Medicare flags this nursing home for abuse. Medicare adds this flag when a home was cited for abuse that harmed a resident, or for potential abuse more than once. Ask the home what changed.
Inspection citations
20’21
2’23
10’24
56’25
23’26
111 shown
| Date | Severity | What inspectors found | Visit |
|---|---|---|---|
| Aug 28, 2026 | D · potential | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Complaint |
| Aug 28, 2026 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Aug 28, 2026 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| Aug 26, 2026 | F · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Complaint |
| Aug 26, 2026 | D · potential | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Complaint |
| Aug 26, 2026 | F · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Complaint |
| Jul 31, 2026 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Jul 31, 2026 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| Jul 30, 2026 | F · potential | Post nurse staffing information every day. | Complaint |
| Jul 22, 2026 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Jul 4, 2026 | G · harm | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Jul 4, 2026 | E · 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. | Complaint |
| Jun 17, 2026 | D · potential | Ensure that residents are fully informed and understand their health status, care and treatments. | Complaint |
| Jun 17, 2026 | D · potential | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Complaint |
| Jun 17, 2026 | D · potential | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | Complaint |
| Jun 17, 2026 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Jun 17, 2026 | F · potential | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Complaint |
| Jun 4, 2026 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Jun 4, 2026 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| May 6, 2026 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Apr 16, 2026 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Complaint |
| Apr 16, 2026 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Mar 25, 2026 | 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. | Complaint |
| Dec 31, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Dec 31, 2025 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Dec 3, 2025 | D · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Complaint |
| Nov 20, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Nov 20, 2025 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Nov 13, 2025 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Nov 13, 2025 | D · potential | Reasonably accommodate the needs and preferences of each resident. | Routine |
| Nov 13, 2025 | E · potential | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Routine |
| Nov 13, 2025 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Complaint |
| Nov 13, 2025 | D · potential | Provide activities to meet all resident's needs. | Routine |
| Nov 13, 2025 | D · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Routine |
| Nov 13, 2025 | D · potential | Provide enough food/fluids to maintain a resident's health. | Routine |
| Nov 13, 2025 | D · potential | Provide safe, appropriate pain management for a resident who requires such services. | Routine |
| Nov 13, 2025 | D · 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. | Routine |
| Nov 13, 2025 | D · potential | Ensure each resident’s drug regimen must be free from unnecessary drugs. | Routine |
| Nov 13, 2025 | E · potential | Ensure medication error rates are not 5 percent or greater. | Routine |
| Nov 13, 2025 | D · potential | Ensure that residents are free from significant medication errors. | Routine |
| Nov 13, 2025 | 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 |
| Nov 13, 2025 | F · potential | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Routine |
| Nov 13, 2025 | F · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Routine |
| Nov 13, 2025 | F · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Nov 13, 2025 | E · potential | Provide and implement an infection prevention and control program. | Complaint |
| Nov 13, 2025 | D · potential | Keep all essential equipment working safely. | Routine |
| Nov 13, 2025 | D · potential | Make sure that a working call system is available in each resident's bathroom and bathing area. | Routine |
| Sep 8, 2025 | D · potential | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Complaint |
| Sep 8, 2025 | G · harm | Ensure that residents are free from significant medication errors. | Complaint |
| Sep 8, 2025 | D · potential | Provide routine and 24-hour emergency dental care for each resident. | Complaint |
| Aug 28, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Aug 28, 2025 | D · potential | PASARR screening for Mental disorders or Intellectual Disabilities | Complaint |
| Aug 20, 2025 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Aug 8, 2025 | D · potential | Ensure that residents are free from significant medication errors. | Complaint |
| Aug 8, 2025 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Jul 18, 2025 | F · potential | Have a Compliance and Ethics Program. | Complaint |
| Jul 9, 2025 | E · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Complaint |
| Jul 9, 2025 | E · potential | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | Complaint |
| Jul 9, 2025 | E · potential | Make sure that a working call system is available in each resident's bathroom and bathing area. | Complaint |
| Jul 3, 2025 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| May 19, 2025 | D · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Complaint |
| May 19, 2025 | F · potential | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Complaint |
| May 19, 2025 | F · potential | Ensure that residents are free from significant medication errors. | Complaint |
| May 19, 2025 | F · potential | Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Complaint |
| May 14, 2025 | D · potential | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Complaint |
| May 14, 2025 | E · potential | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Complaint |
| May 14, 2025 | E · potential | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Complaint |
| May 14, 2025 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Complaint |
| May 14, 2025 | E · potential | Have policies on smoking. | Complaint |
| May 1, 2025 | D · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| May 1, 2025 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Apr 25, 2025 | G · harm | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Apr 23, 2025 | D · potential | Provide or get specialized rehabilitative services as required for a resident. | Complaint |
| Mar 5, 2025 | D · potential | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Complaint |
| Feb 24, 2025 | F · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Complaint |
| Feb 24, 2025 | F · potential | 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. | Complaint |
| Jan 9, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Jan 9, 2025 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Jan 9, 2025 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| Sep 5, 2024 | 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. | Complaint |
| Sep 4, 2024 | E · potential | Ensure that residents are free from significant medication errors. | Complaint |
| Jul 17, 2024 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Jan 11, 2024 | D · potential | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Routine |
| Jan 11, 2024 | D · potential | Keep residents' personal and medical records private and confidential. | Routine |
| Jan 11, 2024 | 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 |
| Jan 11, 2024 | D · potential | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Routine |
| Jan 11, 2024 | D · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Routine |
| Jan 11, 2024 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Jan 11, 2024 | F · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Oct 25, 2023 | D · potential | Provide routine and 24-hour emergency dental care for each resident. | Complaint |
| Oct 9, 2023 | E · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Complaint |
| Apr 23, 2021 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Apr 23, 2021 | E · potential | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Routine |
| Apr 23, 2021 | E · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Routine |
| Apr 23, 2021 | D · potential | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Routine |
| Apr 23, 2021 | D · potential | Ensure each resident receives an accurate assessment. | Routine |
| Apr 23, 2021 | E · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Routine |
| Apr 23, 2021 | D · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Routine |
| Apr 23, 2021 | E · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Routine |
| Apr 23, 2021 | E · potential | Provide activities to meet all resident's needs. | Routine |
| Apr 23, 2021 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Apr 23, 2021 | D · potential | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | Routine |
| Apr 23, 2021 | E · potential | Provide safe and appropriate respiratory care for a resident when needed. | Routine |
| Apr 23, 2021 | 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 |
| Apr 23, 2021 | E · potential | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | Routine |
| Apr 23, 2021 | E · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Routine |
| Apr 23, 2021 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Apr 23, 2021 | D · potential | Provide or get specialized rehabilitative services as required for a resident. | Routine |
| Apr 23, 2021 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Routine |
| Apr 23, 2021 | D · potential | Have a plan that describes the process for conducting QAPI and QAA activities. | Routine |
| Apr 23, 2021 | E · potential | Provide and implement an infection prevention and control program. | 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
Novato Healthcare Center
1565 Hill Road, Novato, CA 94947 · (415) 897-6161
Visit date: ____________ Spoke with: ______________________
Record on file
- Certification
- Medicare and Medi-Cal certified skilled nursing facility
- Medicare number (CCN)
- 555844
- Certified beds
- 181
- Legal owner
- Novato Healthcare Center LLC
Full profile on Medicare's Care Compare. Source: CMS, processed October 1, 2026.
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