Inspection citations
8’22
1’23
21’24
3’25
15’26
48 shown
| Date | Severity | What inspectors found | Visit |
|---|---|---|---|
| Jul 21, 2026 | D · potential | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Complaint |
| Mar 6, 2026 | D · potential | Ensure that residents are fully informed and understand their health status, care and treatments. | Routine |
| Mar 6, 2026 | D · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Routine |
| Mar 6, 2026 | D · potential | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Routine |
| Mar 6, 2026 | G · harm | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| Mar 6, 2026 | D · potential | Ensure each resident’s drug regimen must be free from unnecessary drugs. | Routine |
| Mar 6, 2026 | E · potential | 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. | Routine |
| Mar 6, 2026 | F · potential | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Routine |
| Mar 6, 2026 | E · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Routine |
| Mar 6, 2026 | E · potential | Have a plan that describes the process for conducting QAPI and QAA activities. | Routine |
| Mar 6, 2026 | E · potential | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Routine |
| Mar 6, 2026 | F · potential | Provide and implement an infection prevention and control program. | Routine |
| Mar 6, 2026 | F · potential | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Routine |
| Mar 6, 2026 | F · potential | Keep all essential equipment working safely. | Routine |
| Feb 5, 2026 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Complaint |
| Feb 12, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Feb 12, 2025 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| Feb 12, 2025 | G · harm | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Dec 24, 2024 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Dec 24, 2024 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| May 24, 2024 | E · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| May 24, 2024 | E · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| May 24, 2024 | E · potential | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Complaint |
| May 24, 2024 | D · potential | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Routine |
| May 24, 2024 | E · potential | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Routine |
| May 24, 2024 | E · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Routine |
| May 24, 2024 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| May 24, 2024 | D · potential | Assist a resident in gaining access to vision and hearing services. | Routine |
| May 24, 2024 | D · potential | 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. | Routine |
| May 24, 2024 | E · potential | Provide enough food/fluids to maintain a resident's health. | Routine |
| May 24, 2024 | E · potential | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Routine |
| May 24, 2024 | E · potential | 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. | Complaint |
| May 24, 2024 | F · potential | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Complaint |
| May 24, 2024 | E · potential | Post nurse staffing information every day. | Routine |
| May 24, 2024 | E · potential | 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. | Complaint |
| May 24, 2024 | E · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Routine |
| May 24, 2024 | F · potential | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | Routine |
| May 24, 2024 | F · potential | Have a plan that describes the process for conducting QAPI and QAA activities. | Routine |
| May 24, 2024 | E · potential | Provide and implement an infection prevention and control program. | Routine |
| Dec 6, 2023 | F · potential | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Complaint |
| May 20, 2022 | D · potential | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Routine |
| May 20, 2022 | E · potential | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Routine |
| May 20, 2022 | E · potential | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Routine |
| May 20, 2022 | F · potential | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Routine |
| May 20, 2022 | E · potential | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Routine |
| May 20, 2022 | E · potential | Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | Routine |
| May 20, 2022 | F · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| May 20, 2022 | E · potential | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Routine |
Medicare's severity letters: A–C minimal harm, D–F potential for more than minimal harm, G–L actual harm or immediate danger. Source: CMS health deficiencies file, processed October 1, 2026.
Questions to ask on a visit
Sherwood Oaks Post Acute Care, LLC
130 Dana Street, Fort Bragg, CA 95437 · (707) 964-6333
Visit date: ____________ Spoke with: ______________________
Record on file
- Certification
- Medicare and Medi-Cal certified skilled nursing facility
- Medicare number (CCN)
- 056483
- Certified beds
- 79
- Legal owner
- Sherwood Oaks Post Acute Care, LLC.
Full profile on Medicare's Care Compare. Source: CMS, processed October 1, 2026.
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