4635 College Oak Drive, Sacramento, CA 95841 (opens Google Maps) · Sacramento County · (916) 481-7434· 120 certified beds · avg 115 residents/day · certified since Feb 16, 1970 · Medicare and Medicaid certified
Certified for both programmes. Certification means the facility can bill Medicaid — it does not mean a Medicaid-funded bed is free right now, so ask directly. Who pays for nursing home care →
Part of chain: CYPRESS HEALTHCARE GROUP (13 facilities, chain avg rating 3.8★)
New to these records? How to read an inspection report →
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 3/5 · how star ratings work →
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 quality measures from resident assessments and claims.
▲ Immediate jeopardy, isolated · Nov 20, 2025 · F-0627 · triggered by a complaint
The facility did not make sure a transfer or discharge met the resident's needs and preferences, or did not properly prepare the resident to leave safely.
Why it matters: A rushed or poorly planned move can leave a resident somewhere that can't meet their needs.
Severity (J): Immediate jeopardy to resident health or safety was cited. The scope was isolated: limited residents, staff, or locations were affected. Scope describes the extent of the deficiency, not whether it happened on previous inspections.
Corrected: Nov 25, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, isolated · Feb 9, 2024 · F-0685
The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids.
Why it matters: Untreated vision and hearing problems lead to falls, isolation, and confusion that could be avoided.
Severity (G): Actual harm was cited, below immediate jeopardy. The scope was isolated: limited residents, staff, or locations were affected. Scope describes the extent of the deficiency, not whether it happened on previous inspections.
Corrected: Feb 23, 2024 (Deficient, Provider has date of correction)
Showing the latest 3 of 25 inspection findings. Open the full record below to read every finding.
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). · from a complaint F-0628
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. F-0812
The facility did not honor residents' right to share a room with their spouse or a roommate of their choosing, or moved residents to a different room without written notice beforehand. F-0559
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed — that window is CMS's, not ours. Within it, every citation CMS publishes for this facility is listed here: none excluded.
| Date | Severity | What the facility was cited for |
|---|---|---|
| May 29, 2026 | D · Potential for more than minimal harm, isolated | 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). · from a complaint · F-0628 |
| Apr 9, 2026 | F · Potential for more than minimal harm, widespread | 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. · F-0812 |
| Apr 9, 2026 | D · Potential for more than minimal harm, isolated | The facility did not honor residents' right to share a room with their spouse or a roommate of their choosing, or moved residents to a different room without written notice beforehand. · F-0559 |
| Apr 9, 2026 | D · Potential for more than minimal harm, isolated | The facility did not provide safe and appropriate pain management for a resident who needed it. · F-0697 |
| Apr 9, 2026 | D · Potential for more than minimal harm, isolated | 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. · F-0761 |
| Apr 9, 2026 | D · Potential for more than minimal harm, isolated | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · F-0842 |
| Nov 20, 2025 | ▲ J · Immediate jeopardy, isolated | The facility did not make sure a transfer or discharge met the resident's needs and preferences, or did not properly prepare the resident to leave safely. · from a complaint · F-0627 |
| Nov 20, 2025 | D · Potential for more than minimal harm, isolated | 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). · from a complaint · F-0628 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · F-0755 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time. · F-0759 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | 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. · F-0761 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | 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. · F-0812 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | The facility did not dispose of garbage and refuse properly. · F-0814 |
| Feb 7, 2025 | E · Potential for more than minimal harm, pattern | 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. · F-0880 |
| Feb 7, 2025 | D · Potential for more than minimal harm, isolated | The facility did not make reasonable adjustments to fit each resident's individual needs and preferences — things like call buttons within reach, preferred wake-up times, or accessible room setups. · F-0558 |
| Feb 7, 2025 | D · Potential for more than minimal harm, isolated | The facility did not enter each resident's assessment information into the required format and send it to the state within 7 days of completing the assessment, as the rules require. · F-0640 |
| Feb 7, 2025 | D · Potential for more than minimal harm, isolated | 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. · F-0656 |
| Feb 7, 2025 | D · Potential for more than minimal harm, isolated | The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · F-0658 |
| Oct 24, 2024 | D · Potential for more than minimal harm, isolated | The facility did not provide food that accounts for each resident's allergies, intolerances, and personal preferences, or did not offer appealing alternatives. · from a complaint · F-0806 |
| Aug 6, 2024 | D · Potential for more than minimal harm, isolated | 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 · F-0658 |
| Feb 9, 2024 | ▲ G · Actual harm, isolated | The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids. · F-0685 |
| Feb 9, 2024 | D · Potential for more than minimal harm, isolated | The facility did not provide activities that meet residents' needs and interests. Nursing homes must offer meaningful activity programs, not just leave residents idle. · F-0679 |
| Feb 9, 2024 | D · Potential for more than minimal harm, isolated | The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time. · F-0759 |
| Feb 9, 2024 | D · Potential for more than minimal harm, isolated | 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. · F-0880 |
| Oct 5, 2023 | D · Potential for more than minimal harm, isolated | 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 · F-0684 |
Citations from standard inspections decreased between the last two inspection cycles (10 → 5).
All bars start at zero. Exact values and supporting details remain below.
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 1 | 0 | D |
| 2024 | 6 | 1 | G ▲ |
| 2025 | 12 | 1 | J ▲ |
| 2026 | 6 | 0 | F |
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.
How to file a complaint about care →
1 fine totaling $9,814.
Every penalty CMS publishes for this facility in the 3-year window is listed —none excluded. The count and the dollar total come from two different CMS datasets and agree for this facility. Penalties older than the window are dropped by CMS before publication, not by us.
| Date | Type | Amount / length |
|---|---|---|
| Nov 20, 2025 | Fine | $9,814 |
What these staffing numbers mean →
All bars start at zero. Exact values and supporting details remain below.
| Measure | This facility | California avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 4.27 | 4.31 | 3.95 | top 40% in California; top 30% in the U.S. |
| Registered Nurse hours | 0.79 | 0.61 | 0.69 | top 17% in California; top 28% in the U.S. |
| Weekend total nurse staffing | 3.87 | 3.90 | 3.50 | top 41% in California; top 27% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.58 | 0.51 | 0.48 | top 24% in California; top 25% in the U.S. |
| Total nursing staff turnover (%) | 40.0 | 36.7 | 45.8 | bottom 38% in California; top 36% in the U.S. |
| RN turnover (%) | 47.4 | 38.1 | 42.9 | bottom 31% in California; bottom 40% in the U.S. |
Hours are per resident per day for the most recent quarter of payroll data in this CMS release (2026-08-01) — the same quarter for every facility — 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 4.33, RN 0.81, weekend 3.92.Comparing with Medicare Care Compare? Care Compare shows the raw figure (4.33 here, displayed there as hours and minutes), not the adjusted one above. Both are correct; they answer different questions. Staffing rating: 4/5.
Note: CMS combines facility-reported resident assessments (MDS) with claims-based measures. These are different sources from on-site inspection findings. Read the measures alongside inspection and staffing records; a high QM rating does not establish that a home is safe.
Quality measures rating: 4/5 · long-stay residents: 5/5 · short-stay residents: 4/5
Price evidence · separate from quality
No verified facility-specific private-pay price is available in our data for College Oak Nursing and Rehabilitation Center. CMS inspection and staffing records do not tell us what this home will charge you.
Use a written private-pay quote. This worksheet adds only the amounts you enter; it does not calculate Medicare, Medicaid or insurance benefits.
Formula: (room rate + daily extras) × days + one-time charges. A 30-day scenario is not a calendar-month quote. Refundable deposits, rate changes and charges you omit are not automatically included. Entries are not saved or sent to our server.
Understand who pays for care · How we handle price evidence · Report an incorrect price
How to read ownership records →
Ownership records as published by CMS on 2026-08-01. CMS records when an owner joined but not when they left. Listed here and no longer involved? Tell us →
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Borja, Jean | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/21/2019 |
| Borja, Jean | Individual | ADP of the SNF | NOT APPLICABLE | 11/21/2019 |
| Green-Rastekhiz, Emilee | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/14/2023 |
| Green-Rastekhiz, Emilee | Individual | ADP of the SNF | NOT APPLICABLE | 11/14/2023 |
| Hadrick, Stephany | Individual | Operational/Managerial Control | NOT APPLICABLE | 09/05/2024 |
| Hadrick, Stephany | Individual | ADP of the SNF | NOT APPLICABLE | 09/05/2024 |
| Jackson, Matthew | Individual | Corporate Officer | NOT APPLICABLE | 04/01/2019 |
| Jackson, Matthew | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/25/2026 |
| Jackson, Robert | Individual | Corporate Officer | NOT APPLICABLE | 03/20/2019 |
| Jackson, Robert | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/25/2026 |
| Khan, Alzeena | Individual | Operational/Managerial Control | NOT APPLICABLE | 09/29/2024 |
| Khan, Alzeena | Individual | ADP of the SNF | NOT APPLICABLE | 09/23/2024 |
| McConnell, Christopher | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/20/2023 |
| McConnell, Christopher | Individual | ADP of the SNF | NOT APPLICABLE | 10/20/2023 |
| Roldan, Mary Rose | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/18/2020 |
| Roldan, Mary Rose | Individual | ADP of the SNF | NOT APPLICABLE | 05/18/2020 |
| Sandhu, Harkesh | Individual | Operational/Managerial Control | NOT APPLICABLE | 04/19/2019 |
| Sandhu, Harkesh | Individual | ADP of the SNF | NOT APPLICABLE | 04/19/2019 |
| Sanofsky, Jack | Individual | Corporate Officer | NOT APPLICABLE | 04/01/2019 |
| Sanofsky, Jack | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/25/2026 |
Showing 20 of 24 parties CMS has on file for this facility; 4 are not displayed. The full list is in the CMS Ownership dataset.
CMS lists this facility under the chain Cypress Healthcare Group — 13 facilities in the current records. Chain membership says who operates these homes. It says nothing about how any individual one of them was inspected; each has its own record.
Listed by state, then facility name — not a ranking. Showing 8 of the 12 others, continuing from this facility's own place in that list.
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Eskaton Village Care Center | 0.9 mi | Carmichael, CA | ★★★★☆ | 4/5 | |
| Sacramento Post-Acute | 1.1 mi | Sacramento, CA | ★★★★☆ | 3/5 | |
| American River Center | 1.1 mi | Carmichael, CA | ★★★★☆ | 4/5 | |
| Mission Carmichael Healthcare Center | 1.4 mi | Carmichael, CA | ★★★☆☆ | 3/5 | |
| Whitney Oaks Care Center | 1.4 mi | Carmichael, CA | ★★★☆☆ | 2/5 | |
| Manzanita Healthcare Center | 1.4 mi | Carmichael, CA | ★★★★★ | 3/5 | |
| Mountain Manor Senior Residence | 2.8 mi | Carmichael, CA | ★☆☆☆☆ | 2/5 | |
| River Pointe Post-Acute | 2.9 mi | Carmichael, CA | ★☆☆☆☆ | 2/5 | abuse |
| River City Post Acute | 2.9 mi | Carmichael, CA | ★☆☆☆☆ | 1/5 | abuse |
| Arden Park Post Acute | 3.9 mi | Sacramento, CA | ★★★☆☆ | 2/5 | abuse |
| Citrus Heights Post Acute | 4.0 mi | Citrus Heights, CA | ★★★★☆ | 3/5 | |
| Gramercy Court | 4.1 mi | Sacramento, CA | ★★★★☆ | 2/5 | abuse |
Compare this facility with the 3 closest →
CMS records place this facility in Sacramento, CA — 37 certified facilities there. These are outside the 20-mile list above, or far enough down it not to appear.
Listed by facility name — not a ranking. Homes already in the table above are not repeated here.
Facility data as of CMS processing date 2026-08-01. CCN 056158.
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