PROVIDENCE LITTLE COMP OF MARY SUBACUTE CARE CTR
1322 WEST SIXTH STREET
SAN PEDRO, CA, 90732
3107914518
CCN: 555848
3
Overall3
Health4
Staffing4
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (3)
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.
PROVIDENT HOME HEALTH CARE SER
1128b7
Excluded 2005-06-01
SOUTHERN CALIFORNIA CARDIOLOGY
1128b8
Excluded 2004-08-19
SOUTHERN CALIFORNIA RESPIRATOR
1128b8
Excluded 2005-06-20
Ownership
| Name | Role | % |
|---|---|---|
| PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% |
| GHATAN, BIJAN | CONTRACTED MANAGING EMPLOYEE | NOT APPLICABLE |
| CRAWFORD, ISIAAH | CORPORATE DIRECTOR | NOT APPLICABLE |
| HEJNA, DIANE | CORPORATE DIRECTOR | NOT APPLICABLE |
| HUGHES, PHYLLIS | CORPORATE DIRECTOR | NOT APPLICABLE |
| KINGSTON, MARY BETH | CORPORATE DIRECTOR | NOT APPLICABLE |
| LYONS, MARY | CORPORATE DIRECTOR | NOT APPLICABLE |
| MARKHAM, DONNA | CORPORATE DIRECTOR | NOT APPLICABLE |
| MURPHY, MICHAEL | CORPORATE DIRECTOR | NOT APPLICABLE |
| O'QUINN, MARVIN | CORPORATE DIRECTOR | NOT APPLICABLE |
| SORENSON, CHARLES | CORPORATE DIRECTOR | NOT APPLICABLE |
| SPRUNK, ERIC | CORPORATE DIRECTOR | NOT APPLICABLE |
| PACINI, CAROL | CORPORATE DIRECTOR | NOT APPLICABLE |
| BLAIR, RICHARD | CORPORATE DIRECTOR | NOT APPLICABLE |
| ANDERSON, DONALD | CORPORATE OFFICER | NOT APPLICABLE |
| HOFFMAN, GREGORY | CORPORATE OFFICER | NOT APPLICABLE |
| MARTIN, JAMES | CORPORATE OFFICER | NOT APPLICABLE |
| NEWSOM, ANNA | CORPORATE OFFICER | NOT APPLICABLE |
| WATSON, JAMES | CORPORATE OFFICER | NOT APPLICABLE |
| WEXLER, ERIK | CORPORATE OFFICER | NOT APPLICABLE |
| PROVIDENCE HEALTH & SERVICES - WASHINGTON | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| GOEDERS, JOHN | W-2 MANAGING EMPLOYEE | NOT APPLICABLE |
| RICKS, MICHAEL | W-2 MANAGING EMPLOYEE | NOT APPLICABLE |
Penalties (1)
| Date | Type | Amount |
|---|---|---|
| 2023-12-14 | Fine | $11K |
Health Deficiencies (35)
2025-01-16 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
2024-12-06 · Health
D
F881 · Infection Control Deficiencies
Implement a program that monitors antibiotic use.
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
E
F814 · Nutrition and Dietary Deficiencies
Dispose of garbage and refuse properly.
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
F803 · Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
D
F758 · 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.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
2023-12-14 · Health
E
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
E
F865 · Administration Deficiencies
Have a plan that describes the process for conducting QAPI and QAA activities.
F
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
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
D
F726 · Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
E
F700 · 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.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
E
F694 · Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
D
F693 · 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.
E
F640 · Resident Assessment and Care Planning Deficiencies
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
K
F604 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
D
F558 · Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
2023-11-03 · Health
D
F755 · Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
2023-05-15 · Health
D
F584 · 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.
2023-04-03 · Health
D
F686 · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
2023-01-13 · Health
E
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
E
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
E
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.
E
F688 · Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
D
F687 · Quality of Life and Care Deficiencies
Provide appropriate foot care.
D
F686 · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
D
F656 · 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.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
F561 · Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
8.38
RN Hrs/Resident/Day0.54
1.98
LPN Hrs/Resident/Day0.81
3.17
CNA Hrs/Resident/Day2.33
3.23
PT Hrs/Resident/Day0.12
0.10
Data as of 2026-03-01