Spring Valley Post Acute LLC
14973 Hesperia Rd · Victorville, CA · 92395 · 7602456477
126 certified beds For profit - Limited Liability company Chain: David Johnson
Why this verdict
- 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).
- Federal penalties on record: $15,920 in fines in the last 24 months.
- Inspection results are getting worse cycle over cycle, not better.
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 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.
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: 2 of 5 Staffing: 4 of 5 Quality measures: 1 of 5
| Total nurse hours / resident-day | 4.61 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.40 | 0.55–0.75 |
| Weekend hours / resident-day | 4.06 | ≈ weekday level |
| Nursing turnover / year | 36% | median 45% |
| Fines (3-yr window) | 15 · $82,256 |
Inspection citations (31 in the current record)
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Potential for harm · D March 5, 2026
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Corrected April 4, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 5, 2026
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 5, 2026
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 5, 2026
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected April 4, 2026 · Quality of Life and Care
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Potential for harm · D March 5, 2026
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected April 4, 2026 · Pharmacy Service
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Potential for harm · D March 5, 2026
Provide and implement an infection prevention and control program.
Corrected April 4, 2026 · Infection Control
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Immediate jeopardy · K September 26, 2025 · found via complaint
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected October 17, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D March 13, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected April 7, 2025 · Quality of Life and Care
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Potential for harm · D November 21, 2024
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected December 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D November 21, 2024
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected December 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · E November 21, 2024
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected December 13, 2024 · Resident Assessment and Care Planning
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Potential for harm · D November 21, 2024
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 13, 2024 · Resident Assessment and Care Planning
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Potential for harm · D November 21, 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 December 13, 2024 · Quality of Life and Care
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Potential for harm · D November 21, 2024
Provide and implement an infection prevention and control program.
Corrected December 13, 2024 · Infection Control
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Potential for harm · D November 13, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected November 25, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D June 12, 2024 · 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 July 8, 2024 · Resident Rights
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Potential for harm · D October 9, 2023 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected October 30, 2023 · Quality of Life and Care
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Potential for harm · D September 26, 2023 · found via complaint
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected October 16, 2023 · Quality of Life and Care
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Potential for harm · D August 31, 2023 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected September 11, 2023 · Quality of Life and Care
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Potential for harm · D August 23, 2023 · found via complaint
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected September 12, 2023 · Freedom from Abuse, Neglect, and Exploitation
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Immediate jeopardy · L February 4, 2022
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected April 5, 2022 · Nutrition and Dietary
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Potential for harm · E February 4, 2022
Ensure each resident receives an accurate assessment.
Corrected April 5, 2022 · Resident Assessment and Care Planning
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Potential for harm · D February 4, 2022
Notify the appropriate authorities when residents with MD or ID services has a significant change in condition.
Corrected April 5, 2022 · Resident Assessment and Care Planning
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Potential for harm · D February 4, 2022
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 April 5, 2022 · Nursing and Physician Services
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Potential for harm · D February 4, 2022
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 April 5, 2022 · Pharmacy Service
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| September 26, 2025 | Fine | $15,920 |
| November 6, 2023 | Fine | $4,587 |
| October 17, 2023 | Fine | $4,587 |
| October 10, 2023 | Fine | $4,587 |
| October 2, 2023 | Fine | $4,587 |
| September 25, 2023 | Fine | $4,587 |
| September 18, 2023 | Fine | $4,587 |
| September 11, 2023 | Fine | $4,587 |
| September 5, 2023 | Fine | $4,587 |
| August 28, 2023 | Fine | $4,587 |
| August 21, 2023 | Fine | $4,587 |
| August 14, 2023 | Fine | $4,587 |
| July 17, 2023 | Fine | $10,586 |
| June 26, 2023 | Fine | $2,823 |
| June 20, 2023 | Fine | $2,470 |
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 055076 · certified since February 19, 1971. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.