Nursing Care Index

Trabuco Hills Post Acute

Lake Forest, Orange County, California · CCN 555308 · For-profit (LLC) · part of David Johnson (48 facilities, chain average 3.2 stars)

CMS rates Trabuco Hills Post Acute 2 of 5 overall as of August 2026. 175 certified beds, 164 residents a day on average. 107 citations on record from the current inspection cycles; no fines on record.

CMS’s ratings

The Five-Star Quality Rating System, as CMS publishes it. Where CMS gives no rating, the reason CMS gives is printed instead.

Overall★★☆☆☆ 2 of 5
Health inspections★☆☆☆☆ 1 of 5
Staffing★★☆☆☆ 2 of 5
Quality measures★★★★★ 5 of 5
Quality: long-stay / short-stay5 / 4 of 5

Staffing

Total nurse staffing4.17192 hours per resident per day
Registered nurses0.37387 hours per resident per day
Weekend total3.77872 hours per resident per day
Nursing staff turnover30.4% (registered nurses 29.4%)
Administrators who left2

Citations from health inspections

Each is a finding by a state surveyor on the date shown, in CMS’s words. The severity is CMS’s scope-and-severity grid, spelled out: harm on the left, how widespread on the right.

SurveyFindingSeverityStatus
2026-06-24
complaint survey
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies · tag F0554
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-07-23
2026-05-27
complaint survey
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Resident Rights Deficiencies · tag F0557
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-06-26
2026-05-27
complaint survey
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0607
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-06-26
2026-03-04 Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Nutrition and Dietary Deficiencies · tag F0803
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · tag F0812
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Administration Deficiencies · tag F0849
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide and implement an infection prevention and control program.
Infection Control Deficiencies · tag F0880
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Keep all essential equipment working safely.
Environmental Deficiencies · tag F0908
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Environmental Deficiencies · tag F0925
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies · tag F0554
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 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.
Resident Rights Deficiencies · tag F0578
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Keep residents' personal and medical records private and confidential.
Resident Rights Deficiencies · tag F0583
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0605
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Resident Rights Deficiencies · tag F0627
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Resident Rights Deficiencies · tag F0628
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning Deficiencies · tag F0644
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · tag F0656
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Assist a resident in gaining access to vision and hearing services.
Quality of Life and Care Deficiencies · tag F0685
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · tag F0686
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Quality of Life and Care Deficiencies · tag F0690
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 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.
Quality of Life and Care Deficiencies · tag F0693
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Quality of Life and Care Deficiencies · tag F0694
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · tag F0695
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide safe, appropriate pain management for a resident who requires such services.
Quality of Life and Care Deficiencies · tag F0697
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide safe, appropriate dialysis care/services for a resident who requires such services.
Quality of Life and Care Deficiencies · tag F0698
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · tag F0755
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies · tag F0759
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 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.
Pharmacy Service Deficiencies · tag F0761
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Nutrition and Dietary Deficiencies · tag F0802
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Nutrition and Dietary Deficiencies · tag F0806
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Nutrition and Dietary Deficiencies · tag F0813
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Resident Assessment and Care Planning Deficiencies · tag F0842
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Have a plan that describes the process for conducting QAPI and QAA activities.
Administration Deficiencies · tag F0865
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Implement a program that monitors antibiotic use.
Infection Control Deficiencies · tag F0881
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Develop and implement policies and procedures for flu and pneumonia vaccinations.
Infection Control Deficiencies · tag F0883
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 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.
Infection Control Deficiencies · tag F0887
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Make sure that a working call system is available in each resident's bathroom and bathing area.
Environmental Deficiencies · tag F0919
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Nursing and Physician Services Deficiencies · tag F0947
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-04-03
2026-03-04 Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning Deficiencies · tag F0641
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-03-04 Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
Administration Deficiencies · tag F0838
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-04-03
2026-01-23
complaint survey
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies · tag F0757
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2026-02-22
2026-01-23
complaint survey
Keep residents' personal and medical records private and confidential.
Resident Rights Deficiencies · tag F0583
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-02-22
2026-01-23
complaint survey
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Resident Assessment and Care Planning Deficiencies · tag F0636
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-02-22
2026-01-23
complaint survey
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · tag F0686
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-02-22
2026-01-23
complaint survey
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · tag F0755
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-02-22
2026-01-23
complaint survey
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Resident Assessment and Care Planning Deficiencies · tag F0842
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2026-02-22
2025-09-09
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-10-09
2025-09-09
complaint survey
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · tag F0755
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-10-09
2025-08-21
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-09-21
2025-08-21
complaint survey
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Rights Deficiencies · tag F0580
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2025-09-21
2025-08-21
complaint survey
Provide timely, quality laboratory services/tests to meet the needs of residents.
Administration Deficiencies · tag F0770
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2025-09-21
2025-08-08
complaint survey
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · tag F0656
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-09-08
2025-08-08
complaint survey
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies · tag F0554
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2025-09-08
2025-04-24
complaint survey
Provide or get specialized rehabilitative services as required for a resident.
Quality of Life and Care Deficiencies · tag F0825
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-05-24
2025-02-19
complaint survey
Provide or get specialized rehabilitative services as required for a resident.
Quality of Life and Care Deficiencies · tag F0825
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-03-10
2024-11-15
complaint survey
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.
Resident Rights Deficiencies · tag F0584
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-12-15
2024-10-11
complaint survey
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Quality of Life and Care Deficiencies · tag F0700
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · tag F0812
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide and implement an infection prevention and control program.
Infection Control Deficiencies · tag F0880
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 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.
Environmental Deficiencies · tag F0909
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies · tag F0554
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Reasonably accommodate the needs and preferences of each resident.
Resident Rights Deficiencies · tag F0558
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 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.
Resident Rights Deficiencies · tag F0578
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Rights Deficiencies · tag F0580
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Keep residents' personal and medical records private and confidential.
Resident Rights Deficiencies · tag F0583
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Resident Rights Deficiencies · tag F0623
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide activities to meet all resident's needs.
Quality of Life and Care Deficiencies · tag F0679
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · tag F0689
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 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.
Quality of Life and Care Deficiencies · tag F0693
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · tag F0695
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide safe, appropriate dialysis care/services for a resident who requires such services.
Quality of Life and Care Deficiencies · tag F0698
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies · tag F0755
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Pharmacy Service Deficiencies · tag F0756
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 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.
Pharmacy Service Deficiencies · tag F0758
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies · tag F0759
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 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.
Pharmacy Service Deficiencies · tag F0761
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Nutrition and Dietary Deficiencies · tag F0803
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Implement a program that monitors antibiotic use.
Infection Control Deficiencies · tag F0881
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Keep all essential equipment working safely.
Environmental Deficiencies · tag F0908
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-11-11
2024-10-11 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights Deficiencies · tag F0550
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11
complaint survey
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · tag F0656
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 Assist a resident in gaining access to vision and hearing services.
Quality of Life and Care Deficiencies · tag F0685
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11
complaint survey
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies · tag F0757
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11
complaint survey
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Resident Assessment and Care Planning Deficiencies · tag F0842
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-10-11 Provide bedrooms that don't allow residents to see each other when privacy is needed.
Environmental Deficiencies · tag F0914
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-11-11
2024-08-01
complaint survey
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Rights Deficiencies · tag F0580
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-09-01
2024-06-20
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-07-20
2024-05-16
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-06-16
2024-04-30
complaint survey
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Resident Rights Deficiencies · tag F0553
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-05-30
2024-03-20
complaint survey
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Resident Assessment and Care Planning Deficiencies · tag F0842
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-04-20
2024-03-07
complaint survey
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
Nutrition and Dietary Deficiencies · tag F0809
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2024-04-06
2022-04-08 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · tag F0812
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2022-05-08
2022-04-08 Reasonably accommodate the needs and preferences of each resident.
Resident Rights Deficiencies · tag F0558
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 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.
Resident Rights Deficiencies · tag F0578
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · tag F0656
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · tag F0689
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · tag F0695
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 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.
Pharmacy Service Deficiencies · tag F0761
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Nutrition and Dietary Deficiencies · tag F0813
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 Provide and implement an infection prevention and control program.
Infection Control Deficiencies · tag F0880
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2022-05-08
2022-04-08 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.
Resident Rights Deficiencies · tag F0584
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2022-05-08
2022-04-08 Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Nutrition and Dietary Deficiencies · tag F0803
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2022-05-08
2022-04-08 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Nutrition and Dietary Deficiencies · tag F0806
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2022-05-08
2022-04-08 Dispose of garbage and refuse properly.
Nutrition and Dietary Deficiencies · tag F0814
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2022-05-08
2022-04-08 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Resident Assessment and Care Planning Deficiencies · tag F0842
B No actual harm, with potential for minimal harm; pattern Deficient, Provider has date of correction
2022-05-08

Fines and payment denials

No fines or payment denials on record since 2023.

Who owns and runs it

Every owner, officer and manager CMS lists, as filed. These are the names in CMS’s ownership record; anyone named in the ownership record can ask about it on the about page.

NameRoleShareSince
Lake Forest Post Acute LLC
Organization
adp of the snf2023-05-19
Lake Forest Property Holdings, LLC
Organization
adp of the snf2022-08-16
Sun Meridian Management Services LLC
Organization
adp of the snf2021-03-22
Vbn New York LLC
Organization
adp of the snf2022-08-16
Lake Forest Post Acute LLC
Organization
operational/managerial control2023-05-19
Johnson, Frank
Individual
5% or greater direct ownership interest50%2022-08-16
Cline, Talmadge
Individual
adp of the snf2025-07-01
Eskandari, Hamid
Individual
adp of the snf2025-07-01
Farrales, Mary
Individual
adp of the snf2023-01-01
Johnson, David
Individual
adp of the snf2022-04-01
Kochek, Joshua
Individual
adp of the snf2022-04-01
Oxford, Micheal
Individual
adp of the snf2022-01-03
Dehghanmanesh, Adrian
Individual
corporate officer2022-08-16
Farrales, Mary
Individual
corporate officer2023-01-01
Kochek, Joshua
Individual
corporate officer2022-04-01
Oxford, Micheal
Individual
corporate officer2022-01-03
Johnson, David
Individual
managing control - governing body2022-04-01
Johnson, Frank
Individual
managing control - governing body2021-03-22
Cline, Talmadge
Individual
operational/managerial control2022-09-09
Johnson, David
Individual
operational/managerial control2022-04-01
Kochek, Joshua
Individual
operational/managerial control2022-04-01
Oxford, Micheal
Individual
operational/managerial control2022-01-03

What changed

Nothing has changed in this record since it was first loaded. The next CMS refresh is the next chance.

Tell me when this record changes

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Source: Centers for Medicare & Medicaid Services, Provider Data Catalog (public domain), files dated 2026-08-01. Ratings are CMS’s; citations are state surveyors’ findings; nothing here is estimated or a recommendation. Every nursing home in Orange County.