Pine Creek Care Center
1139 Cirby Way, Roseville, CA 95661 · Placer County · 99 certified beds · avg 97 residents/day · certified since Apr 17, 2003
Part of chain: PACS GROUP (274 facilities, chain avg rating 2.9★)
4/5
Health inspection rating (on-site)
0
Serious findings on record
$0
Fines, last 3 years
3.56
Nurse hours/resident/day (adjusted)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★★☆4/5 · 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 (25)
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 |
|---|---|---|
| Feb 9, 2026 | E · Potential for harm, repeated | 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. · from a complaint |
| Jul 23, 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). · from a complaint |
| Apr 11, 2025 | 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. |
| Apr 11, 2025 | E · Potential for harm, repeated | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. |
| Apr 11, 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. |
| Apr 11, 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. |
| Apr 11, 2025 | E · Potential for harm, repeated | The facility did not provide residents with enough to drink, or with drinks matching their needs and preferences, to keep them properly hydrated. |
| Apr 11, 2025 | E · Potential for harm, repeated | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. |
| Apr 11, 2025 | 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. |
| Apr 11, 2025 | D · Potential for harm, one-off | The facility did not properly run its feeding assistant program — assessing which residents are appropriate for it, following each resident's care plan, and making sure feeding assistants are trained and supervised. Feeding assistants are trained helpers who assist residents at mealtimes. |
| Apr 19, 2024 | 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. |
| Apr 19, 2024 | 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 |
| Apr 19, 2024 | 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. |
| Apr 19, 2024 | D · Potential for harm, one-off | The facility did not create and follow a basic care plan covering a new resident's most immediate needs within 48 hours of admission. The first days are when a new resident is most vulnerable. |
| Apr 19, 2024 | D · Potential for harm, one-off | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. |
| Apr 19, 2024 | 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. |
| Apr 19, 2024 | D · Potential for harm, one-off | The facility allowed residents to lose the ability to do daily activities — like bathing, dressing, and eating — when there was no medical reason for the decline. Good care helps residents keep the abilities they have. |
| Apr 19, 2024 | D · Potential for harm, one-off | 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 19, 2023 | 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. · from a complaint |
| Aug 9, 2023 | 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 |
| Apr 15, 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. |
| Apr 15, 2022 | 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. |
| Apr 15, 2022 | D · Potential for 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. |
| Apr 15, 2022 | D · Potential for harm, one-off | 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. |
| Apr 15, 2022 | D · Potential for harm, one-off | The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. |
Inspection trend by year
Citations from standard inspections stayed about the same across the last two inspection cycles (8 → 8).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2022 | 5 | 0 | E |
| 2023 | 2 | 0 | D |
| 2024 | 8 | 0 | F |
| 2025 | 9 | 0 | E |
| 2026 | 1 | 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) | 3.56 | 4.31 | 3.95 | bottom 13% in California; bottom 40% in the U.S. |
| Registered Nurse hours | 0.43 | 0.61 | 0.69 | bottom 41% in California; bottom 28% in the U.S. |
| Weekend total nurse staffing | 3.13 | 3.90 | 3.50 | bottom 8% in California; bottom 38% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.36 | 0.51 | 0.48 | bottom 48% in California; bottom 45% in the U.S. |
| Total nursing staff turnover (%) | 53.3 | 36.7 | 45.8 | bottom 9% in California; bottom 29% in the U.S. |
| RN turnover (%) | 71.4 | 38.1 | 42.9 | bottom 7% in California; bottom 11% 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 4.44, RN 0.54, weekend 3.89. Staffing rating: 2/5.
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 - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Bay Bridge Capital Partners, LLC | Organization | 5% or Greater Indirect Ownership Interest | 100% | 08/15/2014 |
| Hudson River Opco LLC | Organization | 5% or Greater Direct Ownership Interest | 100% | 12/20/2019 |
| Apt, Frederick | Individual | Corporate Officer | NOT APPLICABLE | 01/01/2024 |
| Cheema, Chandandeep | Individual | Contracted Managing Employee | NOT APPLICABLE | 04/25/2021 |
| Jergensen, Joshua | Individual | Corporate Officer | NOT APPLICABLE | 01/01/2024 |
| Mitchell, John | Individual | Corporate Officer | NOT APPLICABLE | 01/01/2024 |
| Truhar, Bradley | Individual | W-2 Managing Employee | NOT APPLICABLE | 08/01/2021 |
| Truhar, Bradley | Individual | Operational/Managerial Control | NOT APPLICABLE | 08/01/2021 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Can you give me examples of how you adjust daily routines and room setups to fit each resident's preferences?"
- "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?"
- "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
- "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?"
- "How do you make sure residents — especially those who can't ask — get enough fluids throughout the day?"
- "How do you keep residents' medical records accurate, complete, and secure?"
- "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 |
|---|---|---|---|---|---|
| Roseville Care Center | 0.0 mi | Roseville, CA | ★★★☆☆ | 2/5 | abuse |
| Roseville Point Health & Wellness Center | 0.6 mi | Roseville, CA | ★★☆☆☆ | 2/5 | abuse |
| Oak Ridge Healthcare Center | 0.9 mi | Roseville, CA | ★★★★☆ | 3/5 | |
| Citrus Heights Post Acute | 4.4 mi | Citrus Heights, CA | ★★★★☆ | 3/5 | |
| Fair Oaks Healthcare Center | 5.1 mi | Fair Oaks, CA | ★★★☆☆ | 2/5 | |
| Manzanita Healthcare Center | 5.6 mi | Carmichael, CA | ★★★★★ | 3/5 | |
| Sacramento Post-Acute | 6.0 mi | Sacramento, CA | ★★★★☆ | 3/5 | |
| Folsom Care Center | 6.4 mi | Folsom, CA | ★★★★☆ | 3/5 | |
| College Oak Nursing and Rehabilitation Center | 7.0 mi | Sacramento, CA | ★★★☆☆ | 3/5 | |
| American River Center | 7.5 mi | Carmichael, CA | ★★★★☆ | 4/5 | |
| Eskaton Village Care Center | 7.8 mi | Carmichael, CA | ★★★★☆ | 4/5 | |
| Whitney Oaks Care Center | 8.2 mi | Carmichael, CA | ★★★☆☆ | 2/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 555801.