Is your loved one at Pacific Care Nursing Center?
If they fell, developed a bed sore, lost weight, were hurt or abused at Pacific Care Nursing Center, leave your name and phone. We call back today, request the chart and the full inspection file, and tell you plainly whether there is a case. Free, confidential, English or Spanish.
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Pacific Care Nursing Center at a glance: owner, beds and ratings
* California separately requires at least 3.5 direct care service hours per patient day, counted under state rules, so the two numbers are not measured the same way.
Records: Cal Health Find ↗ · Medicare Care Compare ↗
Pacific Care Nursing Center citations and inspection findings
Newest first. State citations come from CDPH; federal deficiencies come from the CMS-2567 inspection report CDPH writes for Medicare. Every row links to the government record.
| Date | Source | Finding | Record |
|---|---|---|---|
| September 16, 2026 | Federal (CMS-2567), Complaint | F609 – Reporting of Alleged Violations, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
| June 18, 2026 | State (CDPH) | Class A citation (Patient Care), penalty $25,000 Read what inspectors found ↓ | Government record (CDPH) ↗ |
| May 7, 2026 | Federal (CMS-2567), Complaint | F689 – Free of Accident Hazards/Supervision/Devices, severity G (actual harm, one or a few residents) Falls / supervision › Read what inspectors found ↓ | Government record (CDPH) ↗ |
| April 17, 2025 | State (CDPH) | Class B Trebled citation (Abuse/Facility Not Self Reported), penalty $9,000 Abuse | Government record (CDPH) ↗ |
| April 8, 2025 | State (CDPH) | Class B Trebled citation (Abuse/Facility Not Self Reported), penalty $9,000 Abuse | Government record (CDPH) ↗ |
| March 5, 2025 | Federal (CMS-2567), Complaint | F600 – Free from Abuse and Neglect, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
| February 26, 2025 | Federal (CMS-2567), Complaint | F609 – Reporting of Alleged Violations, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
| February 25, 2025 | State (CDPH) | Class B citation (Patient Care), penalty $3,000 | Government record (CDPH) ↗ |
| December 31, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $2,000 Abuse | Government record (CDPH) ↗ |
| December 26, 2024 | State (CDPH) | Class A citation (Patient Care), penalty $25,000, appealed by the facility Read what inspectors found ↓ | Government record (CDPH) ↗ |
| December 26, 2024 | State (CDPH) | Class B Trebled citation (Patient Care), penalty $9,000 | Government record (CDPH) ↗ |
| December 10, 2024 | Federal (CMS-2567), Complaint | F600 – Free from Abuse and Neglect, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
Show 8 older findings
| Date | Source | Finding | Record |
|---|---|---|---|
| November 26, 2024 | Federal (CMS-2567), Complaint | F686 – Treatment/Svcs to Prevent/Heal Pressure Ulcer, severity G (actual harm, one or a few residents) Pressure injury › Read what inspectors found ↓ | Government record (CDPH) ↗ |
| November 13, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| October 31, 2024 | State (CDPH) | Class B Trebled citation (Other), penalty $9,000 | Government record (CDPH) ↗ |
| September 26, 2024 | Federal (CMS-2567), Complaint | F610 – Investigate/Prevent/Correct Alleged Violation, severity D (no actual harm, potential for more than minimal harm, isolated) F609 – Reporting of Alleged Violations, severity E (no actual harm, potential for more than minimal harm, pattern) Abuse | Government record (CDPH) ↗ |
| August 8, 2024 | State (CDPH) | Class B citation (Patient Care), penalty $3,000 | Government record (CDPH) ↗ |
| February 22, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| January 10, 2024 | Federal (CMS-2567), Complaint | F609 – Reporting of Alleged Violations, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
| October 6, 2023 | Federal (CMS-2567), Complaint | F686 – Treatment/Svcs to Prevent/Heal Pressure Ulcer, severity G (actual harm, one or a few residents) Pressure injury › Read what inspectors found ↓ | Government record (CDPH) ↗ |
What inspectors found at Pacific Care Nursing Center
Tap a finding to read the summary. Each one is written from the government report linked under it.
June 2026: Class A citation and F689 (severity G) after a resident fell from bed and suffered multiple fractures and bleeding around the brain
According to the citation, CDPH visited on May 7, 2026, to investigate a complaint about an unwitnessed fall with injury. Resident 1 was a 75-year-old man with encephalopathy (a brain disorder) and contractures (permanent tightening) of both legs who depended on staff for mobility. He was assessed at high risk for falls.
CDPH found a physician ordered floor mats and bolsters on both sides of his bed (padded cushions that act as bumpers) on February 12, 2026, and those orders were discontinued the next day, though he remained at high risk. The department also found CNA 1 was not aware of his fall risk and the facility did not follow its policy calling for floor mats at the bedside. On May 2, 2026, he fell from the bed to the floor. A paramedic record cited by CDPH states staff were changing his brief when he rolled out of bed. A hospital note states that, contrary to the facility's report to paramedics, staff told the physician he was accidentally dropped during cleaning.
According to the citation, his injuries included a subdural hematoma (bleeding between the brain and the skull), a fracture in the neck portion of the spine, a fracture and dislocation at the top of the right upper arm, a fractured left rib, a fractured right hip, and bruises with skin tears. CDPH issued a Class A citation with a $25,000 penalty. The federal 2567 report cited F689 (free of accident hazards, supervision and devices) at severity G.
December 2024: Class A citation and F686 (severity G) after a resident developed pressure injuries on both ankles
According to the citation, CDPH visited on November 26, 2024, to investigate a quality-of-care complaint. Resident 2, a man over 89 years old, was admitted on January 9, 2024, with intact skin. He depended on staff for all daily care, could not reposition himself and was at moderate risk for pressure injuries (bed sores).
CDPH found the facility did not carry out his care plan to turn and reposition him at least every two hours from January to March 2024. A deep tissue injury (deep red or purple discoloration from pressure damage) was found on his left lateral malleolus (the outer ankle bone) on February 11, 2024. The department found he was not assessed by the dietitian then, as his care plan and a wound consultant called for, and that the consultant's instruction to clean the wound with saline before applying Betadine was not followed. A family member told inspectors he was not turned often.
According to the citation, by March 26, 2024, 77 days after admission, he had a facility-acquired, preventable Stage IV pressure injury (full-thickness loss exposing muscle or bone) on the left outer ankle, 2.2 by 1.6 by 0.3 centimeters. The citation also lists a Stage III pressure injury on the right outer ankle. CDPH issued a Class A citation with a $25,000 penalty. The federal 2567 report cited F686 (treatment and services to prevent and heal pressure ulcers) at severity G.
October 2023: F686 (severity G) after a resident's skin damage progressed to an infected Stage IV pressure sore
According to the federal 2567 report, Resident 2 was admitted in January 2019, had paralysis on one side of the body after a brain bleed and was at moderate risk for pressure sores (bed sores). The care plans called for repositioning at least every two hours.
Inspectors found the facility did not ensure Resident 2 was repositioned every two hours to relieve pressure on the tailbone area. The report states weekly skin assessments for April 2023 were missing or blank, and LVN 2's wound assessments from May 15 to June 19, 2023, did not record the wound's size or classify it correctly as a Stage III pressure sore. According to the report, moisture-related skin damage on the buttocks found May 15 became a Stage III pressure sore (damage reaching the fat layer) on June 23 and an infected Stage IV pressure sore (damage reaching muscle, tendon or bone) on July 4, 2023.
The 2567 report states the Stage IV wound measured 1.3 by 0.6 by 0.4 centimeters, with moderate pus drainage. It required a wound specialist, excisional debridement (cutting away damaged tissue), an X-ray to rule out bone infection (osteomyelitis) and 14 days of the antibiotic clindamycin through a vein. Inspectors found the Stage IV pressure sore was avoidable and cited F686 (treatment and services to prevent and heal pressure ulcers) at severity G.
Complaints against Pacific Care Nursing Center
| Year | Intakes | Complaints | Facility-reported incidents | Substantiated (at least one allegation) |
|---|---|---|---|---|
| 2023 | 19 | 18 | 1 | 9 |
| 2024 | 46 | 25 | 21 | 16 |
| 2025 | 23 | 15 | 8 | 6 |
| 2026 | 16 | 9 | 7 | 3 |
Cal Health Find lists 104 complaint and facility-reported incident intakes for this facility from 2023 through October 30, 2026. CDPH substantiated at least one allegation in 34 of them. 27 intakes involved an allegation in CDPH’s abuse category, and 7 of those had an abuse allegation substantiated. An intake can contain several allegations; “unsubstantiated” means CDPH did not find enough evidence, not that nothing happened.
Sexual abuse reports at Pacific Care Nursing Center
Cal Health Find lists 4 intakes for Pacific Care Nursing Center from 2023 through October 30, 2026 that included an allegation CDPH classified as sexual abuse (0 from complaints and 4 reported by the facility itself). CDPH substantiated a sexual abuse allegation in 0 of them. Federal rules require a nursing home to report an abuse allegation to the state within two hours, so a facility-reported incident means staff raised the allegation, not that it was proven. “Unsubstantiated” means CDPH did not find enough evidence; it does not mean nothing happened.
| Year | Intakes with a sexual abuse allegation | Substantiated |
|---|---|---|
| 2024 | 3 | 0 |
| 2026 | 1 | 0 |
Warning signs include bruising or bleeding in the genital area or inner thighs, a new genital infection, torn or stained underclothing, and a resident who suddenly fears a particular staff member or resists being bathed or changed. If you suspect sexual abuse, call 911 or local police first, ask that the resident not be bathed before a medical exam, and then report it to CDPH and the long-term care ombudsman. Sexual abuse reports at Los Angeles County nursing homes →
Pacific Care Nursing Center lawsuits and criminal cases
Our search of California Attorney General and Los Angeles County District Attorney announcements, court reports and news coverage for Pacific Care Nursing Center is not finished yet. This section will be updated when it is; until then, do not read the absence of a case here as a finding that none exists.
What this record means for your family
California uses classes for state citations. Under Health and Safety Code section 1424 ↗, a Class AA citation is a Class A violation that CDPH determined was a direct proximate cause of a resident’s death. A Class A citation means CDPH found an imminent danger, or a substantial probability, that death or serious physical harm would result. Class B covers violations with a direct or immediate relationship to residents’ health, safety or security.
Federal deficiencies carry a letter from A to L. G, H and I mean inspectors found actual harm to residents; J, K and L mean immediate jeopardy, the most serious level. F600 is the federal rule that residents be free from abuse and neglect; F609 and F610 cover reporting and investigating allegations; F689 covers accidents and supervision; F686 covers pressure injuries.
Warning signs worth asking about: unexplained bruises or fractures, new bed sores, sudden weight loss or dehydration, a resident who becomes fearful or withdrawn around certain staff, and calls that go unanswered.
What to do now
- If someone is in danger, call 911.
- File a complaint with CDPH about Pacific Care Nursing Center: CDPH complaint form ↗
- Contact the long-term care ombudsman, the state-funded advocate for nursing home residents: California Long-Term Care Ombudsman ↗
- Ask the facility in writing for a copy of the resident’s chart, and write down dates, names of staff on shift, and photos of any injury.
- Talk to a Los Angeles nursing home abuse lawyer →
Free nursing home case review
We read the inspection record and the chart with you and tell you plainly whether there is a case. You pay no fees and no costs unless we win.
Questions families ask
Has Pacific Care Nursing Center been cited by the State of California?
Cal Health Find lists 14 state citations for Pacific Care Nursing Center since 2023, including 0 Class AA and 2 Class A. Each one is listed in the timeline above with a link to the CDPH record.
How many complaints have been filed against Pacific Care Nursing Center?
From 2023 through October 30, 2026, Cal Health Find lists 104 complaint and facility-reported incident intakes, and CDPH substantiated at least one allegation in 34 of them.
Does Medicare flag Pacific Care Nursing Center for abuse?
As of our data date, Medicare Care Compare does not show its abuse icon for Pacific Care Nursing Center. The icon is only one signal; read the citations above.
Have there been sexual abuse reports at Pacific Care Nursing Center?
Cal Health Find lists 4 complaint or facility-reported incident intakes at Pacific Care Nursing Center since 2023 that included an allegation CDPH classified as sexual abuse, and CDPH substantiated 0. The section above breaks them down by year.
Where can I read reviews and complaints about Pacific Care Nursing Center?
Online reviews are opinions. The official record is the state and federal inspection file: this page summarizes it and links each citation, complaint outcome and inspection report on Cal Health Find and Medicare Care Compare, so you can read the source yourself.
How many beds does Pacific Care Nursing Center have?
Pacific Care Nursing Center is licensed by CDPH for 99 beds and has a CMS overall rating of 2 out of 5 stars.
Who owns or operates Pacific Care Nursing Center?
CDPH lists the licensee as PACIFIC CARE NURSING CENTER. CMS lists the facility under the chain or affiliated entity The Mandelbaum Family.
My parent was hurt at Pacific Care Nursing Center. What should I do?
Get medical care first, then report it to CDPH and the long-term care ombudsman, ask for the chart in writing and keep notes and photos. For a free, confidential review of a possible case, call Beverly Law at (310) 552-6959.
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Hurt at Pacific Care Nursing Center? — Beverly Law
If your loved one was hurt at Pacific Care Nursing Center, talk to a California elder abuse attorney. Free, confidential, English or Spanish. You pay no fees and no costs unless we win.
Other nursing homes near Pacific Care Nursing Center
| Facility | City | Distance | CMS stars | Class AA/A | Federal G–L |
|---|---|---|---|---|---|
| Long Beach Healthcare Center | Long Beach | 0.1 mi | 1/5 | 4 | 4 |
| Pacific Villa, Inc. | Long Beach | 0.2 mi | 2/5 | 1 | 2 |
| Bixby Towers Post-Acute Rehab | Long Beach | 0.8 mi | 1/5 | 3 | 7 |
| The Beach Post-Acute | Long Beach | 0.8 mi | 2/5 | 2 | 2 |
| Catered Manor Care Center | Long Beach | 0.9 mi | 3/5 | 4 | 3 |
| Beachside Post Acute | Long Beach | 1.1 mi | 4/5 | 0 | 0 |
Methodology and sources
We pulled this facility’s complaints, state enforcement actions and survey deficiencies from Cal Health Find for 2023 through October 30, 2026, downloaded the CDPH citation notices and CMS-2567 reports behind every Class AA or A citation and every federal deficiency at level G or higher, and wrote the summaries above from those documents. Facility details come from the CDPH licensing file and the CMS Provider Data Catalog. Residents are described only as the government documents describe them. See the methodology page to report an error; we review correction requests within five business days.
Sources
Important: This page reports findings from public records of the California Department of Public Health and the Centers for Medicare & Medicaid Services. A citation or deficiency is a regulatory finding by a government agency; it is not a court judgment and not proof of civil or criminal liability. Criminal defendants are presumed innocent unless proven guilty. Lawsuit allegations are claims, not findings. This page is general information, not legal advice, and reading it does not create an attorney-client relationship with Beverly Law. Attorney advertising. Prior results do not guarantee a similar outcome. Data as of: October 30, 2026. Methodology and corrections.
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