01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-01-30 | 17 | 2026-01-30 | 6 |
| Cycle 2 | 2024-07-19 | 14 | 2024-07-19 | 3 |
| Cycle 3 | 2023-06-09 | 5 | 2023-06-09 | 3 |
CMS CCN 5555242026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Health Care Ctr At The Forum At Rancho San Antonio
23600 Via Esplendor · Cupertino, CA 95014 · Santa Clara County
Certified beds48CMS provider file
Recent citation rows48current CMS citation release
Penalty rows0current 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
48 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 13 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-14 · HEALTHF0551Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give the resident's representative the ability to exercise the resident's rights.
Correction field: Deficient, Provider has date of correction · 2026-05-26 · complaint2026-04-09 · 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 · 2026-04-17 · complaint2026-01-30 · 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 · 2026-02-282026-01-30 · HEALTHF0578Severity E · pattern; 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 · 2026-02-282026-01-30 · HEALTHF0605Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0656Severity E · pattern; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0689Severity D · isolated; potential for more than minimal 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 · 2026-02-282026-01-30 · HEALTHF0697Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0700Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · 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 · 2026-02-282026-01-30 · HEALTHF0756Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · HEALTHF0757Severity E · pattern; 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 · 2026-02-282026-01-30 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-02-282026-01-30 · 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 · 2026-02-282026-01-30 · HEALTHF0880Severity E · pattern; 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 · 2026-02-282026-01-30 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2026-02-252026-01-30 · 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 · 2026-02-252026-01-30 · 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 · 2026-02-252026-01-30 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2026-02-252026-01-30 · FIREK0711Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Provide a written emergency evacuation plan.
Correction field: Deficient, Provider has date of correction · 2026-02-252026-01-30 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2026-02-252024-09-06 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-09-20 · complaint03 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- RANCHO SAN ANTONIO RETIREMENT HOUSING CORPORATIONOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 07/02/1999
- EXLINE, RICKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2025
- JOHNSON, EIKOIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2023
- BRAUMAN, SHARONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2020
- BROWN, KATHYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- BUSH, ELLYNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2023
- FISHBEIN, MARGERYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- LIFE CARE SERVICES LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2012
- JO, DANIELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2025
- KAO, NANCYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2000
- NELSON, MARKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/04/2024
- LIFE CARE SERVICES LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/22/2025
- RANCHO SAN ANTONIO RETIREMENT HOUSING CORPORATIONOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/31/1992
- JO, DANIELIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/22/2025
- NELSON, MARKIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/22/2025
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 hours5.75per resident day
RN hours1.07per resident day
Weekend nurse hours5.28per resident day
Staff turnover28.8%CMS reported field
06 / LOCAL RECORDS
Open the Cupertino ledger →