B81

WOODS HEALTH SERVICES

Grade B 81/100 composite score

Non profit - Corporation

CMS Star Ratings

Overall
3/5
Health Insp.
2/5
Quality
5/5
Staffing
4/5
RN Staffing
Not rated

Certified Beds

74

Ownership

Non profit - Corporation

Total Fines

$8,190

Last Survey

N/A

2600 A STREET, LA VERNE, CA 91750
9095934917

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Staffing Hours & Turnover

Hours per Resident per Day (PBJ)

RN
0.57h
LPN
1.36h
CNA
3.25h
Total
5.18h
Facility
State Average

Turnover Rates

RN Turnover
N/A
Total Nurse Turnover
N/A
Admin Turnover
N/A

Ownership

BRETHREN HILLCREST HOMES

OrganizationOPERATIONAL/MANAGERIAL CONTROLSince May 1969

ALLISON, THOMAS

IndividualCORPORATE DIRECTORSince Jan 2023

BLICKENSTAFF, JON

IndividualCORPORATE DIRECTORSince Jan 2017

DOUD, JACQUELINE

IndividualCORPORATE DIRECTORSince Jan 2023

DUNCAN, KATHLEEN

IndividualCORPORATE DIRECTORSince Jan 2023

GARVEY, KATHLEEN

IndividualCORPORATE DIRECTORSince Jan 2023

HESS, DOROTHY

IndividualCORPORATE DIRECTORSince Jan 2023

JOHNSTON, ROBERT

IndividualCORPORATE DIRECTORSince Jan 2023

LANE, DAN

IndividualCORPORATE DIRECTORSince Jan 2023

MATTESON, RUSS

IndividualCORPORATE DIRECTORSince Jan 2017

MCMULLIN, EDWARD

IndividualCORPORATE DIRECTORSince Jan 2023

MEEK, CHRISTINE

IndividualCORPORATE DIRECTORSince Jan 2023

REDMAN, DONNA

IndividualCORPORATE DIRECTORSince Jan 2023

SADDLEMIRE, LINDA

IndividualCORPORATE DIRECTORSince Jan 2023

SMYTHE, BARBARA

IndividualCORPORATE DIRECTORSince Jan 2023

STANLEY, DALE

IndividualCORPORATE DIRECTORSince Jan 2023

TENORIO, SUSAN

IndividualCORPORATE DIRECTORSince Jan 2023

WANG, TINA

IndividualCORPORATE DIRECTORSince Jan 2023

WELCH, MICHAEL

IndividualCORPORATE DIRECTORSince Jan 2023

BROUWER, JOEL

IndividualCORPORATE OFFICERSince Mar 2023

KASIN, KEITH

IndividualCORPORATE OFFICERSince Sep 1966

NEELEY, MATTHEW

IndividualCORPORATE OFFICERSince Jan 2005

NEELEY, MATTHEW

IndividualW-2 MANAGING EMPLOYEESince Jan 2005

Penalties & Fines (2)

$8,190total fines
DateTypeDescriptionAmount
Mar 11, 2024Payment Denial
Dec 13, 2023Fine$8,190

Health Inspection Deficiencies (56)

November 19, 2025Health1 deficiency
0580DMinimal harm, Isolated

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Resident Rights Deficiencies

June 20, 2025Health1 deficiency
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Jul 17, 2025
May 19, 2025Health3 deficiencies1 severe
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected May 22, 2025
0684GActual harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected May 22, 2025
0842EMinimal harm, Pattern

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Jun 5, 2025
April 4, 2025Health13 deficiencies
0552EMinimal harm, Pattern

Ensure that residents are fully informed and understand their health status, care and treatments.

Resident Rights Deficiencies

Corrected Apr 7, 2025
0558DMinimal harm, Isolated

Reasonably accommodate the needs and preferences of each resident.

Resident Rights Deficiencies

Corrected Apr 14, 2025
0640DMinimal harm, Isolated

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 21, 2025
0641DMinimal harm, Isolated

Ensure each resident receives an accurate assessment.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 21, 2025
0658DMinimal harm, Isolated

Ensure services provided by the nursing facility meet professional standards of quality.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 9, 2025
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Apr 14, 2025
0689DMinimal harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Apr 14, 2025
0732DMinimal harm, Isolated

Post nurse staffing information every day.

Nursing and Physician Services Deficiencies

Corrected Apr 14, 2025
0756EMinimal harm, Pattern

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Pharmacy Service Deficiencies

Corrected Apr 14, 2025
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Apr 14, 2025
0812DMinimal harm, Isolated

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Apr 9, 2025
0842DMinimal harm, Isolated

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 4, 2025
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Apr 14, 2025
January 31, 2025Health1 deficiency
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Feb 18, 2025
December 27, 2024Health2 deficiencies
0842DMinimal harm, Isolated

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Jan 23, 2025
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Jan 22, 2025
September 5, 2024Health3 deficiencies
0657EMinimal harm, Pattern

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Resident Assessment and Care Planning Deficiencies

Corrected Sep 26, 2024
0842DMinimal harm, Isolated

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Sep 25, 2024
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Sep 26, 2024
August 5, 2024Health1 deficiency
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Aug 23, 2024
March 29, 2024Health14 deficiencies
0550EMinimal harm, Pattern

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Resident Rights Deficiencies

Corrected Apr 19, 2024
0558DMinimal harm, Isolated

Reasonably accommodate the needs and preferences of each resident.

Resident Rights Deficiencies

Corrected Apr 19, 2024
0578DMinimal harm, Isolated

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.

Resident Rights Deficiencies

Corrected Apr 19, 2024
0638DMinimal harm, Isolated

Assure that each resident’s assessment is updated at least once every 3 months.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 19, 2024
0656EMinimal harm, Pattern

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 19, 2024
0684EMinimal harm, Pattern

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Apr 19, 2024
0689DMinimal harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Apr 19, 2024
0691DMinimal harm, Isolated

Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.

Quality of Life and Care Deficiencies

Corrected Apr 19, 2024
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Apr 19, 2024
0725EMinimal harm, Pattern

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Nursing and Physician Services Deficiencies

Corrected Apr 19, 2024
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Apr 19, 2024
0812EMinimal harm, Pattern

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Apr 19, 2024
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Apr 19, 2024
0882DMinimal harm, Isolated

Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

Infection Control Deficiencies

Corrected Apr 19, 2024
March 11, 2024Health1 deficiency1 severe
0689GActual harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Mar 26, 2024
December 13, 2023Health1 deficiency1 severe
0689GActual harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Jan 4, 2024
August 25, 2023Health1 deficiency
0609DMinimal harm, Isolated

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Sep 13, 2023
July 27, 2023Health1 deficiency
0689DMinimal harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Aug 4, 2023
January 14, 2022Health13 deficiencies
0584DMinimal harm, Isolated

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.

Resident Rights Deficiencies

Corrected Feb 17, 2022
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Feb 17, 2022
0658DMinimal harm, Isolated

Ensure services provided by the nursing facility meet professional standards of quality.

Resident Assessment and Care Planning Deficiencies

Corrected Feb 17, 2022
0684EMinimal harm, Pattern

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Feb 17, 2022
0689EMinimal harm, Pattern

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Feb 17, 2022
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Feb 17, 2022
0697DMinimal harm, Isolated

Provide safe, appropriate pain management for a resident who requires such services.

Quality of Life and Care Deficiencies

Corrected Feb 17, 2022
0725EMinimal harm, Pattern

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Nursing and Physician Services Deficiencies

Corrected Feb 17, 2022
0732BNo harm, Pattern

Post nurse staffing information every day.

Nursing and Physician Services Deficiencies

Corrected Feb 17, 2022
0761EMinimal harm, Pattern

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.

Pharmacy Service Deficiencies

Corrected Feb 17, 2022
0804EMinimal harm, Pattern

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Nutrition and Dietary Deficiencies

Corrected Feb 17, 2022
0812DMinimal harm, Isolated

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Feb 17, 2022
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Feb 17, 2022

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Frequently Asked Questions

What is the CareGrader rating for WOODS HEALTH SERVICES?

WOODS HEALTH SERVICES in LA VERNE, California has a CareGrader grade of B (Good), with a composite score of 81.3 out of 100. This grade is based on health inspections, staffing levels, quality measures, and penalty history from official CMS government data.

What is the CMS star rating for WOODS HEALTH SERVICES?

WOODS HEALTH SERVICES has an overall CMS star rating of 3 out of 5, a health inspection rating of 2/5, and a staffing rating of 4/5. CareGrader combines this with additional data to calculate an A-F grade.

How many health deficiencies does WOODS HEALTH SERVICES have?

WOODS HEALTH SERVICES has 56 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). View the full inspection timeline above for details on each deficiency.

Has WOODS HEALTH SERVICES been fined?

Yes. WOODS HEALTH SERVICES has $8,190 in total fines from CMS enforcement actions across 2 penalties.

How many beds does WOODS HEALTH SERVICES have?

WOODS HEALTH SERVICES has 74 certified beds with approximately 46 current residents (62% occupancy). The facility is located at 2600 A STREET, LA VERNE, California 91750. It is a non profit - corporation facility.

Data Disclaimer

Inspection data, staffing levels, and star ratings are sourced from CMS Medicare Nursing Home Compare and are largely self-reported by facilities. A 2019 GAO study found that 43% of facilities under-reported falls. CareGrader provides this data for informational purposes only and is not affiliated with CMS or Medicare. Always visit facilities in person before making a decision.