intake and unwanted weight loss.
  6. E
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure: 1. Opened Food items were labeled with an open date. 2. Dented cans were properly discarded. These failures had the potential to cause foodborne illness (illness caused by the ingestion of contaminated food or beverages) for at-risk vulnerable residents.
  7. E
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control practices were implemented when: 1. Three large barrels containing residents' clean personal laundry were stored in the dirty area of the laundry room. 2. One of one sampled Housekeeper (HSK 1) did not perform hand hygiene. These failures had the potential to spread infectious diseases to all residents, visitors, and staff.
  8. E
    Implement a program that monitors antibiotic use.
    F881 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to: 1. Maintain an effective antibiotic stewardship (efforts to ensure that antibiotics are used only when necessary and appropriate) for one of three sampled residents (Resident 73) when the attending physician (MD) 1 was not notified of the results of the urine culture, including the susceptibility/sensitivity (determines how well a microbe [like bacteria or fungi] responds to a specific antimicrobial drug [antibiotic]) results. This failure resulted in Resident 73 not receiving the antibiotic that had the highest efficacy for the treatment of a urinary tract infection (UTI). 2. Follow the facility's policy and procedure on Antibiotic Stewardship when MD 1 did not evaluate one of one sampled resident (Resident 73) within 72 hours after ordering the antibiotic via telephone. [...]
  9. E
    Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
    F887 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to provide in-service education on Covid-19 (severe respiratory illness) for 143 of 186 total staff. This failure had the potential for staff not knowing how to prevent the spread of Covid-19 in the event of a pandemic (widespread outbreak of an infectious disease) affecting all residents, staff, and visitors.
  10. E
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    F921 · Environmental · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an ambient (surrounding air) temperature for three of six sampled resident rooms (room [ROOM NUMBER] A/B, room [ROOM NUMBER] A/B, room [ROOM NUMBER] A/B). This failure resulted in the residents feeling warm and uncomfortable in their respective rooms.
  11. E
    Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
    F947 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to ensure : 1. Six of Six sampled Certified Nursing Assistants (CNA 3, CNA 1, CNA 2, CNA 5, CNA 6 and CNA 4) attended a minimum of five hours of annual dementia (a general term for the loss of memory, language, and reasoning skills) care training. This failure had the potential for CNAs to not have the knowledge and skills on how to meet the care needs of residents with dementia. 2. One of five sampled CNA's (CNA 3) received annual abuse prevention training. This failure had the potential for CNA 3 to not have the knowledge and skills on how to recognize and report abuse.
  12. D
    Ensure that residents are fully informed and understand their health status, care and treatments.
    F552 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to: 1. Ensure Informed Consent (IC, a process in which a healthcare professional educates a patient about the risks, benefits, and alternatives of a given procedure or medication) for one of seven sampled resident (Resident 5's) Mirtazapine (Remeron-antidepressant medication) 15 milligrams (mg) was signed by the physician prior to medication administration. This failure had the potential to result in adverse consequence when the physician had not given the resident sufficient information about the drug, which may have negative effect on the resident. 2. Have accurate informed consent for a psychotropic (medication to treat mental disorders) medication for one of seven sampled residents (Resident 27). This failure had the potential for Resident 27 to not be aware of the risks and benefits of taking psychotropic medications.
  13. D
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to assess the effectiveness of the plan of care for the use of a communication board (a visual aid that facilitates communication between patients and their care team) for one of one sampled resident (Resident 29). This failure resulted in the facility not understanding, identifying, and determining Resident 29's needs and the potential to deprive her of maintaining the highest practicable physical, mental, and psychosocial well-being.
  14. D
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    F756 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to act on a recommendation from the pharmacy consultant (a professional responsible for reviewing each resident's medication profile monthly to identify and report changes) for one of 10 sampled residents (Resident 71). This failure had the potential to result in Resident 71 not receiving a needed medication and possibly leading to medical complications that could diminish quality of life.
  15. D
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    F842 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to maintain accurate medical records for two of 38 sampled residents (Resident 3 and Resident 142) when the Nursing Weekly Summary (NWS) did not reflect the residents' skin condition, including toes and toenails. This failure resulted in Resident 3 and Resident 142's medical records to be incomplete and inaccurate, which could lead to misdiagnosis, inappropriate treatment, and delay in care.
  16. D
    Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
    F909 · Environmental · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 13, 2025
    Inspectors wroteBased on interview and record review, the facility failed to ensure maintenance staff conducted bed rail risk assessments to include evaluation of the bed and measurements of siderails and potential bed entrapment zones for two of two newly admitted sampled residents (Resident 32 and Resident 142). This failure had the potential to place Resident 32 and Resident 142 at risk for harm.
January 10, 2025Complaint inspection · 1 citation
  1. D
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) February 6, 2025
    Inspectors wroteBased on interview and record review, the facility failed to ensure a fall assessment was accurate for one of two sampled residents (Resident 1). This failure had the potential for staff to be unaware of Resident 1's risk for falls.
December 13, 2024Complaint inspection · 2 citations
  1. D
    Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
    F837 · Administration · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) December 18, 2024
    Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure when staff in-service training records were incomplete. This failure resulted in incomplete training records and the potential for staff to be inadequately trained to care for residents.
  2. D
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) December 18, 2024
    Inspectors wroteBased on interview and record review, the facility failed to ensure three of three sampled staff Restorative Nursing Assistant (RNA 1), Registered Nurse (RN 1), and Certified Nursing Assistant (CNA 1), were aware of the facility's Enhanced Barrier Precaution (EBP-infection control measures used to reduce the spread of infection) protocol (blue heart placed above the bed of the affected resident) used to identify the residents requiring staff to wear PPE while providing care. This failure resulted in staff being unaware of which resident required EBP.
November 1, 2024Complaint inspection · 1 citation
  1. D
    Give the resident's representative the ability to exercise the resident's rights.
    F551 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) December 23, 2024
    Inspectors wroteBased on interview and record review, the facility failed to ensure two of three sampled residents (Resident 1 and Resident 2) Responsible Representative (RR 2 and RR 3) were notified and informed of changes made with the existing Physician Orders for Life-Sustaining Treatment (POLST-a focused type of advance directive used in critical situations where immediate medical decisions are needed). This failure resulted in Resident 1 being intubated (involves inserting a plastic tube into the airway to help breath) without consent.
August 20, 2024Complaint inspection · 1 citation
  1. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) August 30, 2024
    Inspectors wroteBased on interview and record review, the facility failed to develop and implement a care plan for two of two sampled residents (Resident 1 and Resident 2). This failure had the potential for Resident 1 and Resident 2 to have unmet care needs.
October 26, 2023Standard inspection · 16 citations
  1. F
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure on: 1. Surveillance for Infections when the monthly reports did not contain the complete information required. 2. Monitoring Compliance with Infection Control when the facility did not complete the hand hygiene monitoring. These failures had the potential to result in a facility-wide infection outbreak affecting all residents, staff, and visitors.
  2. E
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to provide for three of eight sampled residents (Resident 14, Resident 62, Resident 55) a home-like environment when: 1. Resident 14's bathroom wall paint was peeled off. 2. Water temperature in the shower rooms were turning cold during showers. These failures had the potential to negatively affect residents' quality of life.
  3. E
    Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
    F585 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to provide prompt efforts to act on and resolve grievances for two of seven sampled residents (Resident 54 and Resident 70). This failure resulted in residents experiencing frustrations and had the potential to affect their quality of life.
  4. E
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure manufacturers guidelines were followed for use of low air loss (LAL) mattresses (mattress used for prevention of pressure injuries) for five of 14 sampled residents (Resident 84, Resident 51, Resident 347, Resident 11, and Resident 246). This failure had the potential to result in developing new or worsening of pressure injuries.
  5. E
    Provide routine and 24-hour emergency dental care for each resident.
    F790 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to assist three of three sampled residents (Resident 19, Resident 44 and Resident 55) to receive dental services. This failure had the potential for these residents to have difficulty chewing food and maintaining nutritional needs.
  6. E
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food items in the storage area were labeled and dated. This failure had the potential to result in foodborne illnesses.
  7. E
    Put firmly secured handrails on each side of hallways.
    F924 · Environmental · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a handrail was firmly secured and in good repair. This failure had the potential to expose residents and visitors to injuries or accidents as a result of a broken handrail.
  8. D
    Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
    F557 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their policy and procedure titled, Dignity, for one of two sampled residents (Resident 299), when a urine collection bag (a bag used to collect urine that is drained from the bladder) was not covered with a dignity bag. This failure had the potential to cause Resident 299 embarrassment.
  9. D
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    F623 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on interview and record review, the facility failed to follow their policy and procedure (P&P) titled, Transfer or Discharge Notice, when the facility did not send a notice of transfer to the Ombudsman (representatives who assist resident in long-term care facilities with issues related to day-to-day care, health, safety, and personal preferences) for two of five sampled residents (Resident 59 and Resident 17). This failure had the potential to result in residents being discharged inappropriately and not having an advocate who could inform them of their admission, transfer, and discharge rights and options.
  10. D
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a plan of care for two of two sampled residents (Resident 29, Resident 19) when: 1. Resident 29's plan of care did not include nail care. 2. Ensure an accurate assessment to reflect Resident 19's loose fitting dentures. These failures resulted in residents not receiving the services they needed which had the potential for negative health outcomes.
  11. D
    Ensure services provided by the nursing facility meet professional standards of quality.
    F658 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure titled, Administering Medications when: 1. The Director of Nursing of Nursing (DON) did not check the intravenous (IV-given inside of a vein) antibiotic (medication used to treat bacterial infection) for one of one sampled resident (Resident 92). 2. Resident 92' IV antibiotic were not administered at the right time according to physician's order. These failures had the potential for Resident 92 to recieve the wrong medication with potential to result in adverse health outcomes
  12. D
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 19 sampled residents (Resident 29) received nail care. This failure had the potential to cause injury to Resident 29.
  13. D
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, record review, the facility failed to ensure one of eight sampled residents (Resident 14) physician's order for treatment was followed. This failure had the potential for delaying Resident 14's wound healing and result in infection.
  14. D
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their policy and procedure (P&P) titled, Medication Storage, when: 1. Expired medication was not removed from one of three sampled medication refrigerators (Refrigerator C). 2. Diabetic testing strips (strips used to test blood sugar) were not labeled with the date they were opened on one of two sampled medication carts (D Hall Cart). 3. Medication refrigerator temperature was not monitored every shift for three of three sampled medication refrigerators (Refrigerator A, Refrigerator B, and Refrigerator C). These failures had the potential to result in unintended, harmful, or undesirable health outcomes to the residents.
  15. D
    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
    F805 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of two sampled residents (Resident 36)'s diet texture was followed according to the physician's order. This failure had the potential for Resident 36 to experience choking due to incorrect food texture.
  16. D
    Implement a program that monitors antibiotic use.
    F881 · Infection Control · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 16, 2023
    Inspectors wroteBased on interview and record review, the facility failed to implement an effective antibiotic stewardship program when one of six sampled residents (Resident 86) was reviewed and monitored for the use of an antibiotic. This failure had the potential for Resident 86 to continually take inappropriate or unnecessary antibiotic and may result in infections not treated appropriately.
July 23, 2021Standard inspection · 15 citations
  1. F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the dietary staff failed to follow proper sanitation and safe food handling practices when: 1. Ensuring the inside of two clean plate covers were not touching DS uniform while waiting to cover the lunch plates. 2. Performing handwashing and changing gloves prior to preparing a grilled cheese sandwich during tray line. These failures had the potential to result in foodborne illnesses for residents in the facility.
  2. F
    Dispose of garbage and refuse properly.
    F814 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure garbage and refuse were properly collected and disposed in a safe and efficient manner. This failure had the potential to result in harboring, feeding, and attracting pests and vermin.
  3. F
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Handle, store, process linens in a safe and sanitary method to prevent the spread of infection. 2. Store clean briefs appropriately. 3. Maintain a safe and sanitary environment in resident bathroom. 4. Two housekeeping staff failed to follow manufactures contact times for disinfectant. These failures had the potential to spread communicable diseases and infection to the facility's residents, staff, and visitors.
  4. F
    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
    F925 · Environmental · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, record review, the facility failed to provide an effective pest control program. This failure had the potential to spread disease to residents, staff, and visitors.
  5. E
    Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
    F640 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the facility failed to ensure Minimum Data Set (MDS- standardized screening assessment tool) were completed and transmitted within the required time frame for three of 24 sampled residents (Resident 1, Resident 3, and Resident 16). This failure had the potential to negatively affect the provision of necessary care and services for the residents.
  6. E
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the facility failed to follow their policy and procedure (P&P) for the reconciliation of controlled substances (a drug subject to special handling, storage, and disposal because of its potential for abuse or addiction) for one of 24 residents (Resident 321). This failure had the potential for the potential for loss or diversion of controlled substances.
  7. E
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Lock controlled substances in one of five medication carts. This failure had the potential to result in medication loss. 2. Have the correct label on a bag that corresponded to the medication inside for one of 24 sampled residents (Resident 63). This failure had the potential for medication administration errors resulting in significant harm to the resident.
  8. E
    Develop and implement policies and procedures for flu and pneumonia vaccinations.
    F883 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the facility failed to ensure two of five sampled residents (Resident 24 and Resident 50) were offered and administered the pneumococcal vaccine (vaccines to prevent severe pneumococcal disease) in a manner consistent with professional standards and guidance from Centers for Disease Control and Prevention (CDC) recommendation. This failure had the potential to increase potential transmission of pneumonia for Resident 24 and Resident 50.
  9. D
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS- a standardized screening assessment tool) for one of three sampled residents (Resident 68). This failure had the potential to negatively affect the provision of necessary care and services.
  10. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement comprehensive care plans for three of 24 sampled residents (Resident 317, Resident 28, and Resident 59) This failure had the potential for Resident 317's and Resident 28's grooming and personal hygiene needs to go unmet and placed Resident 59 at risk for injury.
  11. D
    Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
    F676 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteSurveyor: [NAME], [NAME] Based on observation, interview, and record review, the facility failed to ensure two of 24 sampled residents (Resident 63 and Resident 28), received necessary services to maintain grooming and personal hygiene. This failure had the potential to result in a negative impact tot he resident's quality of life and self-esteem.
  12. D
    Assist a resident in gaining access to vision and hearing services.
    F685 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 24 sampled residents (Resident 32) received audiology (hearing) services. This failure had the potential for Resident 32 to have unmet care needs.
  13. D
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    F756 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the consultant pharmacist failed to identify and make recommendations to attempt a gradual dose reduction of an antipsychotic drug (classification of drugs used to treat mental disorders) for one of 24 sampled residents (Resident 32). This failure had the potential to result in decreased quality of life, adverse consequences, and significant, irreversible side effects.
  14. D
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    F758 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on interview and record review, the facility failed to attempt a gradual dose reduction of an antipsychotic drug (classification of drugs used to mental disorders) for one of 24 sampled residents (Resident 32). This failure had the potential to result in decreased quality of life, adverse consequences, and significant, irreversible side effects.
  15. D
    Ensure medication error rates are not 5 percent or greater.
    F759 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 14, 2021
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medication error rate was five percent or less when four medication errors were observed out of 42 medication administration opportunities, which yielded a medication error rate of 9.52 percent. These failures had the potential for residents not to receive the therapeutic effects of the medications.

Fire safety inspections

27 fire safety citations on file: 6 on May 22, 2025, 5 on October 26, 2023, 16 on July 23, 2021.

Every fire safety citation27 citations
  1. F
    Have approved installation, maintenance and testing program for fire alarm systems.
    K 345 · May 22, 2025 · Corrected (the home has a date of correction)
  2. F
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · May 22, 2025 · Corrected (the home has a date of correction)
  3. E
    Ensure proper usage of power strips and extension cords.
    K 920 · May 22, 2025 · Corrected (the home has a date of correction)
  4. C
    Conduct testing and exercise requirements.
    E 39 · May 22, 2025 · Corrected (the home has a date of correction)
  5. C
    Inspect, test, and maintain automatic sprinkler systems.
    K 353 · May 22, 2025 · Corrected (the home has a date of correction)
  6. C
    Have simulated fire drills held at unexpected times.
    K 712 · May 22, 2025 · Corrected (the home has a date of correction)
  7. F
    Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
    K 521 · October 26, 2023 · Corrected (the home has a date of correction)
  8. E
    Conduct risk assessment and an All-Hazards approach.
    E 6 · October 26, 2023 · Corrected (the home has a date of correction)
  9. E
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · October 26, 2023 · Waiver
  10. D
    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
    K 321 · October 26, 2023 · Corrected (the home has a date of correction)
  11. D
    Ensure proper usage of power strips and extension cords.
    K 920 · October 26, 2023 · Corrected (the home has a date of correction)
  12. E
    Conduct risk assessment and an All-Hazards approach.
    E 6 · July 23, 2021 · Corrected (the home has a date of correction)
  13. E
    Include a process for Emergency Preparedness collaboration.
    E 9 · July 23, 2021 · Corrected (the home has a date of correction)
  14. E
    Establish procedures for tracking staff and patients during an emergency.
    E 18 · July 23, 2021 · Corrected (the home has a date of correction)
  15. E
    Establish roles under a Waiver declared by secretary.
    E 26 · July 23, 2021 · Corrected (the home has a date of correction)
  16. E
    Implement emergency and standby power systems.
    E 41 · July 23, 2021 · Corrected (the home has a date of correction)
  17. E
    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
    K 321 · July 23, 2021 · Corrected (the home has a date of correction)
  18. E
    Ensure proper usage of power strips and extension cords.
    K 920 · July 23, 2021 · Corrected (the home has a date of correction)
  19. D
    Address patient/client population and determine types of services needed.
    E 7 · July 23, 2021 · Corrected (the home has a date of correction)
  20. D
    Establish policies and procedures for medical documentation.
    E 23 · July 23, 2021 · Corrected (the home has a date of correction)
  21. D
    Provide properly protected cooking facilities.
    K 324 · July 23, 2021 · Corrected (the home has a date of correction)
  22. D
    Install a fire alarm system that can be heard throughout the facility.
    K 341 · July 23, 2021 · Corrected (the home has a date of correction)
  23. D
    Properly select, install, inspect, or maintain portable fire extinguishes.
    K 355 · July 23, 2021 · Corrected (the home has a date of correction)
  24. D
    Install corridor and hallway doors that block smoke.
    K 363 · July 23, 2021 · Corrected (the home has a date of correction)
  25. D
    Provide a written emergency evacuation plan.
    K 711 · July 23, 2021 · Corrected (the home has a date of correction)
  26. D
    Meet requirements for the use of electrical equipment.
    K 919 · July 23, 2021 · Corrected (the home has a date of correction)
  27. D
    Have proper medical gas storage and administration areas.
    K 923 · July 23, 2021 · Corrected (the home has a date of correction)

Fines and payment denials

CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.

Staffing

Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.

MeasureThis homeCaliforniaUnited States
All nursing staff (RN, LPN and aides)4.034.523.86
Registered nurses0.250.670.69
All nursing staff on weekends3.724.093.42
Nurse aides2.75
Licensed practical nurses1.03
Nursing staff turnover (share who left in a year)36.4%36.7%45.8%
Registered nurse turnovernot reported38.1%42.9%
Administrators who left0

CMS expects 3.73 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.

Staffing by quarter, from daily payroll records

Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 4.15 on weekdays and 3.72 on weekends, 10% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.1% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.20 in April to June 2025 to 4.03 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20264.030.254.153.72 0.1%0 of 9093
Oct to Dec 20254.000.224.113.71 0.2%0 of 9289
Jul to Sep 20254.000.184.133.67 0.1%0 of 9292
Apr to Jun 20254.200.164.293.96 0.0%0 of 9192
United States, Jan to Mar 20263.750.623.923.335.3%0.5% of days
California, Jan to Mar 20264.360.594.523.972.3%0.5% of days

Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.

Staff pay reports

Staff pay at this home

No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review. If you work here, your report helps start one.

Official wage estimates for California

JobMedianMiddle halfEmployed
California, all employers
CNAs (nursing assistants)$22.90$22.04 to $26.35110,060
LPNs and LVNs$38.34$35.98 to $45.0682,850
Registered nurses$67.44$58.87 to $83.25338,940
United States, nursing care facilities
CNAs (nursing assistants)$20.67$17.91 to $22.55534,270
LPNs and LVNs$33.86$30.05 to $37.40188,210
Registered nurses$41.11$37.85 to $47.68142,270

Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.

Work here? Share your pay anonymously

For Linwood Meadows Care Center. No name, email or phone, and nothing you could type about a resident: every answer is a number or a choice.

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Mandatory overtime?
How did staffing feel on your usual shift?

Every report is reviewed before it counts; what it says about the home never decides whether it counts. How pay reports are handled.

How staff pay reports work · CNA pay by state

Quality measures

The measures CMS uses for the quality star. Lower is better for every one of them.

MeasureThis homeCaliforniaUS
Percentage of long-stay residents whose need for help with daily activities has increased
Long Stay residents, 2025Q2-2026Q1
10.210.313.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.30.80.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
1.41.21.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
2.51.63.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
0.31.41.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
15.29.814.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
0.74.34.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
0.012.015.4
Percentage of short-stay residents who were rehospitalized after a nursing home admission
Short Stay residents, 20250101-20251231
22.922.923.8
Percentage of short-stay residents who had an outpatient emergency department visit
Short Stay residents, 20250101-20251231
7.811.212.0
Number of hospitalizations per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
1.72.31.9
Number of outpatient emergency department visits per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
1.01.61.8

Short-term rehab results

For a stay to recover after a hospital visit, these are the results CMS publishes for Linwood Meadows Care Center's Medicare short-stay residents. On returning residents home or to the community, CMS rates it better than the national rate (59.1% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.

Went home or back to the community

59.1% this home

Better than the national rate

US median of homes 51.5% · California: 301 better, 190 worse

Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 176 eligible stays.

Potentially preventable readmissions

9.2% this home

No different from the national rate

US median of homes 10.7% · California: 10 better, 22 worse

Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 183 eligible stays.

Infections that led to a hospital stay

7.4% this home

No different from the national rate

US median of homes 7.1% · California: 8 better, 48 worse

Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 113 eligible stays.

Self-care and mobility at discharge

78.3% this home

Median of homes: California59.2% · US 56.6%

Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 60 residents counted.

Falls with major injury

2.4% this home

Median of homes: California0.0% · US 0.0%

Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 125 residents counted.

New or worsened pressure ulcers

0.0% this home

Median of homes: California0.6% · US 1.7%

Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 125 residents counted.

Medication list given at discharge

98.5% this home

Median of homes: California96.2% · US 98.7%

Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 67 residents counted.

Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.

Owners and operators

Legal business name: SNOWDROP HOLDINGS, LLC. CMS links this home to PACS Group, a group of 275 nursing homes averaging 2.9 stars overall.

NameRoleTypeShareSince
Grossman, StephenContracted managing employeeIndividual01/15/2014
Richardson, DanielW-2 managing employeeIndividual07/26/2021
Apt, FrederickCorporate officerIndividual01/01/2024
Hancock, MarkCorporate officerIndividual01/01/2024
Jergensen, JoshuaCorporate officerIndividual01/01/2024
Mitchell, JohnCorporate officerIndividual01/01/2024
Richardson, DanielOperational/managerial controlIndividual07/26/2021

As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.

Questions to ask on a visit

Chosen from this home's own inspection record.

  1. When is the care plan meeting, and can family attend it?Inspectors cited 9 problems in this area, most recently on August 5, 2025: "Ensure services provided by the nursing facility meet professional standards of quality."
  2. How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 8 problems in this area, most recently on May 22, 2025: "Provide activities to meet all resident's needs."
  3. What changed in infection control since the last inspection, and who on staff is the infection preventionist?Inspectors cited 8 problems in this area, most recently on May 22, 2025: "Provide and implement an infection prevention and control program."
  4. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 7 problems in this area, most recently on May 22, 2025: "Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive."
  5. Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.72 hours per resident per day, below the California average of 4.09.

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Assisted living in California

California contacts for a concern about a nursing home

These are the official offices in California. NursingHomeClear cannot take or act on complaints.

Common questions

What is Linwood Meadows Care Center's Medicare star rating?
CMS rates Linwood Meadows Care Center 3 out of 5 stars overall, with 2 for health inspections, 3 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did Linwood Meadows Care Center get at its last inspection?
16 health deficiencies at the standard inspection on May 22, 2025. The California average is 15.6.
Has Linwood Meadows Care Center been fined?
CMS lists no fines in the last three years.
Does Linwood Meadows Care Center accept Medicaid?
It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
Who owns Linwood Meadows Care Center?
CMS lists 7 owners and managers, and links the home to PACS Group. Legal business name: SNOWDROP HOLDINGS, LLC.

Sources

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