Inspection citations
13’22
7’24
10’25
30 shown
| Date | Severity | What inspectors found | Visit |
|---|---|---|---|
| Sep 11, 2025 | D · 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 |
| Sep 11, 2025 | D · potential | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Routine |
| Sep 11, 2025 | D · potential | Ensure each resident receives an accurate assessment. | Routine |
| Sep 11, 2025 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Routine |
| Sep 11, 2025 | 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 |
| Sep 11, 2025 | D · potential | Ensure medication error rates are not 5 percent or greater. | Routine |
| Sep 11, 2025 | D · 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 |
| Sep 11, 2025 | E · potential | Dispose of garbage and refuse properly. | Routine |
| Sep 11, 2025 | F · potential | Provide and implement an infection prevention and control program. | Routine |
| Mar 17, 2025 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| Apr 22, 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 |
| Apr 22, 2024 | E · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| Apr 22, 2024 | F · potential | Post nurse staffing information every day. | Routine |
| Apr 22, 2024 | E · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Routine |
| Apr 22, 2024 | D · 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 |
| Apr 22, 2024 | E · potential | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Complaint |
| Apr 22, 2024 | F · potential | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Routine |
| Mar 4, 2022 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Mar 4, 2022 | D · potential | Allow residents to self-administer drugs if determined clinically appropriate. | Routine |
| Mar 4, 2022 | E · potential | Ensure each resident receives an accurate assessment. | Routine |
| Mar 4, 2022 | 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 4, 2022 | E · 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 4, 2022 | E · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Routine |
| Mar 4, 2022 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| Mar 4, 2022 | E · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Mar 4, 2022 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Routine |
| Mar 4, 2022 | D · potential | Ensure each resident’s drug regimen must be free from unnecessary drugs. | Routine |
| Mar 4, 2022 | D · 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 4, 2022 | E · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Routine |
| Mar 4, 2022 | D · 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
Hillcrest Post Acute
450 Hayes Lane, Petaluma, CA 94952 · (707) 778-8686
Visit date: ____________ Spoke with: ______________________
Record on file
- Certification
- Medicare and Medi-Cal certified skilled nursing facility
- Medicare number (CCN)
- 555127
- Certified beds
- 59
- Legal owner
- Trestles Holdings LLC
- Part of
- West Harbor Healthcare
Full profile on Medicare's Care Compare. Source: CMS, processed October 1, 2026.
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