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Golden Rose Care 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 ↗
Golden Rose Care 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 10, 2026 | State (CDPH) | Class B citation (Patient Care), penalty $3,000 | Government record (CDPH) ↗ |
| December 18, 2025 | State (CDPH) | Administrative Penalty (DHPPD: 2 – 11 Days), penalty $25,000 | Government record (CDPH) ↗ |
| October 1, 2025 | State (CDPH) | Class B citation (Refusal to Readmit), penalty $3,650 | Government record (CDPH) ↗ |
| June 5, 2025 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| May 2, 2025 | Federal (CMS-2567), Complaint | F609 – Reporting of Alleged Violations, severity E (no actual harm, potential for more than minimal harm, pattern) Abuse | Government record (CDPH) ↗ |
| December 19, 2024 | State (CDPH) | Class A citation (Other), penalty $25,000 Sexual abuse allegation › Read what inspectors found ↓ | Government record (CDPH) ↗ |
| November 27, 2024 | State (CDPH) | Class AA citation (Patient Care), penalty $120,000, appealed by the facility Read what inspectors found ↓ | Government record (CDPH) ↗ |
| November 26, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| November 22, 2024 | Federal (CMS-2567), Complaint | F600 – Free from Abuse and Neglect, severity G (actual harm, one or a few residents) AbuseSexual abuse allegation › Read what inspectors found ↓ | Government record (CDPH) ↗ |
| November 7, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| October 29, 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) ↗ |
| October 17, 2024 | Federal (CMS-2567), Complaint | F695 – Respiratory/Tracheostomy Care and Suctioning, severity J (immediate jeopardy, one or a few residents) F755 – Pharmacy Srvcs/Procedures/Pharmacist/Records, severity J (immediate jeopardy, one or a few residents) Read what inspectors found ↓ | Government record (CDPH) ↗ |
Show 12 older findings
| Date | Source | Finding | Record |
|---|---|---|---|
| October 9, 2024 | State (CDPH) | Class B citation (Patient Care), penalty $3,000 | Government record (CDPH) ↗ |
| September 26, 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) ↗ |
| September 6, 2024 | State (CDPH) | Class B citation (Patient Care), penalty $3,000 | Government record (CDPH) ↗ |
| August 22, 2024 | State (CDPH) | Class B Trebled citation (Patient Care), penalty $9,000 | Government record (CDPH) ↗ |
| August 22, 2024 | State (CDPH) | Class B Trebled citation (Patient Care), penalty $9,000 | Government record (CDPH) ↗ |
| August 22, 2024 | State (CDPH) | Class B Trebled citation (Patient Care), penalty $9,050 | Government record (CDPH) ↗ |
| August 7, 2024 | Federal (CMS-2567), Complaint | F609 – Reporting of Alleged Violations, severity D (no actual harm, potential for more than minimal harm, isolated) F607 – Develop/Implement Abuse/Neglect Policies, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
| July 8, 2024 | Federal (CMS-2567), Certification | F610 – Investigate/Prevent/Correct Alleged Violation, severity D (no actual harm, potential for more than minimal harm, isolated) F600 – Free from Abuse and Neglect, severity E (no actual harm, potential for more than minimal harm, pattern) Abuse | Government record (CDPH) ↗ |
| July 5, 2024 | State (CDPH) | Class B citation (Abuse/Facility Not Self Reported), penalty $3,000 Abuse | Government record (CDPH) ↗ |
| May 13, 2024 | Federal (CMS-2567), Complaint | F600 – Free from Abuse and Neglect, severity E (no actual harm, potential for more than minimal harm, pattern) Abuse | Government record (CDPH) ↗ |
| February 6, 2024 | Federal (CMS-2567), Complaint | F880 – Infection Prevention & Control, severity K (immediate jeopardy, a pattern) Read what inspectors found ↓ | Government record (CDPH) ↗ |
| June 23, 2023 | Federal (CMS-2567), Complaint | F602 – Free from Misappropriation/Exploitation, severity D (no actual harm, potential for more than minimal harm, isolated) Abuse | Government record (CDPH) ↗ |
What inspectors found at Golden Rose Care Center
Tap a finding to read the summary. Each one is written from the government report linked under it.
December 2024: Class A citation and F600 (severity G) after a CNA sexually abused a resident
According to the citation, CDPH investigated a complaint on 11/22/2024 alleging employee-to-patient sexual abuse. Patient 1 was a 49-year-old woman with aphasia (difficulty speaking), paralysis on her right side after a stroke, who had severely impaired decision-making and needed maximal staff help with toileting and personal care.
CDPH found that on 7/20/2024 at about 6:50 p.m., Patient 1 told a licensed nurse that a male CNA had touched her private area while changing her incontinence brief. According to the citation, staffing records show CNA 1, a registry (agency) worker, was assigned to her that evening. Nurses noted she was visibly upset and found scant blood-tinged fluid on her brief. Records from an acute care hospital cited in the document state a sexual assault response team examined her early the next morning and recorded bruising; an amended report on 7/23/2024 said the examiner could not confirm the bruising because of vaginal bleeding. The department determined that the facility did not prevent Patient 1 from being sexually abused by CNA 1 and did not carry out its abuse prevention and prohibition policy.
According to the citation, a psychiatric evaluation on 7/24/2024 found Patient 1 anxious, irritable, withdrawn and crying inconsolably. The director of nursing told inspectors the registry agency was notified and told the facility would no longer use CNA 1. CDPH issued a Class A citation with a $25,000 penalty. The federal 2567 report cites F600 (freedom from abuse and neglect) at severity G.
November 2024: Class AA citation, F695 and F755 (severity J) after a resident did not receive prescribed respiratory care
According to the citation, CDPH visited the facility on 10/17/2024 to investigate a complaint about a patient's death. Patient 1 had chronic respiratory failure, COPD (a lung disease that makes breathing hard) and asthma, was on continuous oxygen, and was transferred from a long-term acute care hospital on 9/26/2024. The hospital's transfer packet called for oxygen at 5 liters per minute by nasal cannula and a BiPAP machine (a device that pushes pressurized air into the airways) at night and as needed.
CDPH found staff did not get orders for the oxygen or the BiPAP when Patient 1 was admitted. The department determined staff did not give the ordered albuterol and budesonide breathing treatments by nebulizer from 11:17 p.m. on 9/26/2024 until Patient 1 was found unresponsive on 9/27/2024 before 3:20 p.m., about 16 hours after admission. According to the citation, the facility did not have a system in place to receive medications delivered by the pharmacy, a licensed vocational nurse did not follow up with the pharmacy or check the emergency medication kit, and that nurse had not been trained to do so. The citation states staff started CPR and called 911, paramedics arrived at 3:30 p.m., and Patient 1 was pronounced dead at 4:28 p.m.
CDPH issued a Class AA citation with a $120,000 penalty. The federal 2567 report cites F695 (respiratory care) and F755 (pharmacy services), both at severity J, and also found problems with the oxygen orders or settings of two other residents. Inspectors called an immediate jeopardy on 10/18/2024. According to the report, it was removed on 10/20/2024 after the facility's removal plan, which included one-on-one training for the nurses involved, in-services on oxygen and BiPAP orders, and audits of all residents on oxygen or breathing treatments.
February 2024: F880 (severity K) after a scabies outbreak among residents and staff
The federal 2567 report states that inspectors found the facility did not practice infection control measures to prevent scabies, a contagious, very itchy skin condition caused by a tiny burrowing mite. According to the report, staff did not detect Resident 1's symptoms, such as severe itching and a pimple-like rash, and provide treatment. Four CNAs were identified as suspected scabies cases on 1/24/2024, and Resident 1 tested positive on 1/27/2024.
Inspectors found the facility did not treat this as an outbreak and did not notify CDPH and the local health department on 1/27/2024. The report states that CNAs 1 through 5, who were suspected cases, kept giving direct care to residents and were not offered preventive treatment. The facility did not make sure staff with symptoms were evaluated by occupational health or their own doctor, as its policy required, and had no process to track staff suspected of having scabies. According to the report, CNA 6 kept working with symptoms even after a scabies in-service on 2/7/2024. Two residents, Residents 1 and 2, tested positive.
The 2567 report cites F880 (infection prevention and control) at severity K. Inspectors declared an immediate jeopardy on 2/6/2024. According to the report, the facility gave an acceptable removal plan on 2/8/2024 that included treating both residents with permethrin cream, with oral ivermectin for Resident 1, re-checking all 77 residents for rashes, and starting weekly skin checks by treatment nurses.
Complaints against Golden Rose Care Center
| Year | Intakes | Complaints | Facility-reported incidents | Substantiated (at least one allegation) |
|---|---|---|---|---|
| 2023 | 35 | 21 | 14 | 18 |
| 2024 | 78 | 38 | 40 | 36 |
| 2025 | 72 | 47 | 25 | 28 |
| 2026 | 36 | 27 | 9 | 4 |
Cal Health Find lists 221 complaint and facility-reported incident intakes for this facility from 2023 through October 30, 2026. CDPH substantiated at least one allegation in 86 of them. 68 intakes involved an allegation in CDPH’s abuse category, and 16 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 Golden Rose Care Center
Cal Health Find lists 3 intakes for Golden Rose Care Center from 2023 through October 30, 2026 that included an allegation CDPH classified as sexual abuse (1 from complaints and 2 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 |
|---|---|---|
| 2023 | 1 | 0 |
| 2024 | 2 | 0 |
Cited findings on this page whose government reports describe a sexual abuse allegation: December 2024: Class A citation and F600 (severity G) after a CNA sexually abused a resident
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 →
Staffing at Golden Rose Care Center
Payroll records Golden Rose Care Center filed with the federal Centers for Medicare & Medicaid Services (CMS) for April through June 2026 show an average of 5.10 nursing hours per resident per day, counting registered nurses (RNs), licensed vocational nurses and nurse aides. The California average CMS published for the same period is 4.54, and the Los Angeles County median is 4.32. RN time averaged 0.87 hours per resident per day (California average 0.68). Staffing averaged 4.74 hours on weekends and 5.25 on weekdays.
CMS reports nursing staff turnover of 37.7% at this facility (California average 36.6%) and RN turnover of 33.3% (California average 37.8%).
California requires most skilled nursing facilities to provide at least 3.5 direct care hours per patient day (Health and Safety Code section 1276.65). Counting the RN, LVN and nurse aide hours in the same payroll data, Golden Rose Care Center was below 3.5 on 0 of 91 days. This is our calculation from CMS data, not a CDPH finding: CDPH counts some staff differently (for example psychiatric technicians in special treatment programs) and can grant waivers.
Agency or contract staff worked 10.1% of the facility’s nursing hours in the quarter.
| Golden Rose Care Center | LA County median | California average | |
|---|---|---|---|
| Total nursing hours per resident per day | 5.10 | 4.32 | 4.54 |
| RN hours per resident per day | 0.87 | 0.46 | 0.68 |
| Weekend nursing hours per resident per day | 4.74 | 3.89 | 4.10 |
| Nursing staff turnover | 37.7% | 34.1% | 36.6% |
Compare staffing, profits and fines across Los Angeles County nursing homes →
Who owns Golden Rose Care Center
The owners and operators below are listed for Golden Rose Care Center in the federal CMS nursing home ownership file (data as of October 1, 2026). CMS requires each Medicare-certified nursing home to report anyone with a 5% or greater ownership stake and anyone with operational or managerial control.
| Owner or operator | Role | Share | Since |
|---|---|---|---|
| Mayer 2012 Trust | 5% or greater direct ownership | 35% | December 1, 2020 |
| The Chani Levitin Gst Non-Exempt Trust | 5% or greater direct ownership | 9% | December 1, 2020 |
| Menachem Weiss | Operational or managerial control | – | December 1, 2025 |
In its annual report to the California Department of Health Care Access and Information (HCAI) for the year ending December 31, 2025, the facility listed $1.2 million in payments to related companies (businesses that share owners or management with the facility): $1.2 million to Golden State Health Centers, Inc for support services fee. Payments to related companies are legal; California requires nursing homes to disclose them.
Golden Rose Care Center finances
Golden Rose Care Center reported $20.1 million in health care revenue and net income of $979,358 for the year ending December 31, 2025, a margin of 4.9%, in its annual financial report to HCAI (as submitted; HCAI has not finished reviewing it). The median operating margin that year was 5.9% for Los Angeles County nursing homes and 6.1% statewide. Medi-Cal paid for 72% of resident days. Salaries for RNs, LVNs and nurse aides came to $4.7 million.
| Year | Revenue | Net income | Margin | Occupancy | Medi-Cal days |
|---|---|---|---|---|---|
| 2023 | $11.3 million | -$1.3 million | -11.1% | 72% | – |
| 2024 | $14.8 million | -$1.4 million | -9.2% | 89% | 80% |
| 2025 | $20.1 million | $979,358 | 4.9% | 93% | 72% |
Federal fines and penalties: Golden Rose Care Center
CMS lists Golden Rose Care Center as a candidate for its Special Focus Facility program. CMS created the program for nursing homes with a history of serious quality problems; candidates are facilities whose inspection record qualifies them, and states choose which ones enter the program for closer oversight.
CMS lists 12 federal fines totaling $121,249 and 1 Medicare payment denial for Golden Rose Care Center in the roughly three years its penalty file covers.
| Date | Penalty | Amount or length |
|---|---|---|
| November 26, 2024 | Fine | $12,529 |
| October 20, 2024 | Fine | $18,236 |
| February 20, 2024 | Fine | $4,938 |
| February 8, 2024 | Fine | $29,097 |
| February 8, 2024 | Payment denial | 11 days |
| January 22, 2024 | Fine | $14,814 |
| January 8, 2024 | Fine | $4,938 |
| January 2, 2024 | Fine | $4,587 |
| December 11, 2023 | Fine | $13,762 |
| November 20, 2023 | Fine | $4,587 |
| November 13, 2023 | Fine | $4,587 |
| November 6, 2023 | Fine | $4,587 |
| October 17, 2023 | Fine | $4,587 |
Golden Rose Care Center lawsuits and criminal cases
We searched California Attorney General and Los Angeles County District Attorney announcements and news coverage for Golden Rose Care Center and its licensee and found no public criminal case or civil lawsuit we could tie to this facility as of October 30, 2026. Many civil cases settle quietly or are not covered by the press, so this is not a complete court search.
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 Golden Rose Care 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 →
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Questions families ask
Has Golden Rose Care Center been cited by the State of California?
Cal Health Find lists 17 state citations for Golden Rose Care Center since 2023, including 1 Class AA and 1 Class A. Each one is listed in the timeline above with a link to the CDPH record.
How many complaints have been filed against Golden Rose Care Center?
From 2023 through October 30, 2026, Cal Health Find lists 221 complaint and facility-reported incident intakes, and CDPH substantiated at least one allegation in 86 of them.
Does Medicare flag Golden Rose Care Center for abuse?
As of our data date, Medicare Care Compare does not show its abuse icon for Golden Rose Care Center. The icon is only one signal; read the citations above.
Have there been sexual abuse reports at Golden Rose Care Center?
Cal Health Find lists 3 complaint or facility-reported incident intakes at Golden Rose Care 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 Golden Rose Care 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 Golden Rose Care Center have?
Golden Rose Care Center is licensed by CDPH for 95 beds and has a CMS overall rating of 1 out of 5 stars.
Who owns or operates Golden Rose Care Center?
CDPH lists the licensee as RG LEGACY I, LLC. CMS does not list a chain for this facility. According to the CMS ownership file, Mayer 2012 Trust holds 35% as a direct owner. The full list of owners and operators CMS reports is in the ownership section of this page.
How many nursing hours does Golden Rose Care Center provide per resident?
Payroll data the facility filed with CMS for April through June 2026 show 5.10 total nursing hours per resident per day, including 0.87 RN hours. The California average is 4.54.
My parent was hurt at Golden Rose Care 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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If your loved one was hurt at Golden Rose Care 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 Golden Rose Care Center
| Facility | City | Distance | CMS stars | Class AA/A | Federal G–L |
|---|---|---|---|---|---|
| Camellia Gardens Care Center | Pasadena | 0.1 mi | 2/5 | 0 | 0 |
| Brighton Care Center | Pasadena | 0.1 mi | 2/5 | 0 | 1 |
| Cedar Pine Post Acute | Pasadena | 0.3 mi | 2/5 | 2 | 4 |
| Pasadena Nursing Center | Pasadena | 0.4 mi | 1/5 | 1 | 1 |
| Foothill Heights Care Center | Pasadena | 0.4 mi | 2/5 | 0 | 0 |
| Pasadena Grove Health Center | Pasadena | 0.5 mi | 2/5 | 2 | 1 |
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
- Cal Health Find – Golden Rose Care Center
- Medicare Care Compare – Golden Rose Care Center
- CMS – Payroll-Based Journal Daily Nurse Staffing (2026 Q2)
- CMS – Nursing home Provider Information (staffing, turnover)
- CMS – Nursing home Ownership
- CMS – Nursing home Penalties
- HCAI – Long-Term Care Facility Financial Data
- CDPH – State Enforcement Actions (open data)
- CMS Provider Data Catalog – Nursing homes
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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