Santa Rosa Care Center

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

Therapy staffing: this home’s payroll records show 0.17 therapist hours per resident per day in 2026Q1 — more than 16% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 9% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 144 beds and averages 119.7 residents a day — about 83% occupied, or roughly 24 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.35 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.31 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.08 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.90 hrs/resident/day on weekends vs 3.54 on weekdays — 18% thinner on weekends. RN hours go from 0.34 to 0.23 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 58% is well above the national median of 45%. 1 administrator has left in the past year.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are unchanged from the previous inspection. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

28 citations, most serious first. The 11 most serious are shown; the remaining 17 are one tap away and print in full.

• Actual harm · G2023-08-09 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, staff interviews, and review of policies and procedures, the facility failed to ensure one resident (#99) was free of any significant medication error. The deficient practice could result in resident having adverse effects and complications. Findings include: Resident #99 was admitted on [DATE] with diagnoses included epilepsy, schizophrenia, heart disease, peripheral vascular disease, macular degeneration, and hypertension. The care plan dated 01/18/2022 revealed the resident had seizure disorder. The goal was that the resident will be free from injury related to seizure activity. Interventions included to give seizure medication as ordered by the physician, to monitor/document side effects and effectiveness and to monitor labs and report any sub-therapeutic or toxic results to the physician. A physician order dated 03/29/2022 included for 100 mg (milligram) Dilantin capsule (anti-epileptic) to be given by mouth every Tuesday, Thursday, and Saturday. Another physician order dated…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-02-20 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on the facility observation, staff and resident interviews, and policy review, the facility failed to report to state agencies a serious injury to a resident within the required timeframe for 1 of 3 (Resident #1) residents. Failure of reporting could result in delay in investigation of possible abuse by the appropriate agencies. Findings include:Resident # 1 was re-admitted on [DATE] with diagnoses that included hemiplegia and hemiparesis due to cerebral infarct involving the right dominant side, contracture of the right wrist, need for assistance with personal care, muscle weakness, schizoaffective disorder, bipolar type, major depressive disorder, and anxiety disorder. A comprehensive care plan initiated on November 26, 2025, revealed that the resident had right-sided hemiplegia/hemiparesis due to cerebrovascular disease. Further review of the care plan revealed that the resident had behaviors, including false accusations. A quarterly Minimum Data Set (MDS) dated [DATE], revealed that the Brief Interview…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-10-31 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, interviews, and review of facility policy and procedures, the facility failed to ensure one resident (#87) was free from abuse from another resident (#16). The deficient practice resulted in one resident (#87) sustaining injuries.Based on clinical record review, interviews, and review of facility policy and procedures, the facility failed to ensure one resident (#87) was free from abuse from another resident (#16). The deficient practice resulted in one resident (#87) sustaining injuries.Findings include:Related to Resident #87-Resident #87 was admitted to the facility on [DATE] with diagnoses that included Aphasia, other specified intracranial injury without loss of consciousness, sequela, Anxiety disorder and Schizoaffective disorder, Bipolar type.Review of the quarterly Minimum Data Set (MDS), dated [DATE] indicated the Brief Interview for Mental Status (BIMS) was not completed. However, staff assessed Resident #87's cognitive skills for daily decision making to be moderately…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-08-29 · tag F0812 — failed to store, cook, and serve food safely — pattern
  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, staff interviews, and review of facility policies, the facility failed to store food in accordance with professional standards for food service safety. This deficient practice has the potential to increase the risk of foodborne illness and compromise resident healthFindings Include:An initial kitchen observation was conducted on August 26, 2025 at 08:26 AM in conjunction with the Dietary Director, (Staff # 116). During observation of the food preparation area, two sanitizer buckets, one containing a dish rag, were observed in the food preparation area where a bowl of pudding/pie mix was being prepared. A portable, blue plastic fan was observed sitting on a metal rack, blowing across the food server's side of the tray line. The blades of the fan were noted to be caked with thick, brownish-gray colored dirt.An observation on August 26, 2025, revealed pork and turkey on the bottom shelf of the freezer that were not labeled or dated. Additional observations revealed that two bags of frozen breadsticks and one bag of frozen fish patties were stored with no labels,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-08-29 · tag F0880 — failed to prevent and control infections — pattern
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, staff interviews, and review of policies and procedures, the facility failed to ensure that food was served in accordance with professional standards of food service safety. The deficient practices could result in food-borne illnesses.Findings Include:An initial kitchen observation was conducted on August 26, 2025, at 08:26 AM in conjunction with the Dietary Director (Staff # 116). During observation of the food preparation area, two sanitizer buckets, one containing a dish rag, were observed in the food preparation area where a bowl of pudding/pie mix was being prepared. A portable, blue plastic fan was observed sitting on a metal rack, blowing across the food server's side of the tray line. The blades of the fan were noted to be caked with thick, brownish-gray colored dirt.During observation of tray-line service on August 27, 2025, at 11:15 AM, a slice of cucumber was observed to fall off the plate onto the tray. Dietary Aide, Staff #77, was observed to pick up the item and place it back onto the plate with his hand. The tray line was stopped, and Staff #…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-08-29 · tag F0645 — isolated
  PASARR screening for Mental disorders or Intellectual Disabilities
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, staff interviews, and facility policies, the facility failed to ensure that a Preadmission Screening and Resident Review (PASARR) level I screening was accurately completed for one resident (#41). The sample size was #21. The deficient practice could potentially lead to residents not receiving appropriate placement and services to identified mental health needs. Findings include:Resident #41 was admitted to the facility on [DATE] with diagnoses that included Hemiplegia and Hemiparesis following cerebrovascular infarction affecting right dominant side (weakness and/or complete paralysis on the left side of the body due to a stroke), schizoaffective disorder bipolar type, major depressive disorder, anxiety disorder, and vascular dementia.A review of the quarterly Minimum Data Set (MDS), dated [DATE] revealed Resident #41 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident is cognitively intact. Verbal behaviors and wandering was noted in the…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-08-29 · tag F0658 — failed to meet professional standards of care — isolated
  Ensure services provided by the nursing facility meet professional standards of quality.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, staff interviews, and facility policies, the facility failed to ensure that necessary respiratory care was provided for one resident (#2). Sample size was 23. The deficient practice could lead to residents not receiving appropriate respiratory care.Findings Include:Resident # 2 was admitted to the facility on [DATE], with diagnoses that included: acute respiratory failure with hypoxia and chronic obstructive pulmonary disease.A review of the comprehensive Minimum Data Set (MDS), dated [DATE] revealed that the resident had adequate levels of hearing and the ability to make himself understood and to understand others. However, the resident had a moderate visual impairment that permitted him to identify objects, but not to read newspaper headlines. The Brief Interview of Mental Status (BIMS) revealed a score of 09, which indicated a moderate level of cognitive impairment. The Patient Health Questionnaire-2 (PHQ-2) revealed a score of 00, which indicated no symptoms of depressed…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-29 · tag F0698 — failed to provide proper dialysis care — isolated
  Provide safe, appropriate dialysis care/services for a resident who requires such services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, staff interviews, and facility policy review, the facility failed to ensure that one resident (#16) had a physician's order for dialysis. The sample size was 23. This deficient practice has the potential to result in residents receiving dialysis without appropriate medical authorization.Findings include:Resident #16 was admitted to the facility on [DATE] with diagnoses that include End Stage Renal Disease (ESRD), unspecified atrial fibrillation, and chronic pain syndrome.A review of the Minimum Data Set (MDS), dated [DATE], revealed the resident had a Brief Interview for Mental Status (BIMS) score of 14 which indicated the resident is cognitively intact. The same MDS also indicated the resident was receiving dialysis.Review of Resident #16's care plan, initiated on October 14, 2024 and revised on October 21, 2024 indicated he needed hemodialysis related to renal failure and ESRD. Interventions identified on the care plan indicated dialysis days was on Tuesdays, Thursdays, and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-29 · tag F0761 — failed to label and store drugs safely — isolated
  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.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, staff interviews, and facility observations, the facility failed to ensure that medications were stored in accordance with professional standards for one resident (#66) out of a sample of 23. This deficient practice has the potential to compromise medication safety.Findings Include:Resident # 66 was admitted on [DATE], and readmitted on [DATE], with diagnoses that included: chronic obstructive pulmonary disease, atherosclerotic heart disease, morbid obesity, hypothyroidism, major depressive disorder, anxiety disorder, tremor, hyperlipidemia, osteoarthritis, fibromyalgia, obstructive sleep apnea, Type II Diabetes Mellitus with diabetic neuropathy, restless legs syndrome gout, edema, insomnia, cataracts, alcohol use, unspecified with alcohol-induced persisting dementia, personal history of Covid-19, heart failure, chronic respiratory failure, vitamin D deficiency, low back pain, paroxysmal atrial fibrillation, and hyperesthesia. A review of the quarterly Minimum Data Set (MDS)…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-06-13 · tag F0600 — failed to protect residents from abuse and neglect — pattern
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record reviews, facility documentation, resident and staff interviews, and policy review, the facility failed to ensure that one resident (#235) were free from physical abuse resulting in injury by other residents (resident #205). The deficient practice could result in further incidents of resident to resident abuse. Findings include: -Resident #235 was admitted to the facility on [DATE] with diagnosis that include Diabetes Mellitus type 2, Benign Prostatic hyperplasia, Chronic obstructive pulmonary disease, Dementia, and Hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed a Brief Interview for Mental Status (BIMS) score of 99 which indicated the resident had severe cognitive impairment. A behavioral care plan revised June 5, 2023 revealed the resident is at risk for impaired thought processes related to vascular dementia, with a noted intervention of keeping the resident's routine consistent and try to provide consistent care givers as much as…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-02-07 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, interviews, facility documentation, and review of facility policy, the facility failed to ensure resident #1 was free from abuse from resident #2. The deficient practice could result in further incidents of resident to resident abuse. Findings include: Related to resident #1- Resident #1 was admitted to the facility on [DATE] with diagnoses that include alcohol induced Dementia, peripheral vascular disease, and major depressive disorder. Review of the quarterly Minimum Data Set (MDS), dated [DATE], revealed resident #1 had a Brief Interview for Mental Status (BIMS) assessment completed and scored a 03 which indicated the resident was cognitively impaired. Review of resident #1's care plan indicated that the resident had a behavior problem which included exit seeking, restlessness, and irritability. Interventions included administering psychotropic medications, monitoring for behaviors and remove him from the situation when staff notices he starts to escalate. Review of resident…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

No federal fines in the current CMS record.

Part of a chain

This home belongs to THE ENSIGN GROUP — 342 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

CMS files one row per role, so the 12 rows in the source record cover these 10 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

2 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

What families pay in AZ