CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER
CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER is a 120-bed nursing home in SAN DIEGO, California. CMS has certified it for Medicare and Medicaid since 1988-10-12. It averages 114.9 residents a day.
What harm was found in the violations cited at CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER?
CMS lists 53 health-inspection deficiencies for CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER since 2023-07-28, 46 of them in the three years to 2026-08-01: the highest scope-and-severity letter on record is G; the most recent health inspection was 2026-04-15.
| Survey date | Tag | Deficiency | Severity |
|---|---|---|---|
| 2026-04-15 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G |
| 2026-04-15 | F0657, F0684 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D |
| 2026-01-22 | F0880 | Provide and implement an infection prevention and control program. | E |
| 2025-09-16 | F0550, F0880 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. / Provide and implement an infection prevention and control program. | D |
| 2025-09-04 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E |
| 2025-09-04 | F0684, F0835 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Administer the facility in a manner that enables it to use its resources effectively and efficiently. | D |
| 2025-04-24 | F0558, F0584, F0812, F0865, F0880 | Reasonably accommodate the needs and preferences of each resident. / 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. / Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. / Have a plan that describes the process for conducting QAPI and QAA activities. / Provide and implement an infection prevention and control program. | E |
| 2025-04-24 | F0561, F0656, F0684, F0686, F0689, F0690, F0698, F0758, F0842 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Provide appropriate pressure ulcer care and prevent new ulcers from developing. / Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. / Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. / Provide safe, appropriate dialysis care/services for a resident who requires such services. / 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. / Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D |
| 2024-12-26 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E |
| 2024-10-15 | F0641, F0655 | Ensure each resident receives an accurate assessment. / Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D |
| 2024-09-13 | F0808, F0880 | Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. / Provide and implement an infection prevention and control program. | D |
| 2024-07-30 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D |
| 2024-05-10 | F0812, F0880 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. / Provide and implement an infection prevention and control program. | E |
| 2024-05-10 | F0550, F0554, F0558, F0578, F0583, F0584, F0656, F0677, F0684, F0688, F0693, F0726, F0755, F0761, F0921 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. / Allow residents to self-administer drugs if determined clinically appropriate. / Reasonably accommodate the needs and preferences of each resident. / 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. / Keep residents' personal and medical records private and confidential. / 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. / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Provide care and assistance to perform activities of daily living for any resident who is unable. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. / Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. / Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. / Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. / 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. / Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | D |
| 2023-07-28 | F0558, F0656, F0699, F0755, F0758, F0759, F0812 | Reasonably accommodate the needs and preferences of each resident. / Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Provide care or services that was trauma informed and/or culturally competent. / Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. / 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. / Ensure medication error rates are not 5 percent or greater. / Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D |
How is CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER staffed?
| Measure | This facility | CA average |
|---|---|---|
| Total nurse staffing hours per resident per day | 5.02376 | 4.51570 |
| Total nursing staff turnover (%) | 40.0 | 36.7 |
| Average number of residents per day | 114.9 | 87.9 |
Who owns CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER, and what chain is it in?
CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER is registered with CMS as For profit - Limited Liability company, operates under the legal business name BERNARDO HEIGHTS HEALTHCARE, INC. and belongs to the THE ENSIGN GROUP chain.
| Role | Owner | Association date |
|---|---|---|
| MANAGING CONTROL - GOVERNING BODY | BURNAM, SOON, KALAFER, MICHAEL, MATTHEWS, GLENN | since 03/22/2016 |
| CORPORATE DIRECTOR | PORT, BARRY | since 01/22/2015 |
| CORPORATE OFFICER | BURNAM, SOON, KEETCH, CHAD, OH, KATHERINE, SATO, AMI, WILLITS, ADAM | since 03/01/2006 |
| OPERATIONAL/MANAGERIAL CONTROL | CETNA STAFFING INC, LINCARE INC, SEVENOAKS CAPITAL ASSOCIATES LLC, KALAFER, MICHAEL, MATTHEWS, GLENN | since 03/01/2006 |
| ADP OF THE SNF | CARETRUST GP LLC, CARETRUST REIT INC, CM HEALTH HOLDINGS LLC, CTR PARTNERSHIP LP, ENSIGN SERVICES INC, THE ENSIGN GROUP INC, KALAFER, MICHAEL, MATTHEWS, GLENN | since 01/30/2006 |
Were you or a family member harmed at CARMEL MOUNTAIN REHABILITATION & HEALTHCARE CENTER?