01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-04 | 2 | 2025-12-04 | 1 |
| Cycle 2 | 2024-10-04 | 9 | 2024-10-04 | 6 |
| Cycle 3 | 2023-10-06 | 11 | 2023-10-06 | 8 |
CMS CCN 5559272026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Pih Health Good Samaritan Hospital D/P Snf
1225 Wilshire Blvd · Los Angeles, CA 90017 · Los Angeles County
Certified beds28CMS provider file
Recent citation rows37current 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
37 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 6 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-04 · HEALTHF0604Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Correction field: Deficient, Provider has date of correction · 2025-12-222025-12-04 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2025-12-222025-12-04 · 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 · 2025-12-172025-07-01 · HEALTHF0627Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Correction field: Deficient, Provider has date of correction · 2025-08-05 · complaint2024-10-04 · HEALTHF0640Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Correction field: Deficient, Provider has date of correction · 2024-10-252024-10-04 · 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 · 2024-10-252024-10-04 · HEALTHF0661Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Correction field: Deficient, Provider has date of correction · 2024-10-252024-10-04 · 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 · 2024-10-252024-10-04 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-10-252024-10-04 · HEALTHF0758Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-10-252024-10-04 · HEALTHF0851Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Correction field: Deficient, Provider has date of correction · 2024-10-252024-10-04 · 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 · 2024-10-252024-10-04 · FIREK0325Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Have properly installed hallway dispensers for alcohol-based hand rub.
Correction field: Deficient, Provider has date of correction · 2024-10-172024-10-04 · FIREK0345Severity D · isolated; 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 · 2024-10-172024-10-04 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-10-172024-10-04 · FIREK0511Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2024-10-172024-10-04 · FIREK0712Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-10-172024-10-04 · 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 · 2024-10-172023-10-06 · HEALTHF0558Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Correction field: Deficient, Provider has date of correction · 2023-10-272023-10-06 · 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 · 2023-10-272023-10-06 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2023-10-272023-10-06 · HEALTHF0636Severity F · widespread; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Correction field: Deficient, Provider has date of correction · 2023-10-272023-10-06 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2023-10-272023-10-06 · HEALTHF0732Severity E · pattern; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2023-10-2703 / 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
- PIH HEALTH GOOD SAMARITAN HOSPITALOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2020
- ALVAREZ, ALEXIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/09/2017
- ATWOOD, JIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/25/2005
- BARENDSE, THURSOIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 02/08/2024
- BATISTE, MELANIEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 11/21/2021
- GOLDBERG, MARISSAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2021
- GREANEY, PETERIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 11/13/2018
- HAMAR, HAMILTONIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/10/2016
- KHORSANDI, MOEZIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 03/22/2024
- KROG, SCOTTIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/13/2024
- MEDRANO, DEBORAHIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/13/2024
- MONROE, PATRICKIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/10/2016
- ROTH, WILLIAMIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 03/01/2023
- SARALIEV, TRACEAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 02/08/2024
- SOUTHRON, SCOTTIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/13/2024
- SYDA-LAWTON, REGINEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/13/2024
- TREINEN, PAULIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 11/12/2019
- WEAVER, CHARLOTTEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/10/2016
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 hours10.60per resident day
RN hours5.00per resident day
Weekend nurse hours9.46per resident day
Staff turnover29.3%CMS reported field
06 / LOCAL RECORDS
Open the Los Angeles ledger →Other published facilities nearby
Alcott Rehabilitation Hospital121 beds · CMS overall 5/562 citation rowsAlden Terrace Convalescent Hospital210 beds · CMS overall 5/556 citation rowsAlexandria Care Center177 beds · CMS overall 1/5137 citation rowsAlta View Post Acute99 beds · CMS overall 1/568 citation rowsAlvarado Care Center72 beds · CMS overall 2/585 citation rowsAngels Nursing Health Center49 beds · CMS overall 5/554 citation rowsArarat Convalescent Hospital42 beds · CMS overall 4/545 citation rowsAvalon Villa Care Center131 beds · CMS overall 1/5172 citation rows