Smith Ranch Skilled Nursing & Rehabilitation Cente

Inspectors wroteBased on interview and record review, the facility failed to ensure an allegation of verbal abuse was timely reported to the Department or was investigated for one of three sampled residents (Resident 1). This failure delayed state agency awareness and oversight of an alleged abuse incident and caused Resident 1 unnecessary anxiety. Cross reference F610. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement comprehensive, person-centered nursing care plans for one of three sampled residents (Resident 1), after Resident 1 received verbal threats of violence/death from a family member. This failure had the potential to result in Resident 1's physical harm and/or continued psychological distress. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a care plan for three of five sampled residents (Resident 2, Resident 3, and Resident 5) when:1. Resident 2's care plan for intravenous (IV) therapy (a medical process that administers fluids, medications and nutrients directly into a person's vein) was initiated seven days after the start of his IV therapy, and;2. Resident 3 and Resident 5's IV therapy was not care planned. These failures placed Resident 2, Resident 3, and Resident 5 at risk for unmet care needs and inadequate care planning. Cross reference F684.1. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide services in accordance with professional standards of practice for a census of 71 residents when: 1. A Licensed Vocational Nurse (a licensed nurse responsible for rendering basic nursing care) provided nursing services outside of her scope of practice (a defined range of responsibilities and procedures that a licensed professional is legally permitted to perform) when she provided IV therapy to facility residents without IV certification, and; 2. The facility did not maintain accurate training documentation. These failures posed a potential risk to resident health and safety by compromising adherence to professional nursing standards and by impairing the facility's ability to ensure staff competence through accurate training documentation. Cross reference F684 and F842.1. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide quality of care for three of five sampled residents (Resident 2, Resident 3, and Resident 5) when: 1. A peripheral venous catheter (PIVC- a short, flexible catheter inserted into a small peripheral vein, also known as, peripheral intravenous [PIV] line) was inserted into Resident 2 and Resident 5 without a physician's order, 2. No order was obtained for the removal of the PIVC and the removal of the PIVC was not documented for Resident 2, Resident 3 and Resident 5, and;3. Resident 2, Resident 3, and Resident 5's physician orders were not followed. These failures increased Resident 2, Resident 3, and Resident 5's risk for complications related to intravenous (IV) therapy (a medical process that administers fluids, medications and nutrients directly into a person's vein), infection, and compromised quality of care. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure accurate documentation for three out of five sampled residents (Resident 2, Resident 3, and Resident 5) when medications administered and tasked physician orders were not documented by the nurse who completed the order. This failure had the potential to compromise resident safety, monitoring, and the facility's ability to communicate essential clinical information. Cross reference F658. A review of Resident 2's admission record indicated he was admitted to the facility in March 2026 with medical diagnosis which included muscle wasting and atrophy (wasting or loss of muscle tissue), and adult failure to thrive (a decline caused by chronic diseases and functional impairments which can cause weight loss, decreased appetite, poor nutrition, and inactivity). [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one of five sampled residents (Resident 3) were free from significant medication errors when her breathing treatments and intravenous (IV- into the vein) antibiotics (a medication used to treat or prevent bacterial infections) were not administered in accordance with the physician's order. These failures decreased the facility's potential to safely administer medications and increased Resident 3's risk for compromised respiratory status and infection. A review of Resident 3's admission record indicated she was admitted to the facility in February 2026 with medical diagnosis which included cellulitis (a skin infection that causes swelling and redness) of left lower limb and asthma (inflammatory disease of the airway causing breathing difficulties). [...]

Inspectors wroteBased on observation, interview, and record review, the facility did not provide a safe, hazard free environment for five of eight sampled residents (Resident 3, Resident 23, Resident 61, Resident 81, and Resident 93), when four rooms had damaged wall trims with exposed sharp edges, and Resident 23's wall trim was detached. These failures had the potential to cause harm and injury to the residents, especially those with cognitive impairments who might not recognize the hazards. A review of Resident 3's admission record indicated he was admitted to the facility in December 2025 with medical diagnosis which included chronic obstructive pulmonary disease (COPD-a chronic lung disease causing difficulty in breathing), and narcolepsy (a chronic sleep disorder). [...]

Inspectors wroteBased on interview, and record review, the facility failed to provide services according to professional standards of practice for three of eight sampled residents (Resident 15, Resident 59, and Resident 80) when 72-hour monitoring was not completed following a change of condition (COC). These failures had the potential for Resident 15, Resident 59, and Resident 80 to experience further complications after a COC. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to safely obtain, prepare and serve food to a census of 70 residents receiving food from the kitchen when dietary staff:Used damaged/worn food preparation equipment;Stored frozen meats improperly;Served unpasteurized, uncooked eggs to four residents (Residents 25, 34, 53 and 81);Did not practice appropriate hand hygiene and wore unapproved jewelry during food preparation, and;Used cracked and worn implements to transport and serve resident food. These failures could have led to foodborne illnesses in residents. Additionally, those with weakened immune systems or health conditions faced a higher risk of serious complications. During a concurrent observation and interview on 2/09/26 at 8:58 a.m. with the Dietary Manager (DM), an initial tour of the kitchen was conducted. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure laundry equipment was safely maintained for a census of 71 residents when the inside of one of two laundry dryers was visibly contaminated with debris (pieces of waste). This failure had the potential to expose resident's linens and laundry to unsanitary conditions and damage. During a concurrent observation and interview on 2/11/26 at 12:20 p.m., the Housekeeping Supervisor (HS) removed dry linens from one of two operated laundry dryers. The inside of the dryer cylinder was observed with debris that was melted, hardened, and adhered throughout the inside of the cylinder that was in direct contact with laundry. The HS stated the inside of the dryer cylinder did not get cleaned. The HS further stated the items inside the dryer cylinder appeared to be melted plastic bags and bandages. [...]

Inspectors wroteBased on interview and record review, the facility failed to submit Level I Preadmission Screening and Resident Reviews (PASRR) by the 31st day after admission for two of four sampled residents (Residents 4 and 5), who stayed longer than 30 days. This failure had the potential to result in Resident 4 and Resident 5 losing their eligibility for specialized medical services if diagnosed with a serious mental illness, intellectual disability, developmental disability, or related condition(s). [...]

Inspectors wroteBased on interview and record review, the facility failed to initiate a chance in condition process, and appropriately monitor and document a resident's response to treatment for one of eight sampled residents (Resident 71) after he suffered a hypertensive crisis (a medical emergency characterized by rapid, severe increase in blood pressure above 180/120 millimeters of mercury [mmHg, unit of measurement for blood pressure]). As a result, Resident 71 experienced another acute hypertension episode one week later, which could have been prevented with close supervision. This posed risks of severe harm, such as a heart attack, stroke, or organ damage to Resident 71. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure safe medication storage and administration for one of eight sampled residents (Resident 53) when nursing staff left a medication at Resident 53's bedside, without an assessment, and physician order for self-administration of medications. This failure had the potential to result in serious medication errors, overdoses and theft. In addition, leaving medication unattended risked consumption by other residents, accidental ingestion, or misuse. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication was labeled and stored safely when it was found in an unlocked area accessible by four residents (Resident 21, Resident 31, Resident 55 and Resident 71). This violated professional standards of nursing practice and state and federal regulations. This failure had the potential to result in medication errors potentially requiring medical intervention, theft, diversion and/or accidental ingestion by residents. During an observation on 2/09/26 at 10:30 a.m., in the common bathroom shared by the residents in room [ROOM NUMBER] and the residents in room [ROOM NUMBER], a bottle of medicine was found inside an unlocked, plastic chest of drawers containing various personal care items. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection prevention measures were provided for one of eight sampled residents (Resident 59) when: 1: Resident 59's portable oxygen concentrator (an oxygen delivery device) filter cabinet was dusty,2: Resident 59's nasal cannula (a tube that delivers oxygen directly into the nostrils) was not labeled, and;3: Resident 59's suctioning machine (a medical device used to remove fluids from the airway) was stored close to the floor and the yankauer (a suctioning tool that goes inside the mouth) was not covered during storage. These failures increased Resident 59's risk of infection. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to publicly post California Department of Public Health (CDPH) contact information for residents residing in facility. This failure resulted in residents not being afforded the right to make a complaint to CDPH regarding concerns with their care or the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and prepare food in a safe and sanitary manner when: 1. Lettuce was not rinsed per packing instructions prior to being chopped and plated onto salad bowls. 2. Two carts used for food transport from the Main Kitchen to the Nourishment Room were dirty. 3. Food items were not discarded after their use-by-date. 4. One bin of contaminated rice was not discarded. 5. Food items were not stored in sealed containers to prevent contamination. 6. Opened food items were not properly labeled with open and use-by-date. These failures had the potential to cause food-borne illnesses in an already medically fragile population. The kitchen served a population of 73 residents.

Inspectors wroteBased on interview and record review the facility's Quality Assurance Performance Improvement (QAPI- data-driven approach to improving quality in healthcare facilities) committee failed to identify the need for oversight of the Restorative Nursing Assistance (RNA) program. This failure resulted in residents not receiving the appropriate treatments per physician orders. (Refer to F688).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure licensed nurses followed professional standards of practice when they documented they administered medications which were not dispensed by the pharmacy for one of 24 sampled residents (Resident 6). This failure resulted in inaccurate documentation and the potential for Resident 6 to experience adverse effects such as shortness of breath. During a review of Resident 6's face sheet (demographics), the face sheet indicated Resident 6 was admitted on [DATE] with diagnoses including COPD (Chronic Obstructive Pulmonary Disease [ongoing lung condition that makes it difficult to breathe]) and asthma (a condition which makes it difficult to breathe). During an observation on 5/14/25 at 10:18 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 was observed administering Resident 6's respiratory medications. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure four of 24 sampled residents (Resident 1, 2, 35 and 58) received restorative nursing care (RNA -specialized form of nursing that focuses on helping patients regain or maintain their functional abilities and minimize weakness) per physician order. This failure had the potential to result in contractures (permanent shortening and stiffening of muscles, tendons, ligaments leading to limited movement and deformity) and decline in muscle strength.

Inspectors wroteBased on interview and record review, the facility failed to complete and obtain informed consent (a consent that provides the risks and benefits of taking a medication, possible side effects, alternate treatments, and risk of no use) for a psychotropic medication (medications that affect the mind, emotions and behavior) for one of 24 sampled residents (Resident 1). This failure had the potential for Resident 1 not to be fully informed and consent to receive psychotropic medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the call light was within reach for two of 24 sampled residents (Resident 2 and Resident 35). This failure had the potential to result in Resident 2 and Resident 35 being unable to contact staff for assistance.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a clean environment when: 1. room [ROOM NUMBER] Bed A had a visibly soiled privacy curtain (curtain used between residents' beds). 2. Resident 2 had dirty clothes piled up on her nightstand. 3. room [ROOM NUMBER]'s air conditioner was in disrepair. These failures had the potential for residents to live in an unsafe and unclean, non-homelike environment.

Inspectors wroteBased on interview and record review, the facility failed to assess and submit accurate data for one of 24 sampled residents (Resident 35) when the Minimum Data Set (MDS- an assessment tool used to guide resident care) did not reflect Resident 35's current status. This failure resulted in the transmission of inaccurate data to the Centers for Medicare and Medicaid Services (CMS).

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement interventions the physician prescribed to prevent skin breakdown for one of 24 sampled residents (Resident 37) when Resident 37's pressure reducing mattress (mattress designed to prevent development of pressure ulcers (bedsores) or worsening of existing ulcers by redistributing air and pressure while the machine controlled the air flow) was not turned on for an unknown amount of time. This failure had the potential to result in Resident 37 developing a pressure ulcer, skin damage, skin infections, and discomfort.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure one of 24 sample residents (Resident 35) was weighed daily per physician order. This failure had the potential to result in Resident 35 not being properly monitored for weight loss and nutritional interventions not being implemented in a timely manner.

Inspectors wroteBased on observation, interview, and record review, the facility failed to label an enteral feeding (a method to provide food through a tube placed in the nose, the stomach, or the small intestine) bottle, an enteral feeding pump bag, and a syringe used for enteral feeding for one of 24 sampled residents (Resident 35). This failure had the potential for expired enteral feeding supplement and equipment to be used for Resident 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medication error rate was not five percent or greater when five identified medication errors out of 26 opportunities were observed: 1. Budesonide (medication inhaled into the lungs to prevent inflammation of the airways) was omitted for Resident 6. 2. Midodrine (medication used to treat orthostatic hypotension [a condition characterized by a sudden drop in blood pressure upon standing, leading to dizziness, light-headedness, and fainting]) was omitted for Resident 6. 3. Ipratropium 0.03% (nasal spray used to treat conditions affecting the lungs and nasal passages) was not administered according to manufacturer instructions and was administered at the incorrect time for Resident 6. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement safe medication storage practices for two of 24 sampled residents (Resident 2 and 4) and 1 unsampled resident (Resident 30) when: 1. Resident 30's triamcinolone acetonide cream (medication used to treat various skin conditions) was found on Resident 30's bedside table. 2. Resident 2 had one large container of powdered Magnesium (supplement to support healthy nerve and muscle function), one bottle of [brand name] Sleep Aid, and one bottle of [brand name] PM (at night) Leg Cramp medication on top of a dresser at bedside. 3. Resident 4 had a bottle of multivitamins on the bedside table. These findings had the potential to result in the unauthorized administration of medications and serious adverse events such as overdosing or negative drug interactions.

Inspectors wroteBased on interview and record review, the facility failed to protect one resident (Resident 1) of two sampled residents from misappropriation of resident property when Resident 1's credit card was used by a Front Desk Staff (FDS). This failure resulted in Resident 1 feeling taken advantage of, distrustful, and embarrassed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow policy and procedure when: 1. Steam table pans were not air-dried before stacking; 2. The drain under the dishwasher did not have an air gap (the unobstructed vertical space between the water outlet and the flood level of a fixture and prevents backflow of outlet water); and, 3. A pan of beef was not cooked to the appropriate temperature before placing on the steam table to serve. These failures could potentially result in food-borne illness in a vulnerable population.

Inspectors wroteBased on observation, interview, and record review, the facility failed to place the results of State surveys (inspections) where they were accessible to residents, who were unable to view them without having to ask for assistance. This failure resulted in residents being unable to read the State survey reports when they did not know where the reports were kept, or could not reach or lift the binder containing the reports.

Inspectors wroteBased on interviews and records review, the facility failed to ensure notices of the bed-hold policy were provided to two of three hospitalized residents (Resident 45 and Resident 42). This failure could have resulted in residents being unaware they could return to the facility after hospitalization, and if they needed to submit payment to reserve a bed.

Inspectors wroteBased on interviews and records review, the facility failed to ensure the Minimum Data Set (MDS - health status screening and assessment tool) was accurately completed for three of 15 sampled residents (Residents 3, Resident 29 and Resident 16). This failure resulted in unidentified areas of risk for the residents in order to develop the most appropriate plan of care.

Inspectors wroteBased on observation, interviews, and records review, the facility failed to develop and implement person-centered care plans for 3 of 15 sampled residents (Resident 3; 16; and 159). This failure had the potential for facility staff to provide inadequate care to vulnerable residents when their individual needs and interests were not addressed appropriately.

Inspectors wroteBased on interviews, and records review, the facility failed to ensure showers for one of three sampled residents (Resident 29) was given during his scheduled shower days. This failure to maintain Resident 29's personal grooming and hygiene needs had the potential to raise the risk of unidentified skin issues, bacterial or fungal infections.

Inspectors wroteBased on observations, interviews, and records review, the facility failed to provide meaningful activities for two of 15 sampled residents (Residents 3 and 29). This failure resulted in residents not receiving activities according to their preferences and needs, which could potentially impact their physical, mental, and psychosocial well-being.

Inspectors wroteBased on observations, interviews and records review, the facility failed to ensure the medication error rate was below 5%, when two of four licensed staff (Licensed Staff M and F) did not follow the doctor's order and manufacturer's specifications regarding administration of medication. The failures resulted in a 17% medication error rate which had the potential to compromise the residents' health and well-being for not getting the required medication according to the doctor's order.

Inspectors wroteBased on observations, interviews, and records review, the facility failed to implement measures to reduce the risk of disease and infection transmission when: 1. Two Unlicensed Staff (Unlicensed Staff B and H) did not perform proper hand hygiene before passing food trays to the residents. This failure had the potential for spreading disease-causing microorganisms and/or transmission of diseases to the residents. 2. Four residents (Resident 29, 209, 213 and 19) were not offered hand hygiene before meals. This failure had the potential risk for residents getting sick from common germs including Escherichia coli (E. coli - type of bacteria) which can cause stomach aches and vomiting. 3. Licensed Staff E did not perform hand hygiene, according to the facility policy, during medication pass. [...]

Inspectors wroteBased on interviews and records review, the facility failed to meet professional standards for pain medication administration for one of 15 sampled residents (Resident 29). This failure had the potential to compromise the resident's health and well-being for not getting the required dose of medication according to the doctor's order.

Inspectors wroteBased on interviews and records review, the facility failed to ensure one of 15 sampled residents (Resident 3) was provided with a communication tool or resources to effectively communicate her needs. This failure had the potential for Resident 3 not to understand and carry out activities of daily living (ADL) which could lead to a decline in Resident 3's quality of life. (Reference F679)

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to accurately assess and provide necessary services to prevent the development of a facility-acquired pressure ulcers (injuries to skin and underlying tissue resulting from prolonged pressure on the skin) and worsening of the pressure ulcer, for one of five sampled residents, Resident 20, when: The facility did not identify the presence of a pressure ulcer timely for Resident 20, which resulted in the development of an Unstageable (Full thickness tissue loss in which the ulcer is covered with by slough - Slough is necrotic (dead) tissue that needs to be removed from the wound for healing to take place) and/or eschar (Eschar, pronounced es-CAR, is dead tissue that sheds or falls off from the skin. [...]

Inspectors wroteBased on observation, interview and records review, the facility failed to ensure staff provided appropriate respiratory care for one of three sampled oxygen dependent residents (Resident 3), when the facility did not attach a humidifier bottle (moistens the air to prevent a resident's nasal membranes from becoming dry, sore and scabby) to the oxygen (O2 - life-supporting component of the air) concentrator [a device used to provide oxygen to a resident in a steady even flow by means of a nasal cannula (a small, soft plastic tube that is divided into two prongs, which are placed in the nostrils)] when Resident 3 was on 5 liters (a metric unit of volume) of oxygen. This failure had the potential to result in Resident 3's discomfort associated with a dry nose from continuous oxygen use.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to ensure one of three sampled residents, Resident 109, was free from significant medication errors, when her pain medication, Oxycodone HCL (Oxycodone Hydrochloride is used to relieve pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated) was not administered, as ordered by the physician. This failure had the potential to result in ineffective pain management, sedation, or possible dependence or addiction to the medication.