Devonshire Care Center

1350 East Devonshire Avenue · Hemet, CA · 92544 · 9519252571

99 certified beds For profit - Limited Liability company Chain: Genesis Healthcare

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).
  • Inspection results are getting worse cycle over cycle, not better.

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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.

Cited under the freedom-from-abuse rule

Cited 1 time under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.

Score breakdown

Inspection record 30% of score 24
Serious harm & abuse 20% 70
Staffing 20% 69
Federal penalties 15% 76
Trend 10% 35
Context 5% 100

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: 2 of 5 Quality measures: 4 of 5

Total nurse hours / resident-day3.973.48 min · 4.1 strong
RN hours / resident-day0.440.55–0.75
Weekend hours / resident-day3.76≈ weekday level
Nursing turnover / year51%median 45%
Fines (3-yr window)1 · $10,364

Inspection citations (73 in the current record)

  • Potential for harm · E April 20, 2026 · found via complaint

    Provide and implement an infection prevention and control program.

    Deficient, Provider has no plan of correction · Infection Control

  • Potential for harm · E April 20, 2026 · found via complaint

    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

    Deficient, Provider has no plan of correction · Environmental

  • Potential for harm · D April 1, 2026 · found via complaint

    Provide safe, appropriate pain management for a resident who requires such services.

    Corrected April 8, 2026 · Quality of Life and Care

  • Potential for harm · D January 9, 2026 · found via complaint

    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

    Corrected February 2, 2026 · Nutrition and Dietary

  • Potential for harm · D August 22, 2025 · found via complaint

    Provide safe, appropriate pain management for a resident who requires such services.

    Corrected August 30, 2025 · Quality of Life and Care

  • Potential for harm · D July 29, 2025 · found via complaint

    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

    Corrected July 31, 2025 · Environmental

  • Immediate jeopardy · J July 2, 2025 · found via complaint

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

    Corrected July 3, 2025 · Quality of Life and Care

  • Potential for harm · E July 2, 2025 · found via complaint

    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 July 3, 2025 · Nursing and Physician Services

  • Potential for harm · E July 2, 2025 · found via complaint

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

    Corrected July 3, 2025 · Administration

  • Potential for harm · E July 2, 2025 · found via complaint

    Implement a program that monitors antibiotic use.

    Corrected July 3, 2025 · Infection Control

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

    Ensure services provided by the nursing facility meet professional standards of quality.

    Corrected June 10, 2025 · Resident Assessment and Care Planning

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

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

    Corrected June 10, 2025 · Quality of Life and Care

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

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Corrected June 10, 2025 · Nursing and Physician Services

  • Potential for harm · D May 21, 2025 · found via complaint

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Corrected May 27, 2025 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · D April 14, 2025

    Reasonably accommodate the needs and preferences of each resident.

    Corrected April 16, 2025 · Resident Rights

  • Potential for harm · E April 14, 2025

    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 April 16, 2025 · Resident Rights

  • Potential for harm · D April 14, 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 April 16, 2025 · Resident Rights

  • Potential for harm · D April 14, 2025

    Ensure each resident receives an accurate assessment.

    Corrected April 16, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D April 14, 2025

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

    Corrected April 16, 2025 · Quality of Life and Care

  • Potential for harm · D April 14, 2025

    Assist a resident in gaining access to vision and hearing services.

    Corrected April 16, 2025 · Quality of Life and Care

  • Potential for harm · D April 14, 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 April 16, 2025 · Quality of Life and Care

  • Potential for harm · D April 14, 2025

    Provide enough food/fluids to maintain a resident's health.

    Corrected April 16, 2025 · Quality of Life and Care

  • Potential for harm · D April 14, 2025

    Observe each nurse aide's job performance and give regular training.

    Corrected April 16, 2025 · Nursing and Physician Services

  • Potential for harm · D April 14, 2025

    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 16, 2025 · Pharmacy Service

  • Potential for harm · E April 14, 2025

    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

    Corrected April 16, 2025 · Nutrition and Dietary

Showing the 25 most recent. The Safety Report includes every citation with full findings.

Federal penalties

DateTypeAmount / length
July 2, 2025Fine$10,364

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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 056095 · certified since September 5, 1969. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.