Lakewood Healthcare Center
12023 Lakewood Blvd. · Downey, CA · 90242 · 5628690978
290 certified beds For profit - Corporation Chain: Pacific Healthcare Holdings
Why this verdict
- Carries CMS’s abuse warning icon.
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
- Inspection record is far worse than the national median (deficiency count and severity).
- Staffing levels are well below research benchmarks for safe care.
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
Special Focus Facility candidate
CMS lists this facility as a candidate for its Special Focus program for persistently poor inspection performance.
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 immediate-jeopardy citation in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
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.
2 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
$128,597 in federal fines in the last 24 months
3 fines — CMS fines are reserved for verified, serious non-compliance.
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: 1 of 5 Quality measures: 1 of 5
| Total nurse hours / resident-day | — | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | — | 0.55–0.75 |
| Weekend hours / resident-day | — | ≈ weekday level |
| Nursing turnover / year | — | median 45% |
| Fines (3-yr window) | 3 · $128,597 |
Inspection citations (125 in the current record)
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Potential for harm · D April 28, 2026 · found via complaint
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected May 8, 2026 · Resident Rights
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Potential for harm · E January 28, 2026 · found via complaint
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected February 19, 2026 · Resident Rights
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Potential for harm · D January 28, 2026 · found via complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected February 19, 2026 · Resident Assessment and Care Planning
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Potential for harm · E January 28, 2026 · found via complaint
Provide safe, appropriate pain management for a resident who requires such services.
Corrected February 19, 2026 · Quality of Life and Care
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Potential for harm · D January 9, 2026 · found via complaint
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected January 18, 2026 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D December 31, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected January 17, 2026 · Quality of Life and Care
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Actual harm · G December 18, 2025
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.
Corrected January 21, 2026 · Quality of Life and Care
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Actual harm · G December 18, 2025
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 26, 2026 · Quality of Life and Care
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Potential for harm · D December 18, 2025
Reasonably accommodate the needs and preferences of each resident.
Corrected January 21, 2026 · Resident Rights
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Potential for harm · D December 18, 2025
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected January 21, 2026 · Resident Rights
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Potential for harm · F December 18, 2025
Keep residents' personal and medical records private and confidential.
Corrected January 21, 2026 · Resident Rights
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Potential for harm · D December 18, 2025
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 January 21, 2026 · Resident Rights
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Potential for harm · D December 18, 2025
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected January 21, 2026 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D December 18, 2025
Ensure each resident receives an accurate assessment.
Corrected January 21, 2026 · Resident Assessment and Care Planning
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Potential for harm · D December 18, 2025
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected February 26, 2026 · Resident Assessment and Care Planning
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Potential for harm · E December 18, 2025
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected January 21, 2026 · Quality of Life and Care
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Potential for harm · D December 18, 2025
Provide enough food/fluids to maintain a resident's health.
Corrected January 21, 2026 · Quality of Life and Care
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Potential for harm · E December 18, 2025
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.
Corrected February 26, 2026 · Nursing and Physician Services
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Potential for harm · E December 18, 2025
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected February 26, 2026 · Pharmacy Service
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Potential for harm · D December 18, 2025
Ensure medication error rates are not 5 percent or greater.
Corrected January 21, 2026 · Pharmacy Service
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Potential for harm · D December 18, 2025
Ensure that residents are free from significant medication errors.
Corrected February 26, 2026 · Pharmacy Service
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Potential for harm · E December 18, 2025
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Corrected January 21, 2026 · Nutrition and Dietary
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Potential for harm · E December 18, 2025
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected January 21, 2026 · Nutrition and Dietary
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Potential for harm · E December 18, 2025
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Corrected February 26, 2026 · Nutrition and Dietary
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Potential for harm · E December 18, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 26, 2026 · Nutrition and Dietary
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| December 18, 2025 | Fine | $87,071 |
| December 18, 2025 | Payment Denial | 35 days |
| June 13, 2025 | Fine | $14,901 |
| June 13, 2025 | Payment Denial | 13 days |
| August 2, 2024 | Fine | $26,625 |
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 555099 · certified since August 1, 1978. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.