San Luis Care Center
709 N Street · Newman, CA · 95360 · 2098622862
71 certified beds For profit - Limited Liability company Chain: Avalon Health Care
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- 4 citations involved actual harm to residents.
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
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: 2 of 5 Inspections: 2 of 5 Staffing: 3 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 3.84 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.36 | 0.55–0.75 |
| Weekend hours / resident-day | 3.59 | ≈ weekday level |
| Nursing turnover / year | 36% | median 45% |
| Fines (3-yr window) | 1 · $46,118 |
Inspection citations (42 in the current record)
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Potential for harm · D March 6, 2026
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected March 30, 2026 · Resident Rights
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Potential for harm · D March 6, 2026
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected March 31, 2026 · Resident Rights
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Potential for harm · D March 6, 2026
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected March 30, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 6, 2026
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected March 30, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 6, 2026
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected March 30, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 6, 2026
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected March 30, 2026 · Pharmacy Service
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Potential for harm · E March 6, 2026
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 March 30, 2026 · Pharmacy Service
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Potential for harm · D March 6, 2026
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · E March 6, 2026
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · D March 6, 2026
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.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · E March 6, 2026
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · E March 6, 2026
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · F March 6, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected March 30, 2026 · Nutrition and Dietary
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Potential for harm · E March 6, 2026
Provide and implement an infection prevention and control program.
Corrected March 30, 2026 · Infection Control
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Potential for harm · E March 6, 2026
Keep all essential equipment working safely.
Corrected March 30, 2026 · Environmental
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Potential for harm · E March 6, 2026
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected March 30, 2026 · Environmental
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Actual harm · G September 12, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected October 3, 2025 · Quality of Life and Care
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Potential for harm · D August 8, 2024
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected August 26, 2024 · Resident Rights
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Potential for harm · E August 8, 2024
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected August 26, 2024 · Resident Rights
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Potential for harm · D August 8, 2024
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected August 26, 2024 · Resident Assessment and Care Planning
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Potential for harm · D August 8, 2024
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 August 26, 2024 · Quality of Life and Care
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Potential for harm · D August 8, 2024
Provide enough food/fluids to maintain a resident's health.
Corrected August 26, 2024 · Quality of Life and Care
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Potential for harm · D August 8, 2024
Provide and implement an infection prevention and control program.
Corrected August 26, 2024 · Infection Control
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Potential for harm · E May 29, 2024 · found via complaint
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected June 24, 2024 · Resident Rights
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Potential for harm · D May 29, 2024 · found via complaint
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected June 24, 2024 · Resident Assessment and Care Planning
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| January 30, 2024 | Fine | $46,118 |
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 055839 · certified since August 1, 1969. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.