CLOVERDALE HEALTHCARE CENTER

300 CHERRY CREEK RD
CLOVERDALE, CA, 95425
7078945201
CCN: 055756
5
Overall
5
Health
4
Staffing
5
Quality
ChainTHE ENSIGN GROUP
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (6)
This facility's name matches one or more entities on the OIG List of Excluded Individuals/Entities (LEIE). Excluded parties are prohibited from participation in Medicare and Medicaid programs.
CENTURION HEALTHCARE, INC
1128a1
Excluded 2013-04-18
FINE GOLD HEALTH CENTER, INC
1128a1
Excluded 2002-07-18
GOLD RIVER HEALTHCARE SALES
1128b8
Excluded 2001-09-20
HIGHLAND PARK HEALTHCARE CENTE
1128b8
Excluded 2004-01-20
SAINT JOSEPH HEALTH CENTER
1128b8
Excluded 2000-04-20
SOUTHGATE HEALTH CENTER
1128b8
Excluded 2000-04-20
Ownership
NameRole%
FLAGSTONE HEALTHCARE NORTH LLC5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
THE ENSIGN GROUP INC5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
WILLITS, ADAMCORPORATE OFFICERNOT APPLICABLE
BURNAM, SOONCORPORATE OFFICERNOT APPLICABLE
KEETCH, CHADCORPORATE OFFICERNOT APPLICABLE
TWOMAGNETS LLCOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
GAMBLE, SHAWNDEEOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SERRANO, NOELOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Health Deficiencies (13)
2025-12-19 · Health
E
F761 · 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.
E
F755 · Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
D
F628 · Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
2025-03-05 · Health
D
F580 · Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
2025-01-09 · Health
B
F912 · Environmental Deficiencies
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
2022-10-21 · Health
E
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F805 · Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
D
F802 · Nutrition and Dietary Deficiencies
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
E
F761 · 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.
E
F755 · Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
4.40
3.68
RN Hrs/Resident/Day
0.44
0.54
LPN Hrs/Resident/Day
1.26
0.81
CNA Hrs/Resident/Day
2.70
2.33
PT Hrs/Resident/Day
0.11
0.12
Data as of 2026-03-01