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
9’23
33’24
59’25
23’26
124 shown
| Date | Severity | What inspectors found | Visit |
|---|---|---|---|
| Aug 25, 2026 | D · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Aug 25, 2026 | 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. | Complaint |
| Aug 25, 2026 | D · potential | Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Complaint |
| Mar 18, 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 |
| Mar 18, 2026 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Mar 13, 2026 | D · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Mar 13, 2026 | D · potential | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Routine |
| Mar 13, 2026 | D · potential | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Routine |
| Mar 13, 2026 | D · potential | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | Routine |
| Mar 13, 2026 | D · potential | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Routine |
| Mar 13, 2026 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Routine |
| Mar 13, 2026 | D · potential | Provide activities to meet all resident's needs. | Routine |
| Mar 13, 2026 | D · potential | Assist a resident in gaining access to vision and hearing services. | Routine |
| Mar 13, 2026 | E · potential | Ensure that residents are free from significant medication errors. | Routine |
| Mar 13, 2026 | D · 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 |
| Mar 13, 2026 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Mar 13, 2026 | D · potential | Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Routine |
| Mar 13, 2026 | D · potential | Provide and implement an infection prevention and control program. | Routine |
| Mar 6, 2026 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Mar 6, 2026 | D · potential | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | Complaint |
| Feb 23, 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. | Complaint |
| Feb 23, 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. | Complaint |
| Jan 30, 2026 | E · potential | Provide and implement an infection prevention and control program. | Complaint |
| Dec 17, 2025 | D · potential | Honor the resident's right to organize and participate in resident/family groups in the facility. | Complaint |
| Dec 12, 2025 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Dec 12, 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 |
| Dec 12, 2025 | E · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Complaint |
| Dec 12, 2025 | E · potential | Ensure that residents are free from significant medication errors. | Complaint |
| Nov 9, 2025 | D · potential | Provide doctor's orders for the resident's immediate care at the time the resident was admitted. | Complaint |
| Nov 9, 2025 | D · potential | Ensure each resident receives an accurate assessment. | Complaint |
| Nov 9, 2025 | J · harm | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Nov 9, 2025 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Nov 9, 2025 | D · potential | Have a plan that describes the process for conducting QAPI and QAA activities. | Complaint |
| Nov 3, 2025 | 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. | Complaint |
| Nov 3, 2025 | E · potential | Ensure that residents are free from significant medication errors. | Complaint |
| Nov 3, 2025 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Oct 17, 2025 | D · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Oct 17, 2025 | G · harm | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Oct 15, 2025 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Oct 15, 2025 | D · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Complaint |
| Oct 15, 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 |
| Sep 17, 2025 | D · potential | Let each resident or the resident's legal representative access or purchase copies of all the resident's records. | Complaint |
| Sep 3, 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 3, 2025 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Sep 3, 2025 | E · potential | Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Complaint |
| Sep 3, 2025 | D · potential | Keep all essential equipment working safely. | Complaint |
| Aug 19, 2025 | E · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Complaint |
| Aug 19, 2025 | J · harm | Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. | Complaint |
| Aug 19, 2025 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Aug 19, 2025 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Aug 19, 2025 | D · potential | Have a plan that describes the process for conducting QAPI and QAA activities. | Complaint |
| Jul 11, 2025 | D · potential | Reasonably accommodate the needs and preferences of each resident. | Complaint |
| Jul 11, 2025 | D · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Complaint |
| Jul 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. | Complaint |
| Jul 11, 2025 | 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. | Complaint |
| Jul 11, 2025 | D · potential | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | Complaint |
| Jun 3, 2025 | D · potential | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Complaint |
| May 16, 2025 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| May 16, 2025 | D · potential | Ensure that residents are free from significant medication errors. | Complaint |
| Mar 28, 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 |
| Mar 28, 2025 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Jan 31, 2025 | D · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Jan 31, 2025 | E · potential | Reasonably accommodate the needs and preferences of each resident. | Routine |
| Jan 31, 2025 | D · potential | Keep residents' personal and medical records private and confidential. | Routine |
| Jan 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 |
| Jan 31, 2025 | D · potential | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Routine |
| Jan 31, 2025 | E · potential | PASARR screening for Mental disorders or Intellectual Disabilities | Routine |
| Jan 31, 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. | Routine |
| Jan 31, 2025 | 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 |
| Jan 31, 2025 | D · potential | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Routine |
| Jan 31, 2025 | E · potential | Provide care and assistance to perform activities of daily living for any resident who is unable. | Routine |
| Jan 31, 2025 | E · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Jan 31, 2025 | D · potential | Provide safe and appropriate respiratory care for a resident when needed. | Routine |
| Jan 31, 2025 | 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. | Routine |
| Jan 31, 2025 | D · potential | Ensure medication error rates are not 5 percent or greater. | Routine |
| Jan 31, 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 |
| Jan 31, 2025 | D · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Jan 31, 2025 | D · potential | Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. | Complaint |
| Jan 31, 2025 | E · potential | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Complaint |
| Jan 31, 2025 | D · potential | Provide and implement an infection prevention and control program. | Routine |
| Jan 31, 2025 | D · potential | Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. | Routine |
| Jan 31, 2025 | D · potential | Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Routine |
| Dec 30, 2024 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Oct 30, 2024 | D · potential | Allow resident to participate in the development and implementation of his or her person-centered plan of care. | Complaint |
| Sep 30, 2024 | C · minimal | Post nurse staffing information every day. | Complaint |
| Sep 10, 2024 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Aug 21, 2024 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Aug 21, 2024 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jul 21, 2024 | 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. | Complaint |
| Jul 21, 2024 | E · potential | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Complaint |
| May 6, 2024 | E · potential | Reasonably accommodate the needs and preferences of each resident. | Complaint |
| May 6, 2024 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| May 6, 2024 | 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 |
| May 6, 2024 | D · potential | Provide safe, appropriate dialysis care/services for a resident who requires such services. | Complaint |
| May 6, 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. | Complaint |
| Feb 9, 2024 | G · harm | Provide safe, appropriate pain management for a resident who requires such services. | Complaint |
| Feb 9, 2024 | E · potential | Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. | Complaint |
| Feb 9, 2024 | E · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jan 31, 2024 | 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 |
| Jan 31, 2024 | E · potential | Provide safe, appropriate pain management for a resident who requires such services. | Complaint |
| Jan 31, 2024 | E · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jan 31, 2024 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Jan 12, 2024 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Jan 12, 2024 | D · potential | Allow residents to self-administer drugs if determined clinically appropriate. | Routine |
| Jan 12, 2024 | D · potential | Reasonably accommodate the needs and preferences of each resident. | Complaint |
| Jan 12, 2024 | D · potential | Ensure each resident receives an accurate assessment. | Routine |
| Jan 12, 2024 | 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 |
| Jan 12, 2024 | G · harm | Provide enough food/fluids to maintain a resident's health. | Routine |
| Jan 12, 2024 | E · potential | Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Routine |
| Jan 12, 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. | Complaint |
| Jan 12, 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 |
| Jan 12, 2024 | E · potential | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Complaint |
| Jan 12, 2024 | F · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Jan 12, 2024 | D · potential | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Routine |
| Jan 12, 2024 | F · potential | Provide and implement an infection prevention and control program. | Complaint |
| Dec 21, 2023 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| Dec 7, 2023 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Nov 15, 2023 | 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 |
| Oct 31, 2023 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Complaint |
| Oct 31, 2023 | D · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Complaint |
| Oct 31, 2023 | D · potential | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Complaint |
| Oct 5, 2023 | 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 |
| Oct 5, 2023 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Oct 5, 2023 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
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
Bay Crest Care Center
3750 Garnet Street, Torrance, CA 90503 · (310) 371-2431
Visit date: ____________ Spoke with: ______________________
Record on file
- Certification
- Medicare and Medi-Cal certified skilled nursing facility
- Medicare number (CCN)
- 055559
- Certified beds
- 80
- Legal owner
- Bay Crest Care Center, LLC
- Part of
- Genesis Healthcare
Full profile on Medicare's Care Compare. Source: CMS, processed October 1, 2026.
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