Glendora Canyon Transitional Care Unit
401 W. Ada Ave. · Glendora, CA · 91741 · 6263359810
120 certified beds For profit - Limited Liability company Chain: Abraham Bak & Menachem Gastwirth
Why this verdict
- Carries CMS’s abuse warning icon.
- Inspection record is far worse than the national median (deficiency count and severity).
- No federal fines or payment denials in CMS’s 3-year window.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
CMS abuse warning
CMS flags this facility with its abuse icon: cited for abuse that caused harm in the past year, or potential harm in the past two years.
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 1 of 5 Inspections: 1 of 5 Staffing: 3 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 3.97 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.40 | 0.55–0.75 |
| Weekend hours / resident-day | 3.75 | ≈ weekday level |
| Nursing turnover / year | 40% | median 45% |
| Fines (3-yr window) | none |
Inspection citations (73 in the current record)
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Potential for harm · D March 27, 2026 · found via complaint
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected April 17, 2026 · Resident Assessment and Care Planning
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Potential for harm · D February 5, 2026 · found via complaint
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Corrected February 27, 2026 · Quality of Life and Care
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Potential for harm · E January 16, 2026
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected February 13, 2026 · Resident Rights
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Potential for harm · D January 16, 2026
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected February 13, 2026 · Resident Rights
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Potential for harm · E January 16, 2026
Reasonably accommodate the needs and preferences of each resident.
Corrected February 13, 2026 · Resident Rights
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Potential for harm · D January 16, 2026
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.
Corrected February 13, 2026 · Resident Rights
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Potential for harm · E January 16, 2026
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected February 13, 2026 · Resident Assessment and Care Planning
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Potential for harm · D January 16, 2026
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected February 13, 2026 · Resident Assessment and Care Planning
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Potential for harm · E January 16, 2026
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · D January 16, 2026
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · E January 16, 2026
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · D January 16, 2026
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.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · E January 16, 2026
Provide safe and appropriate respiratory care for a resident when needed.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · E January 16, 2026
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.
Corrected February 13, 2026 · Quality of Life and Care
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Potential for harm · E January 16, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 13, 2026 · Nutrition and Dietary
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Potential for harm · E January 16, 2026
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected February 13, 2026 · Resident Assessment and Care Planning
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Potential for harm · E January 16, 2026
Provide and implement an infection prevention and control program.
Corrected February 13, 2026 · Infection Control
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Potential for harm · E January 16, 2026
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected February 13, 2026 · Environmental
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Actual harm · G September 17, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected October 10, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D September 17, 2025 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected October 10, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D August 26, 2025 · found via complaint
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.
Corrected September 17, 2025 · Resident Rights
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Potential for harm · D August 26, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected September 17, 2025 · Quality of Life and Care
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Potential for harm · E March 21, 2025 · found via complaint
Provide and implement an infection prevention and control program.
Corrected April 5, 2025 · Infection Control
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Potential for harm · D January 29, 2025 · found via complaint
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Corrected February 12, 2025 · Resident Rights
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Potential for harm · D January 29, 2025 · found via complaint
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.
Corrected February 12, 2025 · Pharmacy Service
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 555416 · certified since April 13, 1990. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.