Compiled from official CMS federal data
THE ELLISON JOHN TRANSITIONAL CARE CENTER, LANCASTER, CA — Violations & Inspection Reports
Does THE ELLISON JOHN TRANSITIONAL CARE CENTER have a federal violation or abuse history?
According to the public federal record on file with the Centers for Medicare & Medicaid Services (CMS), THE ELLISON JOHN TRANSITIONAL CARE CENTER (CCN 555904), in LANCASTER, CA, has federal inspection findings.
In its current inspection cycle, CMS cited the facility for 45 deficiencies; the most severe is rated G, a level CMS classifies as actual harm. The latest standard health inspection on file is dated 2025-02-28. Earlier-cycle citations appear in the dated timeline below as historical, not current. CMS has $205,171 in civil money penalties on file against the facility. The record also includes 6 abuse- or neglect-related citations in CMS's "Freedom from Abuse, Neglect, and Exploitation" family (F600-series; most recent Nov 2025). This page restates the federal record and draws no conclusion of its own.
Abuse-, fall-, and care-related findings on the federal record
- 6 citations in CMS's "Freedom from Abuse, Neglect, and Exploitation" family (F600-series) — most recent Nov 2025.
- 6 citations for accident hazards or inadequate supervision (F689) — the deficiency family behind fall-related findings; most recent Nov 2025.
- 2 pressure-ulcer care citations (F686) — the consumer term is "bedsores"; most recent Feb 2024.
- 1 nutrition and hydration citation (F692) — the consumer terms are "malnutrition" and "dehydration"; most recent May 2025.
- 59 findings on file from complaint-triggered inspections.
Every figure above restates CMS’s own dated record; this page draws no conclusion of its own. Strict state filing deadlines can apply to nursing-home injury claims — a licensed attorney in your state can review this record.
FOR FAMILIES
What brings you to this record?
The Federal Record
At its most recent federal inspection, CMS cited this facility for 1 deficiency that CMS classified as "actual harm" — its category for harm that reached a resident, above the level of risk alone.
Below is this facility's federal inspection record as on file with CMS.
Scope & Severity — current cycle
CMS's own A–L scope/severity grid. Plotted cells mark this facility's most recent (current-cycle) citations.
Civil money penalties on file
$205,171
CMS also records 21 days of payment denial.
Have a lawyer review this record →
About this record: Federal nursing-home surveys are conducted on a recurring cycle by state survey agencies acting on CMS's behalf, and the figures on this page are compiled from CMS's published provider data, as on file with CMS; the federal record may understate what actually occurred, and inspection findings are point-in-time survey results, not a determination that any specific resident was harmed.
Deficiency timeline
Citations are listed by scope/severity (most severe first), not chronologically; each entry is labeled current-cycle or historical.
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
57 more citations on file — Abuse & neglect 2 · Accidents & supervision 1 · Nutrition & hydration 1 · Medication & pharmacy 11 · Resident rights 7 · Other citations 31 (expand)
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Reasonably accommodate the needs and preferences of each resident.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ensure that residents are free from significant medication errors.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ensure that residents are free from significant medication errors.
Provide timely, quality laboratory services/tests to meet the needs of residents.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
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.
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide timely, quality laboratory services/tests to meet the needs of residents.
Provide enough food/fluids to maintain a resident's health.
Provide and implement an infection prevention and control program.
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.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ensure that residents are free from significant medication errors.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Ensure services provided by the nursing facility meet professional standards of quality.
Provide safe and appropriate respiratory care for a resident when needed.
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 each resident’s drug regimen must be free from unnecessary drugs.
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
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.
Provide and implement an infection prevention and control program.
Provide care and assistance to perform activities of daily living for any resident who is unable.
Ensure that residents are fully informed and understand their health status, care and treatments.
Provide or obtain dental services for each resident.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 pain management for a resident who requires such services.
Ensure each resident receives an accurate assessment.
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Provide and implement an infection prevention and control program.
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Provide and implement an infection prevention and control program.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
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.
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Overall CMS star rating
This facility: 1 · CMS state average: 3.2
Both figures as published by CMS.
You may be reading this record for the first time.
If something happened to someone you love at this facility, this federal record may be new to you today. The company that operates a nursing home, by contrast, is rarely seeing records like this for the first time — operators like these typically retain standing legal, risk, and insurance teams whose routine work includes records exactly like the one on this page. That is not a judgment of this facility; it is how the business is structured. Because strict time limits can apply, families often find it helps to have a qualified person review the record with them sooner rather than later.
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Federal record
THE ELLISON JOHN TRANSITIONAL CARE CENTER — Federal Record
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SECTION 7 — CASE CONTEXT
Add what you saw at THE ELLISON JOHN TRANSITIONAL CARE CENTER to this record
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Strict time limits can apply to taking legal action — consider consulting a qualified attorney promptly.
If you believe a resident is in immediate danger, call 911. Care concerns can also be reported at no cost to your state survey agency or the Long-Term Care Ombudsman program (ltcombudsman.org) — independent of any legal inquiry.
How to read this record
Making sense of a CMS inspection record
CMS scores every citation on a grid from A to L, combining how widespread a finding was with how serious it was. A–C is a deficiency CMS classifies as no harm; D–F as the potential for harm; G–I as actual harm that reached a resident; and J–L as immediate jeopardy, CMS’s most serious level. Later letters mark more serious findings.
Three questions to ask on a tour
- How is the home staffed on nights, weekends, and holidays?
- What happens when a resident’s condition changes suddenly?
- How, and how quickly, are families told about an incident?