South Marin Health & Wellness Center
Greenbrae, California · CCN 055093
28 surveys since 2011. The first finding at harm level was recorded in 2016.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 118
- Surveys
- 28
- Harm or worse
- 3
- Immediate jeopardy
- 0
Findings where a surveyor recorded actual harm to a resident.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 72
- Ownership
- For profit - Limited Liability company
- Chain
- ASPEN SKILLED HEALTHCARE
- County
- Marin
- Medicare-certified since
- 1969
CMS ratings
- Overall
- 4
- Health inspection
- 3
- Staffing
- 4
- Quality measures
- 5
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded fewer weighted findings than most of its peer group.
Weighted by harm level, against 423 for-profit facilities of 66–99 beds in California.
Last survey on record
Jan 23, 2026
290 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 4.42 | 4.16 |
| Registered-nurse hours per resident day | 0.92 | — |
| Annual nurse turnover | 37.8% | 37.5% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
No fines, payment denials or special-focus designation on the current CMS record.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J— | K— | L— |
| Actual harm | G— | H— | I— |
| No harm, potential for more than minimal | D1745.9% | E2054.1% | F— |
| No harm, potential for minimal | A— | B— | C— |
Most frequently cited here
In CMS’s current monthly file.
- F6583×
Ensure services provided by the nursing facility meet professional standards of quality.
- F6282×
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
- F6562×
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- F6862×
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- F7612×
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
In the surveyor’s words
From the most serious findings on record at South Marin Health & Wellness Center, in the surveyor’s own words.
- No harm, potential for more than minimal, patternF557Dec 4, 2025
Based on observation, interview and record review the facility failed to ensure the dignity of three sampled residents (Resident 27, Resident 76 and Resident 52), when the residents reported missing clothing and personal items to the facility and the facility did not respond according to their Facility Policy and Procedure for Theft and Loss.This failure to follow their Policy and Procedure for theft and loss resulted in a loss of dignity and respect for the residents when they did not have access to clothing from home that felt familiar as well as personal item that were important to their day-to-day life in the facility. […]
- No harm, potential for more than minimal, patternF759Dec 4, 2025
Based on observation, interviews and record reviews, the facility failed to follow the physician's orders for three out of three sampled residents (Residents 11, 63 and 68) when: 1. Residents 11 and 63 did not received their insulin before meals as ordered. 2. Resident 68 received pain medication that was ordered to relieve mild pain only when Resident 68 was complaining of severe pain.This failure could result in:1. Inappropriate Diabetes management, which could result in blood sugar spike (hyperglycemia) followed by a potential delayed low blood sugar (hypoglycemia) several hours later. 2. increased pain and suffering. […]
- No harm, potential for more than minimal, patternF880Dec 4, 2025
Based on observations, interviews and record reviews, the facility:A. did not implement Enhanced Barrier Protection (EBP, an infection control intervention, primarily used in nursing homes, that involve the use of gowns and gloves during high-contact resident care activities to reduce the transmission of Multidrug-Resistant Organisms (MDROs, microorganisms, primarily bacteria, that are resistant to one or more classes of antimicrobial agents) ) for one out of three sampled residents (Resident 53) when Resident 53s surgical thoracic wound was treated using Negative Pressure Wound Therapy (NPWT/wound vac, a treatment that uses a sealed dressing, connected to a vacuum pump to apply continuous or intermittent suction to a wound).B. […]
- No harm, potential for more than minimal, patternF881Dec 4, 2025
Based on interview and record review, the facility failed to develop an antibiotic use protocol in addition to a system to effectively monitor the use of antibiotics.This failure can result in inappropriate use of antibiotics that can lead to the development of antibiotic-resistant organisms, difficulty treating infections and severe health complications. Findings:During an interview on 12/04/2025 at 1:00 PM, the facility Infection Preventionist (IP) stated the facility use the McGeer criteria ( an evidence-based guideline for defining infections in long-term care facilities (LTCFs), focusing on specific group of symptoms and laboratory results for respiratory, gastrointestinal, and urinary infections) to guide treatment. […]
- No harm, potential for more than minimal, patternF761Nov 22, 2024
Based on observation, interview and record review, the facility failed to ensure two of three medication carts (Medication cart for Station 2 and medication cart for Station 3), in addition to the medication room, were free of expired and outdated medications and medical supplies for residents. This failure had the potential to result in inadvertently using these products on residents, which could have caused them harm and infections. Findings: During a medication storage observation and interview on 11/18/24 at 10:55 a.m., with Licensed Nurse (LN) F, the medication Latanoprost 0.005% (A medication to treat increased pressure in the eye) was observed stored inside the medication cart for Station 2 with other active medications. […]
Read 23 findings in full →The most serious and the most recent: 23 of 118 on record.
Every survey on record
FindingsAt actual harm or above
- Jan 23, 2026Complaint2 findings
- Dec 4, 2025Standard11 findings
- Nov 22, 2024Standard10 findings
- Jun 12, 2024Complaint1 finding
- Mar 18, 2024Complaint1 finding
- May 17, 2022Standard12 findings
- May 12, 2021Complaint2 findings
- Oct 8, 2020Infection control1 finding
Show the 20 earlier surveys
- Jun 9, 2020Infection control1 finding
- Feb 20, 2020Complaint1 finding
- May 28, 2019Standard16 findings · 1 harm
- May 31, 2018Standard6 findings
- Apr 6, 2018Complaint1 finding · 1 harm
- Jun 28, 2017Complaint1 finding
- Mar 3, 2017Standard6 findings
- Feb 24, 2017Complaint1 finding
- Jan 11, 2017Complaint1 finding
- Jan 10, 2017Complaint1 finding
- Oct 10, 2016Complaint1 finding
- Jan 22, 2016Standard12 findings · 1 harm
- Nov 7, 2014Standard8 findings
- Apr 15, 2014Complaint1 finding
- Jan 31, 2014—2 findings
- Nov 19, 2013—9 findings
- Sep 13, 2012—3 findings
- Aug 30, 2012—1 finding
- Aug 6, 2012—1 finding
- Jul 15, 2011—5 findings
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction