01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-21 | 4 | 2025-03-21 | 3 |
| Cycle 2 | 2023-06-09 | 21 | 2023-06-09 | 6 |
| Cycle 3 | 2021-05-24 | 16 | 2021-05-24 | 13 |
CMS CCN 0555652026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Waterman Canyon Post Acute
1850 N. Waterman Ave. · San Bernardino, CA 92404 · San Bernardino County
Certified beds166CMS provider file
Recent citation rows63current 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
63 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 14 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-02-25 · HEALTHF0553Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Correction field: Deficient, Provider has date of correction · 2026-03-25 · complaint2025-09-23 · 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 · 2025-10-23 · complaint2025-05-13 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2025-06-13 · complaint2025-03-21 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2025-04-142025-03-21 · HEALTHF0912Severity D · isolated; potential for more than minimal harm
Environmental Deficiencies
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Correction field: Deficient, Provider has date of correction · 2025-04-142025-03-21 · 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 · 2025-04-172025-03-21 · FIREK0511Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2025-04-172025-03-21 · FIREK0741Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2025-04-172025-03-06 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2025-04-06 · complaint2025-01-21 · 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 · 2025-02-21 · complaint2024-04-13 · 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 · 2024-05-07 · complaint2024-04-02 · HEALTHF0770Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide timely, quality laboratory services/tests to meet the needs of residents.
Correction field: Deficient, Provider has date of correction · 2024-04-12 · complaint2024-03-11 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2024-03-25 · complaint2024-01-24 · 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 · 2024-02-14 · complaint2023-12-15 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2024-01-02 · complaint2023-10-10 · 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 · 2023-10-24 · complaint2023-06-09 · 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 · 2023-07-012023-06-09 · 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 · 2023-07-012023-06-09 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-09 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2023-06-302023-06-09 · 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 · 2023-06-302023-06-09 · 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 · 2023-06-302023-06-09 · 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 · 2023-06-302023-06-09 · HEALTHF0692Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2023-06-3003 / 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
- GOLBOO, SEPEHRIndividual · CONTRACTED MANAGING EMPLOYEENOT APPLICABLE · since 09/01/2022
- JENKINS, NICOLETTAIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 05/01/2022
- APT, FREDERICKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- HANCOCK, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- JERGENSEN, JOSHUAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- MITCHELL, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- JENKINS, NICOLETTAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2022
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 hours4.01per resident day
RN hours0.23per resident day
Weekend nurse hours3.79per resident day
Staff turnover40.6%CMS reported field
06 / LOCAL RECORDS
Open the San Bernardino ledger →Other published facilities nearby
Arrowhead Healthcare Center, Llc58 beds · CMS overall 4/540 citation rowsArrowhead Springs Healthcare119 beds · CMS overall 4/544 citation rowsCommunity Convalescent Center Of San Bernardino84 beds · CMS overall 5/531 citation rowsCommunity Hospital Of San Bernardino Dp Snf88 beds · CMS overall 2/534 citation rowsDel Rosa Villa104 beds · CMS overall 2/549 citation rowsHaven Post Acute99 beds · CMS overall 4/538 citation rowsHillcrest Nursing Home59 beds · CMS overall 5/536 citation rowsMedical Center Convalescent Hospital99 beds · CMS overall 4/541 citation rows