WEST COVINA MEDICAL CENTER D/P SNF
725 S. ORANGE AVENUE
WEST COVINA, CA, 91790
6263388481
CCN: 555649
3
Overall4
Health1
Staffing3
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (7)
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.
CITY MEDICAL SUPPLY, INC
1128b8
Excluded 2002-09-19
CORONADO MEDICAL CLINIC, INC
1128b8
Excluded 2001-04-19
FAIRFIELD MEDICAL CENTER, INC
1128b8
Excluded 2015-06-18
MEDICAL REPAIR CENTER, INC
1128b8
Excluded 2001-01-18
ORPHAN MEDICAL INC
1128a3
Excluded 2008-12-18
P D MEDICAL SUPPLY
1128b8
Excluded 2001-10-18
PAIN RELIEF MEDICAL CENTER
1128b8
Excluded 2005-03-20
Ownership
| Name | Role | % |
|---|---|---|
| WEST COVINA MEDICAL CENTER INC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| NELSON, WILLIAM | 5% OR GREATER DIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| ROLLINS, VICKI | 5% OR GREATER DIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| ROLLINS, VICKI | 5% OR GREATER MORTGAGE INTEREST | NOT APPLICABLE |
| WEST COVINA PROPERTY HOLDING, LLC | 5% OR GREATER MORTGAGE INTEREST | NOT APPLICABLE |
| NELSON, WILLIAM | 5% OR GREATER MORTGAGE INTEREST | NOT APPLICABLE |
| ROLLINS, VICKI | 5% OR GREATER SECURITY INTEREST | NOT APPLICABLE |
| NELSON, WILLIAM | CORPORATE DIRECTOR | NOT APPLICABLE |
| ROLLINS, VICKI | CORPORATE DIRECTOR | NOT APPLICABLE |
| ROLLINS, VICKI | CORPORATE OFFICER | NOT APPLICABLE |
| NELSON, WILLIAM | CORPORATE OFFICER | NOT APPLICABLE |
| BROOKS, MARK | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| ROLLINS, VICKI | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| WEST COVINA MEDICAL CENTER INC | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| BESHARAT, FARID | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| FRANCISCO, ANN | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Penalties (3)
| Date | Type | Amount |
|---|---|---|
| 2023-06-26 | Fine | $2K |
| 2023-06-20 | Fine | $2K |
| 2023-05-30 | Fine | $3K |
Health Deficiencies (34)
2025-12-23 · Health
D
F842 · Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
2025-12-18 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
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
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.
D
F756 · Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
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.
D
F692 · Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
D
F690 · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
E
F657 · 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.
D
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
D
F637 · Resident Assessment and Care Planning Deficiencies
Assess the resident when there is a significant change in condition
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
2024-10-18 · Health
D
F921 · Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
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
F756 · Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
E
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F694 · Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
E
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.
D
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
F686 · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
F623 · Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
E
F578 · 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.
E
F558 · Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
2023-11-22 · Health
D
F908 · Environmental Deficiencies
Keep all essential equipment working safely.
E
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
E
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.
E
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
F694 · Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
E
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
F690 · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
E
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.
E
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
7.80
RN Hrs/Resident/Day0.54
1.22
LPN Hrs/Resident/Day0.81
2.93
CNA Hrs/Resident/Day2.33
3.65
PT Hrs/Resident/Day0.12
0.00
Data as of 2026-03-01