01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-04-25 | 8 | 2025-04-25 | 5 |
| Cycle 2 | 2024-01-23 | 12 | 2024-01-23 | 22 |
| Cycle 3 | 2022-08-05 | 8 | 2022-08-05 | 2 |
CMS CCN 5558672026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Forest Hill Manor Health Center
551 Gibson Avenue · Pacific Grove, CA 93950 · Monterey County
Certified beds26CMS provider file
Recent citation rows57current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
57 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 9 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-10 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2026-05-01 · complaint2025-10-01 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-10-20 · complaint2025-04-25 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0755Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-05-152025-04-25 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-05-152024-01-23 · FIREE0007Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address patient/client population and determine types of services needed.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0015Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0023Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures for medical documentation.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0024Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures for volunteers.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0034Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide a means of sharing information on occupancy/needs.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0035Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide family notifications of emergency plan.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0036Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish emergency prep training and testing.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0037Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish staff and initial training requirements.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · FIREE0039Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2024-03-052024-01-23 · HEALTHF0578Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-02-092024-01-23 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2024-02-0903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-10-01 | Fine | $8,278 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ACOSTA, MARIAHIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/16/2025
- CALABAZARON, REDENTORIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/14/2022
- CHINTHAKINDI, RAVIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/21/2022
- FUENTES, RAYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/06/2022
- PIQUE, JANNETIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/23/2023
- TAYLOR, RYANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/08/2023
- THAPA, NISCHALIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/06/2024
- ACOSTA, MARIAHIndividual · ADP OF THE SNFNOT APPLICABLE · since 02/16/2025
- CALABAZARON, REDENTORIndividual · ADP OF THE SNFNOT APPLICABLE · since 02/14/2022
- CHINTHAKINDI, RAVIIndividual · ADP OF THE SNFNOT APPLICABLE · since 11/21/2022
- FUENTES, RAYIndividual · ADP OF THE SNFNOT APPLICABLE · since 12/06/2022
- PIQUE, JANNETIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/23/2023
- TAYLOR, RYANIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/08/2023
- THAPA, NISCHALIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/06/2024
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours5.04per resident day
RN hours0.90per resident day
Weekend nurse hours4.35per resident day
Staff turnover44.4%CMS reported field
06 / LOCAL RECORDS
Open the Pacific Grove ledger →