Cloverdale Healthcare Center
300 Cherry Creek Rd, Cloverdale, CA 95425 · Sonoma County · 72 certified beds · avg 56 residents/day · certified since Jul 16, 1974
Part of chain: THE ENSIGN GROUP (342 facilities, chain avg rating 3.2★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★★★5/5 · 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.
All citations in the current public record (13)
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 |
|---|---|---|
| Dec 19, 2025 | E · Potential for harm, repeated | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. |
| Dec 19, 2025 | E · Potential for harm, repeated | The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. |
| Dec 19, 2025 | D · Potential for harm, one-off | The facility did not provide required paperwork or notices about a resident's needs, their right to appeal a transfer or discharge, or the facility's bed-hold policy (how long a bed is saved during a hospital stay). |
| Dec 19, 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. |
| Mar 5, 2025 | D · Potential for harm, one-off | The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away. · from a complaint |
| Jan 9, 2025 | B · Minimal risk, repeated | The facility had resident rooms smaller than required — at least 80 square feet per person in shared rooms and 100 square feet in single rooms. |
| Oct 21, 2022 | E · Potential for harm, repeated | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. |
| Oct 21, 2022 | E · Potential for harm, repeated | The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. |
| Oct 21, 2022 | E · Potential for harm, repeated | 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 21, 2022 | 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. |
| Oct 21, 2022 | 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. |
| Oct 21, 2022 | D · Potential for harm, one-off | The facility did not have enough support staff to safely and effectively run its food and nutrition service. |
| Oct 21, 2022 | D · Potential for harm, one-off | The facility did not prepare and serve food in a form that meets each resident's individual needs — for example, chopped, pureed, or softened food for residents with chewing or swallowing problems. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (1 → 4).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2022 | 7 | 0 | E |
| 2025 | 6 | 0 | E |
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) | 4.35 | 4.31 | 3.95 | top 36% in California; top 27% in the U.S. |
| Registered Nurse hours | 0.36 | 0.61 | 0.69 | bottom 23% in California; bottom 16% in the U.S. |
| Weekend total nurse staffing | 3.84 | 3.90 | 3.50 | top 43% in California; top 28% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.29 | 0.51 | 0.48 | bottom 32% in California; bottom 30% in the U.S. |
| Total nursing staff turnover (%) | 36.5 | 36.7 | 45.8 | bottom 49% in California; top 28% in the U.S. |
| RN turnover (%) | 0.0 | 38.1 | 42.9 | — |
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 4.36, RN 0.36, weekend 3.85. Staffing rating: 3/5.
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: 5/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| The Ensign Group INC | Organization | 5% or Greater Direct Ownership Interest | 100% | 01/30/2006 |
| Burnam, Soon | Individual | Corporate Officer | NOT APPLICABLE | 02/01/2006 |
| Ensign Services INC | Organization | ADP of the SNF | NOT APPLICABLE | 11/17/2003 |
| Gamble, Shawndee | Individual | Managing Control - Governing Body | NOT APPLICABLE | 11/15/2001 |
| Gamble, Shawndee | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/15/2001 |
| Gamble, Shawndee | Individual | ADP of the SNF | NOT APPLICABLE | 11/15/2001 |
| Keetch, Chad | Individual | Corporate Officer | NOT APPLICABLE | 03/01/2011 |
| Port, Barry | Individual | Individual Is an Owner, Partner or Trustee of Any ADP of the SNF | NOT APPLICABLE | 08/20/2025 |
| Red Barn Lakeside Holdings, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2019 |
| Serrano, Noel | Individual | Managing Control - Governing Body | NOT APPLICABLE | 05/01/2021 |
| Serrano, Noel | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/01/2021 |
| Serrano, Noel | Individual | ADP of the SNF | NOT APPLICABLE | 05/01/2021 |
| Twomagnets LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 11/15/2001 |
| Twomagnets LLC | Organization | ADP of the SNF | NOT APPLICABLE | 11/15/2001 |
| Willits, Adam | Individual | Corporate Officer | NOT APPLICABLE | 11/15/2025 |
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 does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
- "Can you show me how medications are stored and secured on the units, including controlled drugs?"
- "What written notices do we get before any transfer or discharge, and what is your bed-hold policy?"
- "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
- "If my family member falls or their condition changes, exactly when and how will I be notified?"
- "Can I see the actual room my family member would live in before we decide?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "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 |
|---|---|---|---|---|---|
| Healdsburg Hospital D/P SNF | 14.4 mi | Healdsburg, CA | ★★★★☆ | 5/5 | |
| Lakeport Post Acute | 17.4 mi | Lakeport, CA | ★★★☆☆ | 2/5 | |
| Rocky Point Care Center | 18.6 mi | Lakeport, CA | ★★★☆☆ | 2/5 | abuse |
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Facility data as of CMS processing date 2026-08-01. CCN 055756.