Home / California / Lake Arrowhead
Mountains Community Hosp Dp/SNF
29101 Hospital Road, Lake Arrowhead, CA 92352 · San Bernardino County · (909) 336-3651
19 certified beds, about 17 residents a day · Government - Hospital district · Medicare and Medicaid since 1991
Inside a hospital Certified for Medicaid Certified for Medicare
Overall
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
CMS note: This facility reported a high number of days without a registered nurse onsite.
Quality measures
3 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 555467 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on July 30, 2026, inspectors cited 1 health deficiency (the California average is 15.6, the national average 9.2).
None of its 6 health citations since March 2024 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 7.12 hours per resident per day, against 4.52 across California and 3.86 nationally. Registered nurses accounted for 1.22 of those hours.
37.5% of nursing staff left within the year CMS measured (California average 36.7%).
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.
003/24
506/25
107/26
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 6 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
0G
0H
0I
Potential for more than minimal harm
5D
0E
1F
Potential for minimal harm
0A
0B
0C
July 30, 2026Standard inspection · 1 citation
- D Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on interview and record review, the facility failed to ensure residents' comprehensive care plan (person centered, individualized roadmap used to outline specific care interventions for a nursing home resident) was updated to address psychotropic (chemical that affects how the brain works, changing a person mood) medications for one of two sampled residents (Resident 13) .This failure had the potential to result in inconsistent implementation of care, missed monitoring for effectiveness, adverse side effects (harmful, unintended reactions to medications), lapses on non-pharmacological interventions (evidence-based non-drug methods used to prevent or manage symptoms), and individualized approaches to care.
June 5, 2025Standard inspection · 5 citations
- F Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview, and record review, the facility failed to follow infection control guidelines for a universe of 19 residents when expired medical supplies were found in procedure cart and medical supply room and were readily available for use. This failure had the potential to cause unsafe care provided to the facility's 19 residents with beyond the use date (expired) supplies, which could potentially cause infection, injuries, and/ or death.
- D Assess the resident when there is a significant change in condition
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Resident Assessment Instrument/Minimum Data Set (RAI/MDS-a facility assessment and care planning process used by nursing home staff as required by the Centers of Medicare and Medicaid Services [CMS]) for a change of condition was completed within 14 days as stated within their policy and procedures (P&P) and in accordance with the federal submission timeframes for one of eight sampled residents (Resident 6) when Resident 6's condition was changed from having clear speech and no impairment with movements to unable to lift right arm, speech was very weak and was having difficulty making a sentence. This failure resulted in inadequate monitoring of Residents 6 and had the potential to delay necessary interventions leading to deterioration, increased risk of complications and poor resident prognosis.
- D Ensure each resident receives an accurate assessment.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Resident Assessment Instrument/Minimum Data Set (MDS-a facility assessment and care planning process used by nursing home staff as required by the Centers of Medicare and Medicaid Services [CMS]) was completed accurately for one of eight sampled residents (Resident 6) when the MDS assessment did not show Resident 6's current condition of having functional limitations to the right upper extremity and speech impairments. This failure resulted in inaccurate documentation of assessment for Residents 6 and had the potential to cause inadequate care planning, delay of necessary interventions that can lead to deterioration, increased risk of complications and poor resident prognosis.
- D Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Inspectors wroteBased on observations, interview, and record reviews, the facility failed to establish a comprehensive care plan (an individualized plan that includes residents' health problems, preferences and goals) consistent with the resident's medical needs for one of four residents (Resident 6) when the facility staff did not update Resident 6's care plan after identifying a change of condition. This failure resulted in inadequate response to Resident 6's changing needs, and had the potential increased risk of harm, delayed treatment, and reduced quality of life.
- D Ensure that residents are free from significant medication errors.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of four residents (Resident 9) was free from significant medication error, when a furosemide (a medication commonly called as water pill that used to eliminate water and salt from the body) was held for a systolic blood pressure (the top number in a blood pressure reading and represents the pressure in the arteries when the heart beats) less than 100 without a hold order. This failure resulted in lack of appropriate documentation and had the potential to cause adverse health outcomes by not achieving the effective purpose of the medication and miscommunication amongst the following nursing staff.
March 29, 2024Standard inspection · 0 citations
Fire safety inspections
23 fire safety citations on file: 7 on July 30, 2026, 5 on June 5, 2025, 11 on March 29, 2024.
Every fire safety citation23 citations
- F Properly install and monitor supervisory attachments on automatic sprinkler systems.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Have simulated fire drills held at unexpected times.
- F Have power receptacles that are properly grounded.
- F Have generator or other power source capable of supplying service within 10 seconds.
- D Have properly installed hallway dispensers for alcohol-based hand rub.
- D Properly select, install, inspect, or maintain portable fire extinguishes.
- D Use approved construction type or materials.
- D Inspect, test, and maintain automatic sprinkler systems.
- D Properly select, install, inspect, or maintain portable fire extinguishes.
- D Install corridor and hallway doors that block smoke.
- D Ensure proper usage of power strips and extension cords.
- F Establish policies and procedures for sheltering.
- F List the names and contact information of those in the facility.
- F Provide family notifications of emergency plan.
- F Provide properly protected cooking facilities.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- D Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D Install an approved automatic sprinkler system.
- D Properly select, install, inspect, or maintain portable fire extinguishes.
- D Have generator or other power source capable of supplying service within 10 seconds.
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.
| Measure | This home | California | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 7.12 | 4.52 | 3.86 |
| Registered nurses | 1.22 | 0.67 | 0.69 |
| All nursing staff on weekends | 6.38 | 4.09 | 3.42 |
| Nurse aides | 3.93 | ||
| Licensed practical nurses | 1.96 | ||
| Nursing staff turnover (share who left in a year) | 37.5% | 36.7% | 45.8% |
| Registered nurse turnover | 16.7% | 38.1% | 42.9% |
| Administrators who left | not reported |
CMS expects 3.65 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 7.42 on weekdays and 6.38 on weekends, 14% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 4.1% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 6.33 in April to June 2025 to 7.12 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 7.12 | 1.22 | 7.42 | 6.38 | 4.1% | 6 of 90 | 17 |
| Oct to Dec 2025 | 5.59 | 1.21 | 5.77 | 5.13 | 7.3% | 10 of 92 | 19 |
| Jul to Sep 2025 | 6.79 | 1.50 | 6.93 | 6.44 | 7.5% | 1 of 92 | 18 |
| Apr to Jun 2025 | 6.33 | 1.38 | 6.32 | 6.36 | 0.0% | 0 of 91 | 19 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| California, Jan to Mar 2026 | 4.36 | 0.59 | 4.52 | 3.97 | 2.3% | 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.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | California | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 14.3 | 10.3 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.8 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 6.9 | 1.2 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 1.4 | 1.6 | 3.2 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 20.1 | 9.8 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 5.0 | 4.3 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 6.3 | 12.0 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.1 | 2.3 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.8 | 1.6 | 1.8 |
Owners and operators
Legal business name: SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| San Bernardino Mountains Community Hospital District | 5% or greater direct ownership interest | Organization | 100% | 02/11/2013 |
| Pena, Terry | Corporate officer | Individual | 09/03/2013 | |
| Turner, Mark | Corporate officer | Individual | 02/21/2022 | |
| Waggener, Yvonne | Corporate officer | Individual | 10/01/2009 | |
| Altmeyer, Cheri | Operational/managerial control | Individual | 01/16/2012 | |
| Bush, Cynthia | Operational/managerial control | Individual | 07/08/2011 | |
| Dahlquist, Gregory | Operational/managerial control | Individual | 09/01/2023 | |
| Hernandez, Carmen | Operational/managerial control | Individual | 03/20/2013 | |
| Turner, Mark | Operational/managerial control | Individual | 02/21/2022 | |
| Waggener, Yvonne | Operational/managerial control | Individual | 10/01/2009 | |
| Weiland, Taylor | Operational/managerial control | Individual | 03/24/2022 | |
| Bush, Cynthia | Adp of the SNF | Individual | 07/08/2011 | |
| Dahlquist, Gregory | Adp of the SNF | Individual | 09/01/2023 | |
| Hernandez, Carmen | Adp of the SNF | Individual | 03/20/2013 | |
| Turner, Mark | Adp of the SNF | Individual | 07/29/2025 | |
| Waggener, Yvonne | Adp of the SNF | Individual | 10/01/2009 |
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.
- When is the care plan meeting, and can family attend it?Inspectors cited 4 problems in this area, most recently on July 30, 2026: "Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals."
- What changed in infection control since the last inspection, and who on staff is the infection preventionist?Inspectors cited 1 problem in this area, most recently on June 5, 2025: "Provide and implement an infection prevention and control program."
- How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 1 problem in this area, most recently on June 5, 2025: "Ensure that residents are free from significant medication errors."
Other nursing homes nearby
- Arrowhead Healthcare Center, LLC San Bernardino, 9.7 mi · 4 of 5 stars · 23 citations
- Sierra Vista Highland, 9.7 mi · 3 of 5 stars · 30 citations
- Haven Post Acute San Bernardino, 10.1 mi · 4 of 5 stars · 22 citations
- Hillcrest Nursing Home San Bernardino, 10.2 mi · 5 of 5 stars · 20 citations
- Del Rosa Villa San Bernardino, 10.2 mi · 4 of 5 stars · 34 citations
- Shandin Hills Behavior Therapy Center San Bernardino, 10.4 mi · 5 of 5 stars · 16 citations
- Highland Palms Healthcare Center Highland, 10.6 mi · 4 of 5 stars · 30 citations
- Waterman Canyon Post Acute San Bernardino, 11.2 mi · 4 of 5 stars · 41 citations
California contacts for a concern about a nursing home
These are the official offices in California. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: California Department of Public Health, Center for Health Care Quality, Licensing and Certification Program, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: California Long-Term Care Ombudsman Program, 1-800-231-4024. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: Cal Health Find, where California publishes its own records on licensed homes.
Common questions
- What is Mountains Community Hosp Dp/SNF's Medicare star rating?
- CMS rates Mountains Community Hosp Dp/SNF 4 out of 5 stars overall, with 5 for health inspections, 1 for staffing and 3 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Mountains Community Hosp Dp/SNF get at its last inspection?
- 1 health deficiency at the standard inspection on July 30, 2026. The California average is 15.6.
- Has Mountains Community Hosp Dp/SNF been fined?
- CMS lists no fines in the last three years.
- Does Mountains Community Hosp Dp/SNF 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 Mountains Community Hosp Dp/SNF?
- CMS lists 16 owners and managers. Legal business name: SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.