Dept Of State Hospitals - Napa D/P SNF

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 <0.01 therapist hours per resident per day in 2026Q1 — more than 0% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 0% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. 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 36 beds and averages 23.1 residents a day — about 64% occupied, or roughly 13 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. 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 10.32 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 5.84 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.18 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 9.89 hrs/resident/day on weekends vs 10.50 on weekdays — 6% thinner on weekends. RN hours go from 5.88 to 5.72 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 31% is below the national median of 45%.

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 more than at the previous inspection — worsening. 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.

25 citations, most serious first. The 10 most serious are shown; the remaining 15 are one tap away and print in full.

• Potential for harm · F2026-05-15 · tag F0641 — widespread
  Ensure each resident receives an accurate assessment.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to submit accurate Minimum Data Set (MDS- a federally mandated assessment tool used to guide resident care) data for eight of 13 sampled residents (Residents 1, 2, 3, 7, 15, 16, 17, and 21) when the MDS did not reflect the following: 1. Resident 1 had a diagnosis of psychotic disorder (mental health condition that causes a person to lose touch with reality). 2. Resident 2 received hospice care (end-of-life care). 3. Resident 3 had diagnoses of Traumatic Brain Injury (TBI- damage to the brain caused by an outside physical force), dementia (decline in brain function that affects a person's memory and thinking skills) and hemiplegia (paralysis of one vertical half of the body). 4. Resident 7 received anticonvulsant (medication used to calm the brain) daily. 5. Resident 15 received daily treatment for viral hepatitis (inflammation of the liver caused by an infection). 6. Resident 16 had Preadmission Screening and Resident Review (PASRR- used to ensure individuals are placed in an appropriate setting and receive needed mental…

  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 · Fcited before2026-05-15 · tag F0812 — failed to store, cook, and serve food safely — widespread
  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 observation, interview, and record review, the facility failed to ensure food safety and sanitation guidelines were followed when:Six cups of sherbet were undated in the freezer of the satellite kitchen.Six cups of ice cream were undated in the freezer of the satellite kitchen.One cup of cooked rice was expired in the refrigerator of the satellite kitchen.Two cups of tofu were expired in the refrigerator of the satellite kitchen.Six cups of egg salad were unlabeled and undated in the refrigerator in the satellite kitchen.One refrigerator had a holding temperature of 48 degrees Fahrenheit, above the maximum temperature, in the satellite kitchen.One package of oven roasted turkey breast was unlabeled and undated in the cooler of the main kitchen.A scoop was stored in a food bin labeled Thickener in the main kitchen.These failures posed the risk of food borne illness in a medically fragile resident population of 22 facility residents who received food prepared in the kitchen. During a concurrent observation and interview on 5/11/26 at 1:35 PM with Food Service Technician…

  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 · F2026-05-15 · tag F0838 — failed to assess facility resources and resident needs — widespread
  Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to develop and maintain a comprehensive, data-driven facility assessment that accurately identified the resources necessary to care for its resident population. These failures had the potential to result in insufficient staffing, unmet resident care needs, delayed interventions, and inability to safely provide services consistent with resident acuity and diagnoses.Findings:During a concurrent interview and record review on 5/14/26 at 10:47 AM with Assistant Executive Director (AED) and Standards Compliance Director (SCD), the Facility Assessment, dated 2026, was reviewed. The Facility Assessment did not include the following: 1. A data-driven staffing plan based on resident acuity and care needs. 2. Documentation of participation by leadership, direct care staff, and resident/family representatives. 3. Assessment of staffing contingency plans during emergencies or staffing shortages. 4. Ongoing evaluation of competencies and resources necessary to provide behavioral health services to the facility's specialized 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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2026-05-15 · tag F0865 — failed to run a quality-improvement (QAPI) program — widespread
  Have a plan that describes the process for conducting QAPI and QAA activities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to ensure its Quality Assurance and Performance Improvement (QAPI) program was comprehensive and data-driven when the facility failed to identify, monitor, and correct facility-wide non-compliance in two areas:1. Ongoing inaccuracies in Minimum Data Set (MDS- standardized, federally mandated assessment tool used to evaluate the health, functional abilities and care needs of every patient in a skilled nursing facility) submissions were identified.2. Continued detection of legionella pneumophila (harmful bacteria causing Legionnaires' disease- type of serious infection in the lungs) in the kitchen cooling tower was not resolved.This deficient practice resulted in a lack of system-wide tracking, data analysis, and quality oversight for issues of non-compliance that affected 22 of 22 residents.Findings:1. During a concurrent observation and interview on 5/13/26 at 1:59 PM with Director of Nursing (DON) and MDS Coordinator (MDSC), the list of all skilled nursing facility (SNF) residents was observed on Internet Quality Improvement…

  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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2026-05-15 · tag F0880 — failed to prevent and control infections — widespread
  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 observation, interview, and record review, the facility failed to implement infection prevention and control practices that protect residents from the spread of infectious diseases when:Remediation was not completed and documented after legionella pneumophila (harmful bacteria causing Legionnaires' disease- type of serious infection in the lungs) was detected in the kitchen cooling tower.12 of 12 residents (Residents 1, 2, 3, 5, 8, 10, 11, 12, 15, 16, 21, and 22 ) were on Enhanced Barrier Precaution (EBP-infection control intervention used to protect patients from the spread of multi-drug resistant organisms (MDROs- bacteria that are resistant to most antibiotics)) and did not have Personal Protective Equipment (PPE-specialized clothing or equipment used to reduce exposure to hazards or infections) available immediately outside the residents' rooms in accordance with The Center for Disease Control and Prevention (CDC) guidelines.Licensed Vocational Nurse (LVN) 1 did not wear PPE while administering medication to Resident 1 via gastrostomy tube (G-tube- a soft flexible tube…

  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 · F2026-05-15 · tag F0921 — failed to keep a safe, functional, sanitary building — widespread
  Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
  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 observation and interview and record review, the facility failed to maintain the environment in a safe, comfortable, and functional condition for residents when: 1. One pothole and a large area of uneven surface was observed in the courtyard. 2. Multiple walls in the day hall with deep gouges exposing the drywall were observed. These failures had the potential to affect the safety and well-being of residents, staff, and visitors.During a concurrent observation and interview on 5/13/26 at 10:45 AM, with the Supervising Registered Nurse (SRN 1), of the courtyard, a pothole and a large area of uneven surface were identified. SRN 1 confirmed the presence of a pothole measuring approximately 1 foot by 2 feet, as well as a large area of uneven surface in the courtyard. SRN 1 further stated the unit census was 20 residents, including 10 residents who use wheelchairs and can self-propel, and one resident who used a walker for mobility and confirmed all residents in the unit have access to the courtyard. During…

  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.

  Environmental Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-05-15 · tag F0640 — pattern
  Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
  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 interview and record review, the facility failed to ensure a transmittal of a quarterly Minimum Data Set (MDS- a federally mandated assessment tool used to guide resident care) was submitted no more than 14 days after the assessment reference date (ARD-the date the resident assessment was completed) for one of 13 sampled residents (Resident 15). This failure resulted in Resident 15's Quarterly MDS being submitted untimely.Findings:During a review of Resident 15's Treatment Plan, dated 4/14/26, the Treatment Plan indicated Resident 15 was admitted to the facility on [DATE], with diagnoses to include dysphagia (difficulty swallowing) and need for total care (staff assisting with all daily activities of living).During a concurrent interview and record review on 5/13/26 at 2:26 PM with MDS Coordinator (MDSC) and the Director of Nursing (DON), Resident 15's Quarterly MDS, dated 2/26/26 was reviewed. Resident 15's Quarterly MDS indicated the ARD was 1/30/26 and the assessment was not submitted until 2/26/26.…

  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 · E2026-05-15 · tag F0645 — pattern
  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 interview and record review, the facility failed to ensure completion and submission of federally mandated Preadmission Screening and Resident Review (PASRR- used to ensure individuals are placed in an appropriate setting and receive needed mental health services) were completed for seven of 13 sampled residents (Resident 1, 3, 4, 5, 8, 11, and 21). These failures resulted in seven residents not receiving federally mandated evaluations and determinations, which could result in residents with serious mental illness' not receiving a standardized plan of care consistent with their assessed needs.Findings:During a review of Resident 1's Treatment Plan, dated 3/17/26, the Treatment Plan indicated Resident 1 was admitted to the facility on [DATE] with diagnoses to include major neurocognitive disorder (severe, ongoing decline in memory and thinking that makes it impossible for a person to live independently), personality change, psychotic disorder (mental health condition that causes a person to lose touch…

  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 · D2026-05-15 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  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 observation, interview, and record review, the facility failed to ensure staff maintained resident's dignity and provided care in a manner that was respectful for one of 13 sampled residents (Resident 15) when Psychiatric Technician Assistant (PTA) 1 stood over Resident 15 while feeding him dinner. This failure had the potential to result in Resident 15 feeling intimidated or uncomfortable during meal assistance.Findings:During a review of Resident 15's Treatment Plan, dated 4/14/26, the Treatment Plan indicated Resident 15 was admitted to the facility on [DATE], with diagnoses to include dysphagia (difficulty swallowing) and need for total care (staff assisting with all daily activities of living).During an observation on 5/11/26 at 5:42 PM in Resident 15's room, Resident 15 was sitting upright in bed and PTA 1 was at bedside, standing over him and feeding him dinner.During an interview on 5/11/26 at 5:57 PM with PTA 1, PTA 1 stated she normally stood over residents while feeding them.During an…

  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 Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-05-15 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
  Reasonably accommodate the needs and preferences of each resident.
  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 observation, interview, and record review, the facility failed to ensure that the call light for one of 13 sampled residents (Resident 6) was placed within reach, preventing Resident 6 from independently requesting assistance from staff. This failure resulted in putting Resident 6 at risk for unmet needs and delayed care.Findings:During a review of Resident 6's Treatment Plan, dated 2/24/26, the Treatment Plan indicated Resident 6 was admitted on [DATE] with diagnosis of spastic quadriparesis (muscle weakness and stiffness resulting in jerky and difficult movement of both arms and legs) and required total assistance provided by staff with regards to transferring (moving in and out of bed) and activities of daily living (ADLs- basic, routine personal care tasks such as hygiene, toileting, dressing and eating).During a concurrent observation and interview on 5/12/26 at 9:24 AM with Registered Nurse (RN) 1 in Resident 6's room, Resident 6 was observed lying in bed with his E-Z call light (a specialized…

  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 Rights 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.

Who owns this facility

The source lists no ownership percentage for any party here — PECOS records a share only for equity interests, not for board or management roles.

What families pay in CA