Community Hospital Of San Bernardino DP 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 0.08 therapist hours per resident per day in 2026Q1 — more than 4% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 28% 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

No payroll-based (PBJ) staffing hours are on file for this home — and the record suggests that is because it did not report them. CMS rates its staffing 1 of 5, which is the rating CMS assigns when a home does not report. Every Medicare-certified nursing home is required to submit its actual payroll data quarterly, and that submission is what makes staffing numbers auditable rather than a claim. A home that does not file is not the same as a home with no data yet: ask this home directly what its nurse-to-resident ratios and weekend RN coverage are, why its payroll data is not filed, and weigh the independent health-inspection score heavily in the meantime.

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.

21 citations, most serious first. The 12 most serious are shown; the remaining 9 are one tap away and print in full.

• Actual harm · Gcited before2025-11-20 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  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 one of four sampled residents (Resident 1) was safely reconnected to the ventilator (a machine that supports or controls a person's breathing when they cannot breathe adequately on their own) following a shower. This failure resulted in an avoidable interruption in Resident 1's life supporting respiratory assistance and requiring a code blue response (an emergency code indicating a patient needs immediate medical attention), which had the potential to cause brain damage from lack of oxygen, and lead up to death. Resident 1 was subsequently transferred to Intensive Care Unit (ICU) for close observation and treatment.Findings: A review of Resident 1's face sheet (contain demographic and medical information), indicated Resident 1 was admitted to the facility on [DATE], with diagnoses including sepsis (a life threating medical emergency that happens when the body's extreme response to an infection causes widespread inflammation…

  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
• Actual harm · Gcited before2025-10-10 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  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 residents are free of accidents for one of three residents (Resident 1) when Licensed Vocational Nurse (LVN 1) and Certified Nursing Assistant (CNA 1) did not ensure the attachment holding the bar and scale of the Hoyer lift (a mechanical device used to transfer people from one surface to another) was properly secure prior to Resident 1's transfer. This failure resulted in the attachment holding the bar and scale of the Hoyer lift became disconnected which caused Resident 1 falling from the Hoyer lift, sustaining a head laceration (cut), and requiring suture and closed observation in the Intensive Care Unit (ICU).Findings: A review of Resident 1's face sheet (contains demographic and medical information), indicated, Resident 1 was admitted to the facility on [DATE], with diagnoses including anemia (insufficient red blood cells), chronic respiratory failure (when lungs are too weak to keep oxygen in and carbon dioxide out of 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-05-04 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  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 implement a fall care plan intervention for one of four sampled residents (Resident 1).This failure resulted in Resident 1 falling off the bed, placing his safety at risk.Findings:During a review of Resident 1's clinical record, the face sheet (contains demographic and medical information), it indicated Resident 1 was admitted to the facility on [DATE], with diagnoses that included respiratory failure (life-threatening condition which causes shortness of breath) and cardiac arrest (medical emergency where the heart suddenly stops beating).During a review of the Resident 1's Fall Care Plan, initiated on June 14, 2024, it indicated an intervention of Assess for need for side rails or any.During a review of Resident 1's Minimum Data Set (MDS - a standardized clinical assessment tool), under Section GG (Functional Abilities - focuses on a resident's functional abilities and goals, specifically assessing self-care and mobility performance to capture 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2025-08-27 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to maintain an infection control program for 14 of 85 sampled residents (Resident 16, 18, 22, 24, 33, 41, 43, 52, 63, 68, 77, 82 and 83) when: 1. For one resident (Resident 41), there was no date or staff initial on Resident 41's gastro enteral tube (G tube- a feeding tube inserted through abdomen into the stomach to provide nutrition, fluids, and medication directly to the digestive system) and water flush bag (a bag with water administered to residents through G tube). 2. For 10 residents (Resident 83, 82, 63, 77, 52, 68, 22, 60, 24, and 41), suction tubes( a plastic tube used to remove bodily fluids and secretions, or foreign materials from a body cavity or passage by creating vacuum) were not used according to the policy and procedures (P&P) for disposable equipment change associated with artificial airway(a medical device such as a tube or other devices inserted into a patient's respiratory track to maintain and open airway) 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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-27 · tag F0604 — failed to not use physical restraints improperly — isolated
  Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
  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 implemented appropriate interventions and oversight of restraints for two of eight sampled residents (Resident 38 and Resident 45) when: 1. Resident 38's mitten restraint (soft hand cover used to prevent a person from scratching or removing medical devices) was not properly worn or secured to Resident 38's right hand. 2. Resident 45's restraint was not reassessed monthly as required by the facility's policy and procedures (P&P) for Restraint, Physical Guidelines for Use and Assessment. These failures had the potential to result in unsafe restraint use, decreased resident safety and violation of residents' rights. Findings: 1. A review of resident 38's Face sheet (FS-Document containing resident demographics), indicated, Resident 38 was admitted to the facility on [DATE]. A review of Resident 38's History and Physical (H&P- a document containing demographic information), dated January 9, 2025, indicated, Resident 38 had a…

  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 before2025-08-27 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  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 residents received necessary treatments and services to promote wound healing and prevent pressure ulcer (PU- a sore that develops on the skin when there is too much pressure on one area for a long time) development for two of 12 sampled residents (Resident 7 and Resident 37) when: 1. For two residents (Resident 7 and Resident 37), who were at risk for PU development, the repositioning was not documented every two hours. 2. For Resident 37, low air mattress was programmed with the incorrect resident weight. These failures may have contributed to the development of pressure ulcers in Resident 7 and Resident 37, potentially exposing them to harm and resulting in prolonged hospitalization. Findings: 1a. A review of Resident 7’s “admission Record (contains medical and resident demographics), undated, indicated, Resident 7 was admitted to the facility on [DATE]. A review of Resident 7’s “History & Physical” (H&P- a document containing…

  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 · D2025-08-27 · tag F0688 — failed to keep residents mobile / prevent decline — isolated
  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.
  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 one of six sampled residents (Resident 5) received necessary treatment and services to maintain, increase range of motion (ROM- moving the joints to keep them flexible and prevent stiffness) or prevent further decline when nursing staff did not perform ROM as ordered by physician and specified in the care plan (a guide for nurses to follow regarding the plan of care). This failure had the potential to result in decreased mobility and pain and increased the risk of further contractures (muscles and tendons have tightened and shortened).Findings: A review of Resident 5's Face sheet (FS-Document containing resident demographics), indicated, Resident 5 was admitted to the facility on [DATE]. A review of Resident 5's History & Physical (H&P- a document containing demographic information), dated May 6, 2025, indicated, Resident 5 has a history of cerebral palsy (CP-a condition that affects movement, balance, and muscle control), tracheostomy (trach- a…

  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 · Dcited before2025-08-27 · 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

  Based on observation, interview, and record review, the facility failed to ensure the safety and security of medications when Licensed Vocational Nurse 5 (LVN 5) left 12 medications on a computer desk unattended, and unsecured in a resident's room. This failure had the potential to place all 87 residents living on the unit at risk of harm due to increased risk for medication diversion (when a medication is taken for use by someone other than whom it was prescribed.)Findings: During a concurrent observation and interview on August 26, 2025, at 8:46 AM, with LVN 5, in Resident 18's room, LVN 5 placed 12 medications on a portable computer desk located at the bedside of Resident 18. The 12 medications included:-Glycopyrrolate (a medication commonly used to treat stomach ulcers or to inhibit respiratory secretions) 1 milligram (mg - unit of measure) tablet crushed-Vitamin C 500 mg tablet crushed-baclofen (a muscle relaxant) 10 mg tablet crushed-sennosides/docusate/sodium (a combination medication used to treat constipation) 8.6 mg /(per) 50 mg tablet crushed-amlodipine besylate…

  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 · D2025-08-27 · tag F0914 — isolated
  Provide bedrooms that don't allow residents to see each other when privacy is needed.
  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, interviews, and record review, the facility failed to provide full visual privacy for two of 28 sampled residents (Resident 59 and Resident 70) when there was no curtain between Resident 59's and Resident 70's bed. This failure had the potential to compromise resident 59's and Resident 70's dignity and right to full visual privacy.Findings: A review of Resident 59's Face sheet (FS-Document containing resident demographics), indicated, resident 59 was admitted to the facility on [DATE]. A review of Resident 59's History & Physical (H&P- a document containing demographic information), dated February 11, 2025, indicated, Resident 59 has a history of cerebral palsy (CP-a condition that affects movement, balance, and muscle control), tracheostomy (trach- a small surgical hole made in the front of the neck into the windpipe to help a person breath) dependent, gastrostomy (G-tube-a small tube placed through the skin into the stomach to give foods, liquids, and medicine) dependent, and seizures (a…

  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 · Fcited before2024-08-16 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to maintain infection control practices for four (4) of seven (7) sampled residents (Resident 51, Resident 69, Resident 57, and Resident 85) when: 1. Resident 51, who was not on transmission-based precaution (methods that are used to help stop the spread of germs from person to another), was observed less than three (3) feet (unit of measurement) apart from Resident 69 who was on transmission-based precautions. 2. The visitor of Resident 85, who was on droplet isolation (an infection control practice uses to prevent the spread of infection that are transmitted through respiratory droplets), was not educated about the proper use of Personal Protective Equipment (PPE-such as mask, gown and gloves worn to minimize exposure to illnesses) and was seen walking out of the isolation room without taking off the PPE. 3. Resident 57, who was not on transmission-based precautions was observed in the same room with Resident 85, who was on…

  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 · F2024-08-16 · tag F0882 — widespread
  Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
  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 the Centers for Disease Control and Prevention (CDC-a service organization that protects the public's health's) guideline was followed appropriately for two (2) of four sampled residents (Resident 57 and Resident 85) when the Infection Preventionist (IP) did not assess, monitor, and manage the transmission-based precaution (methods that are used to help stop the spread of germs from person to another) appropriately. This failure had the potential to spread infectious disease (disease caused by bacteria, viruses, fungi, or parasite) to all residents and staff in the facility. Findings: During a review of Resident 85's History and Physical (H&P-contain diagnoses information), indicated, Resident 85 was admitted on [DATE], with diagnoses which included respiratory failure (a condition when lungs cannot get enough oxygen into the blood) with tracheostomy (a procedure to help air and oxygen reach the lungs by creating an opening into…

  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 · D2024-08-16 · tag F0552 — isolated
  Ensure that residents are fully informed and understand their health status, care and treatments.
  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 resident's right were followed for one of four sample residents (Resident 81), when Resident 81 was placed on a left soft wrist restraint (device to prevent excessive movement of a body part to which they are attached) without an Informed Consent. This failure resulted in Resident 81 and Resident 81's Representative not being fully informed about the care and treatment provided. Findings: During a review of Resident 81's clinical record, the Record of Admission (contains demographic and medical information), indicated Resident 81 was admitted to the facility on [DATE]. A review of the Resident 81's History and Physical (H&P-contains information of health issues), dated July 28, 2024, indicated, admission diagnoses which include Cerebral Palsy (disorder that permanently affect a person's movement and muscle coordination), Tracheostomy status (an opening through the neck into the windpipe to allow air to fill the lungs and help a…

  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

$9,110 in federal fines across 1 penalty.

• $9,110 — penalty dated 2025-11-20

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to COMMONSPIRIT HEALTH — 18 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 21 rows in the source record cover these 19 parties — each is shown once here with every role it holds. Nothing is omitted.

4 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 CA