Broadway Villa Post Acute

Name: Broadway Villa Post Acute
Address: 1250 BROADWAY, Sonoma, CA, 95476, US
Telephone: 7079388406

1250 Broadway, Sonoma, CA 95476 · Sonoma County · 144 certified beds · avg 137 residents/day · certified since Jul 1, 1974

Part of chain: THE ENSIGN GROUP (342 facilities, chain avg rating 3.2★)

3/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

4.53

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 5/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

Most serious findings (actual harm or immediate jeopardy)

▲ Actual harm, one-off · Jul 2, 2026 · F-0684 · triggered by a complaint

The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.

Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

All citations in the current public record (33)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Jul 2, 2026	▲ G · Actual harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Jul 2, 2026	E · Potential for harm, repeated	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint
Apr 10, 2026	F · Potential for harm, facility-wide	The facility did not keep its building and grounds safe, functional, clean, and comfortable for residents, staff, and visitors.
Apr 10, 2026	D · Potential for harm, one-off	The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs.
Feb 27, 2026	D · Potential for harm, one-off	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. · from a complaint
Feb 27, 2026	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint
Jan 14, 2026	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Dec 24, 2025	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
Sep 8, 2025	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Apr 21, 2025	E · Potential for harm, repeated	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Apr 21, 2025	E · Potential for harm, repeated	The facility did not have a working call system — the button or cord residents use to summon help — in each resident's bathroom and bathing area. · from a complaint
Jan 23, 2025	D · Potential for harm, one-off	The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives.
Jan 23, 2025	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow.
Jan 23, 2025	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Jan 23, 2025	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Jan 23, 2025	C · Minimal risk, facility-wide	The facility did not post its nurse staffing information every day. Nursing homes must publicly display how many nurses and aides are on duty each day.
Jan 14, 2025	D · Potential for harm, one-off	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint
Jan 14, 2025	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
Oct 23, 2023	F · Potential for harm, facility-wide	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Oct 23, 2023	F · Potential for harm, facility-wide	The facility has more than 120 beds but did not hire a qualified full-time social worker as required. · from a complaint
Oct 23, 2023	F · Potential for harm, facility-wide	The facility did not run an ongoing quality assurance committee that reviews care problems and creates plans to fix them.
Oct 23, 2023	E · Potential for harm, repeated	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights.
Oct 23, 2023	E · Potential for harm, repeated	The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives.
Oct 23, 2023	E · Potential for harm, repeated	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. · from a complaint
Oct 23, 2023	E · Potential for harm, repeated	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint
Oct 23, 2023	E · Potential for harm, repeated	The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration.
Oct 23, 2023	E · Potential for harm, repeated	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Oct 23, 2023	D · Potential for harm, one-off	The facility did not make sure residents were fully informed about their own health, care, and treatments in a way they could understand.
Oct 23, 2023	D · Potential for harm, one-off	The facility did not treat residents with respect and dignity, or did not let them keep and use their own personal belongings.
Oct 23, 2023	D · Potential for harm, one-off	The facility did not honor residents' right to manage their own money and financial affairs.
Oct 23, 2023	D · Potential for harm, one-off	The facility did not reassess a resident after a significant change in their condition, such as a sudden decline in health. A full new assessment is required when a resident's condition changes in a major way.
Oct 23, 2023	D · Potential for harm, one-off	The facility did not provide care that took into account residents' past trauma or their cultural backgrounds. Care is supposed to be sensitive to what residents have lived through and where they come from. · from a complaint
Oct 23, 2023	D · Potential for harm, one-off	The facility did not provide special eating equipment and utensils — like adaptive cups or easy-grip silverware — for residents who need them, along with appropriate help at meals.

Inspection trend by year

Citations from standard inspections decreased between the last two inspection cycles (5 → 2).

Year	Citations	Serious (G–L)	Worst severity that year
2023	15	0	F
2025	11	0	E
2026	7	1	G ▲

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

No fines or payment denials in the published 3-year window.

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	California avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	4.53	4.31	3.95	top 27% in California; top 22% in the U.S.
Registered Nurse hours	0.70	0.61	0.69	top 24% in California; top 37% in the U.S.
Weekend total nurse staffing	4.02	3.90	3.50	top 32% in California; top 22% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.45	0.51	0.48	top 38% in California; top 40% in the U.S.
Total nursing staff turnover (%)	31.5	36.7	45.8	top 35% in California; top 17% in the U.S.
RN turnover (%)	33.3	38.1	42.9	top 40% in California; top 33% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.99, RN 0.61, weekend 3.54. Staffing rating: 5/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 5/5 · long-stay residents: 5/5 · short-stay residents: 3/5

Who owns this facility

For profit - Corporation

Owner / manager	Type	Role	Stake	Since
Burnam, Soon	Individual	Corporate Officer	NOT APPLICABLE	01/30/2006
Empey, Michael	Individual	Managing Control - Governing Body	NOT APPLICABLE	04/01/2019
Empey, Michael	Individual	Operational/Managerial Control	NOT APPLICABLE	04/01/2019
Empey, Michael	Individual	ADP of the SNF	NOT APPLICABLE	04/01/2019
Ensign Services INC	Organization	ADP of the SNF	NOT APPLICABLE	11/15/2001
Keetch, Chad	Individual	Corporate Officer	NOT APPLICABLE	03/01/2011
Mariano Health Holdings LLC	Organization	ADP of the SNF	NOT APPLICABLE	01/01/2022
Port, Barry	Individual	Individual Is an Owner, Partner or Trustee of Any ADP of the SNF	NOT APPLICABLE	08/25/2025
Serrano, Noel	Individual	Operational/Managerial Control	NOT APPLICABLE	06/01/2020
Serrano, Noel	Individual	ADP of the SNF	NOT APPLICABLE	06/01/2020
Standard Bearer Healthcare Op LP	Organization	ADP of the SNF	NOT APPLICABLE	01/01/2022
The Ensign Group INC	Organization	ADP of the SNF	NOT APPLICABLE	01/01/2022
Willits, Adam	Individual	Corporate Director	NOT APPLICABLE	01/01/2019

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
"Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
"Can we tour the whole building today, including resident bathrooms and common areas, not just the lobby?"
"Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
"Can you show me an example care plan, and how are families included when it's created and updated?"
"How do you assess and manage residents' pain, especially for those who have trouble communicating?"
"What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
"When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
Sonoma Post Acute	0.8 mi	Sonoma, CA	★★★★☆	3/5
Valley of the Moon Post Acute	0.9 mi	Sonoma, CA	★★★☆☆	2/5	abuse
The Meadows of Napa Valley	8.7 mi	Napa, CA	★★★★★	5/5
Napa Community Health Center	9.0 mi	Napa, CA	★☆☆☆☆	1/5
Vineyard Post Acute	9.4 mi	Petaluma, CA	★★★☆☆	2/5
Veterans Home of California - Yountville - SNF	9.7 mi	Yountville, CA	★★★★★	4/5
Napa Valley Care Center	9.7 mi	Napa, CA	★★★☆☆	2/5
Napa Post Acute	9.8 mi	Napa, CA	★☆☆☆☆	1/5
Dept of State Hospitals - Napa D/P SNF	10.3 mi	Napa, CA	★★★☆☆	2/5
North Bay Post Acute	10.4 mi	Petaluma, CA	★☆☆☆☆	1/5	abuse
Hillcrest Post Acute	11.0 mi	Petaluma, CA	★★★★☆	4/5
Petaluma Post-Acute Rehabilitation	11.0 mi	Petaluma, CA	★★★★★	5/5

Compare this facility with the 3 closest →

All facilities in Sonoma →

Facility data as of CMS processing date 2026-08-01. CCN 055987.

The Care File

Visit checklist — Broadway Villa Post Acute

1250 Broadway, Sonoma, CA 95476 · 7079388406

Health inspection rating 3/5 · CMS overall 5/5· Fines (3y): $0

Most serious findings on record:

▲ Jul 2, 2026 (F-0684, Actual harm, one-off): The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.

Questions for the administrator:

☐ "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
☐ "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
☐ "Can we tour the whole building today, including resident bathrooms and common areas, not just the lobby?"
☐ "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
☐ "Can you show me an example care plan, and how are families included when it's created and updated?"
☐ "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
☐ "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
☐ "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 055987 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)