Carmel Mountain Rehabilitation & Healthcare CenterCMS ratings, inspections and fines
- Address
- 11895 Avenue of Industry, San Diego, CA 92128
- CCN
- 555326
- Ownership type
- For-profit, limited liability company
- Certified beds
- 120
- Chain
- The Ensign Group
- Residents per day
- 115
- CMS flags
- None in the CMS record
Open the watch listCare Compare record (Medicare.gov)
The watch list stays in this browser. After each CMS update, it shows the values that changed at the homes on the list.
CMS gives Carmel Mountain Rehabilitation & Healthcare Center an overall rating of 3 of 5 stars. The last standard survey was on 24 Apr 2025. The latest survey cycle has 23 health citations. The median for nursing homes in California is 14. CMS lists no fines for this home in its penalties file.
Facilities may see a change in their overall rating for a number of reasons. Since the overall rating is based on three individual domains, a change in any one of the domains can affect the overall rating. Any new data for a nursing home could potentially change a star rating domain.
Centers for Medicare & Medicaid Services, Five-Star Quality Rating System: Technical Users' Guide, July 2026. CMS processed this record on .
Since the last CMS update
The site has no recorded change for this home. In each CMS update, the site compares the ratings, the penalties and the citations of each home.
Changes in the CMS recordFeed of changes in California (RSS)
Ratings
CMS gives each home 1 to 5 stars for health inspections, for staffing and for quality measures, and one overall rating.
| Rating (1 to 5 stars) | This home | San Diego County median | California median | US average (CMS) |
|---|---|---|---|---|
| Overall rating | 3 | 4.0 | 3.0 | 3.0 |
| Health inspection rating | 2 | 4.0 | 3.0 | 2.8 |
| Staffing rating | 3 | 3.0 | 3.0 | 2.9 |
| Quality measure rating | 5 | 5.0 | 4.0 | 3.6 |
A median is the middle value of the homes in the group: 83 homes in the county, 1,165 homes in the state. What the CMS star ratings measure
Citations by survey cycle
CMS keeps the last three cycles, and cycle 1 is the latest. A cycle has one standard survey. Citations from complaint and infection control inspections go into cycles of 12 months.
| Survey cycle | Standard survey | Citations | California median |
|---|---|---|---|
| Cycle 1 (latest) | 24 Apr 2025 | 23 | 14 |
| Cycle 2 | 10 May 2024 | 22 | 14 |
| Cycle 3 | No date | 8 | 15 |
Health citations
The record of one deficiency in an inspection. One inspection can give many citations.
Scope and severity. A letter from A to L on each citation. Scope is the number of residents that the deficiency affected. Severity is the level of harm.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J0 | K0 | L0 |
| Actual harm that is not immediate jeopardy | H0 | I0 | |
| No actual harm, potential for more than minimal harm | F0 | ||
| No actual harm, potential for minimal harm | A0 | B0 | C0 |
Survey cycle 1 (latest): 23 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 15 Apr 2026 | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Complaint investigation | 4 May 2026 |
| 15 Apr 2026 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint investigation | 4 May 2026 |
| 15 Apr 2026 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint investigation | 4 May 2026 |
| 22 Jan 2026 | F0880 | Provide and implement an infection prevention and control program. | E | Complaint investigation | 12 Feb 2026 |
| 16 Sep 2025 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Complaint investigation | 5 Oct 2025 |
| 16 Sep 2025 | F0880 | Provide and implement an infection prevention and control program. | D | Complaint investigation | 5 Oct 2025 |
| 4 Sep 2025 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint investigation | 5 Oct 2025 |
| 4 Sep 2025 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | Complaint investigation | 22 Sep 2025 |
| 4 Sep 2025 | F0835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. | D | Complaint investigation | 22 Sep 2025 |
| 24 Apr 2025 | F0558 | Reasonably accommodate the needs and preferences of each resident. | E | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0584 | 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. | E | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Complaint investigation | 24 May 2025 |
| 24 Apr 2025 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint investigation | 24 May 2025 |
| 24 Apr 2025 | F0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0758 | 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. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | E | Standard survey | 24 May 2025 |
| 24 Apr 2025 | F0880 | Provide and implement an infection prevention and control program. | E | Standard survey | 24 May 2025 |
Survey cycle 2: 22 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 26 Dec 2024 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | Complaint investigation | 3 Feb 2025 |
| 15 Oct 2024 | F0641 | Ensure each resident receives an accurate assessment. | D | Complaint investigation | 15 Nov 2024 |
| 15 Oct 2024 | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | Complaint investigation | 15 Nov 2024 |
| 13 Sep 2024 | F0808 | 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. | D | Complaint investigation | 15 Oct 2024 |
| 13 Sep 2024 | F0880 | Provide and implement an infection prevention and control program. | D | Complaint investigation | 15 Oct 2024 |
| 10 May 2024 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0578 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0583 | Keep residents' personal and medical records private and confidential. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0584 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0688 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0693 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0726 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0761 | 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. | D | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0880 | Provide and implement an infection prevention and control program. | E | Standard survey | 21 Jun 2024 |
| 10 May 2024 | F0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | D | Standard survey | 21 Jun 2024 |
Survey cycle 3: 8 citations
The CMS provider file has no standard survey date for this cycle.
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 30 Jul 2024 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint investigation | 22 Aug 2024 |
| 28 Jul 2023 | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0699 | Provide care or services that was trauma informed and/or culturally competent. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0758 | 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. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0759 | Ensure medication error rates are not 5 percent or greater. | D | Standard survey | 28 Aug 2023 |
| 28 Jul 2023 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | Standard survey | 28 Aug 2023 |
The requirement text is the CMS summary of the F-tag. It is not the report of the surveyor. How to read an inspection report
Penalties
A fine, or a payment denial: a period in which Medicare or Medicaid does not pay for new admissions. The CMS penalties file holds three years.
CMS lists no fine and no payment denial for this home in its penalties file.
Staffing
Hours per resident per day. The nurse hours for one resident on an average day. CMS calculates the figure from the hours that the home reports for a quarter.
| Staff | This home | California median | California average (CMS) |
|---|---|---|---|
| All nurse staff | 5.02 | 4.20 | 4.52 |
| Registered nurses (RN) | 0.96 | 0.50 | 0.67 |
| Licensed practical nurses (LPN) | 1.57 | 1.20 | |
| Nurse aides | 2.49 | 2.65 | |
| All nurse staff, weekends | 4.61 | 3.80 | 4.09 |
- Nurse staff turnover in a year
- 40.0%
- Nurse staff turnover, California median
- 36.4%
- RN turnover in a year
- 37.9%
- Administrators who left in a year
- 1
Homes report the hours to CMS in the Payroll-Based Journal.
Quality measures
A figure that CMS calculates from the assessments of residents. One example is the percentage of long-stay residents with a fall and a major injury.
| Measure (CMS text) | Residents | This home | California median | US median |
|---|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 3.9% | 8.9% | 12.6% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 1.1% | 0.3% | 0.3% |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 2.2% | 0.7% | 0.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 1.4% | 1.3% | 2.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 0.3% | 0.8% | 1.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 5.9% | 8.6% | 12.5% |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 2.8% | 3.6% | 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 10.4% | 9.1% | 13.4% |
For each measure in this table, CMS gives more points in the quality measure rating for a lower percentage. The site calculates the medians from the CMS file. What the CMS star ratings measure
Ownership
An organisation in the CMS ownership file. CMS records its role, for example an ownership interest, operational or managerial control, or a mortgage interest.
- Ownership type
- For-profit, limited liability company
- Legal business name
- Bernardo Heights Healthcare, Inc.
- Chain
- The Ensign Group (342 homes in the CMS chain file)
| Organisation | Role in the CMS record | Interest | Since |
|---|---|---|---|
| Cetna Staffing Inc | Operational/managerial control | 1 Mar 2006 | |
| Lincare Inc | Operational/managerial control | 1 Mar 2006 | |
| Sevenoaks Capital Associates LLC | Operational/managerial control | 1 Mar 2006 | |
| Caretrust GP LLC | Adp of the snf | 1 Mar 2006 | |
| Caretrust REIT Inc | Adp of the snf | 1 Mar 2006 | |
| CM Health Holdings LLC | Adp of the snf | 1 Mar 2006 | |
| Ctr Partnership LP | Adp of the snf | 1 Mar 2006 | |
| Ensign Services Inc | Adp of the snf | 1 Mar 2006 | |
| The Ensign Group Inc | Adp of the snf | 30 Jan 2006 |
The site shows organisations only. It does not show the names of persons.
Other homes in San Diego County
| Nursing home | City | Overall rating | Citations, latest cycle | Fines | Last standard survey | |
|---|---|---|---|---|---|---|
| Villa Rancho Bernardo Care Center | San Diego | 5 of 5 | 7 | $0 | 7 Nov 2024 | |
| Poway Healthcare Center | Poway | 4 of 5 | 6 | $0 | 8 May 2025 | |
| The Villas at Poway | Poway | 5 of 5 | 11 | $57,124 | 22 May 2025 | |
| Boulder Creek Post Acute | Poway | 4 of 5 | 14 | $0 | 14 Feb 2025 | |
| Casa De Las Campanas | San Diego | 2 of 5 | 14 | $0 | 8 Aug 2025 | |
| Ocean View Post Acute | Escondido | 4 of 5 | 15 | $0 | 5 Jun 2025 | |
| Redwood Terrace Health Center | Escondido | 5 of 5 | 7 | $0 | 14 Aug 2025 | |
| Valley Vista Post Acute | Escondido | 4 of 5 | 18 | $0 | 11 Sep 2025 | |
| Bayshire Torrey Pines Post-Acute | San Diego | 5 of 5 | 8 | $87,153 | 12 Dec 2024 | |
| Palomar Vista Healthcare Center | Escondido | 2 of 5 | 22 | $0 | 12 Sep 2025 | |
| Palomar Heights Post Acute | Escondido | 3 of 5 | 25 | $8,176 | 30 May 2025 | |
| Escondido Post Acute | Escondido | 5 of 5 | 9 | $0 | 8 May 2025 |
Official channels
- Care Compare record of this nursing homeMedicare.gov. The official CMS record of this home.
- Contact information for State Survey AgenciesCMS. The web address and the telephone number of the State Survey Agency of each state. These agencies investigate complaints about nursing homes.
- Filing a complaintMedicare.gov. The page names the State Survey Agency as the place for a complaint about nursing home care or facility conditions.
- Eldercare LocatorAdministration for Community Living. A public service that connects older adults and their families to local services. Telephone: 1-800-677-1116.
Cite this page
Centers for Medicare & Medicaid Services, Care Compare. Record of Carmel Mountain Rehabilitation & Healthcare Center (CCN 555326). Data processed 1 Aug 2026. Elder Care Record, https://eldercarerecord.com/facility/carmel-mountain-rehabilitation-healthcare-center-san-diego-ca-555326/
Provenance
- Licence
- US government work, public domain
- CMS processed the data on
A program makes this page from the CMS files, and the same files always give the same text. How the site makes the figures. Report an error.
Questions
- When was Carmel Mountain Rehabilitation & Healthcare Center last inspected?
- The latest inspection with a citation in the CMS record was on 15 Apr 2026. It was a complaint investigation. It gave 3 citations. The standard survey before the last one was on 10 May 2024.
- Who operates Carmel Mountain Rehabilitation & Healthcare Center?
- The CMS record gives the ownership type as for-profit, limited liability company. CMS lists the home in the chain The Ensign Group. The CMS ownership file names 3 organisations for operational or managerial control. This site does not show the names of persons.
- Is Carmel Mountain Rehabilitation & Healthcare Center a Special Focus Facility?
- No. The CMS provider file lists no Special Focus status for this home. CMS lists 5 homes in California as Special Focus Facilities and 31 as candidates.
- Where does the data on this page come from?
- The data comes from the CMS Care Compare files for nursing homes. CMS processed the files on 1 Aug 2026. The Care Compare record on Medicare.gov is the official record of the home.