01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-28 | 10 | 2025-03-28 | 6 |
| Cycle 2 | 2023-12-01 | 11 | 2023-12-01 | 6 |
| Cycle 3 | 2022-02-11 | 12 | 2022-02-11 | 11 |
CMS CCN 0558662026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Plum Tree Care Center
2580 Samaritan Drive · San Jose, CA 95124 · Santa Clara County
Certified beds76CMS provider file
Recent citation rows56current 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
56 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 15 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-11 · 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 · 2026-06-24 · complaint2025-08-07 · HEALTHF0573Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Let each resident or the resident's legal representative access or purchase copies of all the resident's records.
Correction field: Deficient, Provider has date of correction · 2025-08-30 · complaint2025-07-16 · 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 · 2025-08-22 · complaint2025-07-16 · HEALTHF0773Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
Correction field: Deficient, Provider has date of correction · 2025-08-22 · complaint2025-03-28 · 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 · 2025-04-262025-03-28 · 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 · 2025-04-262025-03-28 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2025-04-262025-03-28 · HEALTHF0658Severity E · pattern; 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 · 2025-04-262025-03-28 · HEALTHF0695Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2025-04-262025-03-28 · 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 · 2025-04-262025-03-28 · HEALTHF0812Severity D · isolated; 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 · 2025-04-262025-03-28 · 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 · 2025-04-262025-03-28 · FIREK0293Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2025-04-182025-03-28 · 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 · 2025-04-182025-03-28 · FIREK0363Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-04-182025-03-28 · 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 · 2025-04-182025-03-28 · FIREK0919Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the use of electrical equipment.
Correction field: Deficient, Provider has date of correction · 2025-04-182025-03-28 · FIREK0920Severity E · pattern; 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 · 2025-04-182024-09-24 · 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 · 2024-10-09 · complaint2024-05-31 · 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 · 2024-06-30 · complaint2024-05-31 · 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 · 2024-06-30 · complaint2023-12-01 · 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 · 2023-12-312023-12-01 · 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 · 2023-12-312023-12-01 · HEALTHF0684Severity E · pattern; 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 · 2023-12-3103 / 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 |
|---|---|---|---|
| 2024-09-24 | Fine | $8,018 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- BMO BANK NATIONAL ASSOCIATIONOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 09/20/2023
- MASTROCOLA, LOISIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 09/20/2023
- MASTROCOLA, LOISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/1998
- OLDS, THOMASIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/1998
- MASTROCOLA, LOISIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/1998
- OLDS, THOMASIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/1998
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 hours4.53per resident day
RN hours0.70per resident day
Weekend nurse hours4.16per resident day
Staff turnover42.6%CMS reported field
06 / LOCAL RECORDS
Open the San Jose ledger →Other published facilities nearby
A Grace Sub Acute & Skilled Care166 beds · CMS overall 4/580 citation rowsAlmaden Health And Rehabilitation Center77 beds · CMS overall 4/577 citation rowsCanyon Springs Post-Acute199 beds · CMS overall 4/5109 citation rowsCourtyard Care Center76 beds · CMS overall 3/574 citation rowsCreekside Post-Acute130 beds · CMS overall 5/572 citation rowsEmpress Care Center, Llc67 beds · CMS overall 4/568 citation rowsHerman Health Care Center99 beds · CMS overall 1/5107 citation rowsInspire Behavioral Health116 beds · CMS overall 2/567 citation rows