The nursing home failed to protect residents from abuse and neglect by others. Cited January 2024 — isolated incident, immediate jeopardy to residents.
View the original federal record
F-Tag 600 — 42 CFR §483.12 — S/S: J
Nursing home report
GOLDEN SAN ANDREAS CARE CENTER
SAN ANDREAS, CA · Medicare-certified · 99 beds
Needs attention
For-profitChain member
Data as of July 1, 2026
1 of 5 overall
Golden San Andreas Care Center in San Andreas, CA has an overall 1-star rating, with a 1-star health inspection rating, 3-star staffing and quality ratings, and reported nurse staffing just below the federal benchmark (4.09 vs 4.1 hours per resident per day). It also has a recent federal penalty and $14,293 in fines over the last 24 months.
Facility ratings
Health inspections
Staffing
4.0939 hrs/resident/day
Quality measures
Last inspection: May 29, 2026Penalties, last 24 months: $14,293recent federal penalty
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 4.0939.
Staffing detail
- Registered nurses
- 0.25
- Licensed practical nurses
- 1.31
- Nurse aides
- 2.53
- Weekend nursing
- 3.62
Hours per resident per day.
Total staff turnover: 50%
Registered nurse turnover: 60%
Resident outcomes
Each measure compares a year ago with the most recent quarter. Green means the facility moved the right way; red means the wrong way.
Negative outcomes
Lower is better — fewer affected residents. A decrease is good (green); an increase is concerning (red).
Long-stay residents on antipsychotic medication
11.4%6.8%Improving
Residents with a fall causing major injury
0%0%No change
Residents with pressure ulcers (bedsores)
2.7%6.7%Worsening
Residents with a urinary tract infection
3.2%0%Improving
Residents who lost too much weight
11.3%2%Improving
Residents who were physically restrained
0%0%No change
Residents needing more help with daily activities
20.4%10.2%Improving
Residents whose ability to walk got worse
17.4%16%Improving
Long-stay residents on antianxiety or sleep medication
8.9%14%Worsening
Short-stay residents newly given an antipsychotic
0%0%No change
Residents with a long-term catheter
0%0%No change
Residents with new or worsening incontinence
28%22.9%Improving
Residents with depressive symptoms
3.6%0%Improving
Positive outcomes
Higher is better — e.g. vaccinations. An increase is good (green); a decrease is concerning (red).
Long-stay residents given the seasonal flu vaccine
—100%—
Long-stay residents given the pneumonia vaccine
100%100%No change
Short-stay residents given the seasonal flu vaccine
—96.3%—
Short-stay residents given the pneumonia vaccine
98.5%99.2%Improving
What the inspectors found
The nursing home failed to provide proper pressure ulcer care and failed to prevent new pressure sores from developing. Cited May 2025 — isolated incident, actual harm.
View the original federal record
F-Tag 686 — 42 CFR §483.25(b) — S/S: G
The nursing home failed to keep the area free of hazards and provide enough supervision to prevent accidents. Cited October 2024 — isolated incident, actual harm.
View the original federal record
F-Tag 689 — 42 CFR §483.25(d) — S/S: G
The home failed to provide appropriate care to help a resident maintain or improve movement and mobility. Cited January 2024 — isolated incident, actual harm.
View the original federal record
F-Tag 688 — 42 CFR §483.25(c) — S/S: G
The nursing home failed to provide appropriate treatment and care according to residents' orders, preferences, and goals. Cited November 2023 — isolated incident, actual harm.
View the original federal record
F-Tag 684 — 42 CFR §483.25 — S/S: G
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- STAFFING
Reported nurse staffing met or exceeded the federal recommendation.
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- INSPECTION
Health inspection found 3 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- PENALTY
A federal fine of $14,293 was recorded.
Penalties & enforcement
On record with Medicare: 3 fines · $91,172 in total fines · 1 payment denial.
- $14,293
Federal fine
Oct 15, 2024
- 14 days
Medicare/Medicaid payment denial
Jan 30, 2024
- $52,241
Federal fine
Jan 30, 2024
- $24,638
Federal fine
Oct 3, 2023
Operator & ownership
Recent ownership change · Mar 1, 2023
Now operated by Golden San Andreas Care Center, previously Avalon Health Care San Andreas.
- Ownership
- For profit - Limited Liability company
- Chain
- Part of GOLDEN SNF OPERATIONS · 7 homes · 2.7 stars avg
- Occupancy
- 81.9 residents on an average day (83% of 99 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 49 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.