Carmel Mountain Rehabilitation & Healthcare Center

11895 Avenue of Industry · San Diego, CA · 92128 · 8586730101

120 certified beds For profit - Limited Liability company Chain: The Ensign Group

Why this verdict

  • Inspection record is far worse than the national median (deficiency count and severity).
  • Staffing hours comfortably above national benchmarks.
  • No federal fines or payment denials in CMS’s 3-year window.

The composite number cleared 73 points, but Recommended is gated: inspection record below the Recommended bar. That rule is part of the published method.

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Red flags

No red flags in the current CMS record. Genuinely good news — pair it with an in-person tour before deciding.

Score breakdown

Inspection record 30% of score 36
Serious harm & abuse 20% 94
Staffing 20% 92
Federal penalties 15% 100
Trend 10% 49
Context 5% 100

Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.

CMS ratings & staffing

Overall: 3 of 5 Inspections: 2 of 5 Staffing: 3 of 5 Quality measures: 5 of 5

Total nurse hours / resident-day5.153.48 min · 4.1 strong
RN hours / resident-day1.040.55–0.75
Weekend hours / resident-day4.67≈ weekday level
Nursing turnover / year39%median 45%
Fines (3-yr window)none

Inspection citations (53 in the current record)

  • Actual harm · G April 15, 2026 · found via complaint

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

    Deficient, Provider has no plan of correction · Quality of Life and Care

  • Potential for harm · D April 15, 2026 · found via complaint

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

    Deficient, Provider has no plan of correction · Resident Assessment and Care Planning

  • Potential for harm · D April 15, 2026 · found via complaint

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

    Deficient, Provider has no plan of correction · Quality of Life and Care

  • Potential for harm · E January 22, 2026 · found via complaint

    Provide and implement an infection prevention and control program.

    Corrected February 12, 2026 · Infection Control

  • Potential for harm · D September 16, 2025 · found via complaint

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

    Corrected October 5, 2025 · Resident Rights

  • Potential for harm · D September 16, 2025 · found via complaint

    Provide and implement an infection prevention and control program.

    Corrected October 5, 2025 · Infection Control

  • Potential for harm · D September 4, 2025 · found via complaint

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

    Corrected October 5, 2025 · Quality of Life and Care

  • Potential for harm · E September 4, 2025 · found via complaint

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Corrected September 22, 2025 · Pharmacy Service

  • Potential for harm · D September 4, 2025 · found via complaint

    Administer the facility in a manner that enables it to use its resources effectively and efficiently.

    Corrected September 22, 2025 · Administration

  • Potential for harm · E April 24, 2025

    Reasonably accommodate the needs and preferences of each resident.

    Corrected May 24, 2025 · Resident Rights

  • Potential for harm · D April 24, 2025

    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

    Corrected May 24, 2025 · Resident Rights

  • Potential for harm · E April 24, 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 May 24, 2025 · Resident Rights

  • Potential for harm · D April 24, 2025

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

    Corrected May 24, 2025 · Quality of Life and Care

  • Potential for harm · D April 24, 2025

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Corrected May 24, 2025 · Quality of Life and Care

  • Potential for harm · D April 24, 2025

    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 May 24, 2025 · Quality of Life and Care

  • Potential for harm · D April 24, 2025

    Provide safe, appropriate dialysis care/services for a resident who requires such services.

    Corrected May 24, 2025 · Quality of Life and Care

  • Potential for harm · D April 24, 2025

    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.

    Corrected May 24, 2025 · Pharmacy Service

  • Potential for harm · E April 24, 2025

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

    Corrected May 24, 2025 · Nutrition and Dietary

  • Potential for harm · D April 24, 2025

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

    Corrected May 24, 2025 · Resident Assessment and Care Planning

  • Potential for harm · E April 24, 2025

    Have a plan that describes the process for conducting QAPI and QAA activities.

    Corrected May 24, 2025 · Administration

  • Potential for harm · E April 24, 2025

    Provide and implement an infection prevention and control program.

    Corrected May 24, 2025 · Infection Control

  • Potential for harm · D April 24, 2025 · 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 May 24, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D April 24, 2025 · found via complaint

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

    Corrected May 24, 2025 · Quality of Life and Care

  • Potential for harm · E December 26, 2024 · 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 3, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D October 15, 2024 · found via complaint

    Ensure each resident receives an accurate assessment.

    Corrected November 15, 2024 · Resident Assessment and Care Planning

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 555326 · certified since October 12, 1988. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.