Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

NORTH BAY POST ACUTE

PETALUMA, CA · 98 certified beds · Last Life Safety survey January 9, 2026

CMS Certification Number 056120 · first certified November 1969

Ownership

Independently operated (no chain recorded by CMS) · For profit - Limited Liability company

  • Ownership changed April 13, 2022 (change of ownership)from EVERGREEN AT PETALUMA, L.L.C.
28
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
6
Tags cited more than once
Across separate surveys
13
Inspection & testing records
Of the citations on file

Position within CA

28 citations — more than 79% of the 1,165 certified nursing homes in CA. Compared within CA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 6 citations; the earlier surveys in the window averaged 11. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens January 2027 — about 4 months from now. This facility’s last Life Safety survey was January 2026. Facilities in CA are typically surveyed 12–18 months after the last one (median 14), measured over 1,766 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

4 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

1 of the 28 citations on file is Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

12 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 28 Life Safety citations above. The Physical Environment Index

  • F-0584 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  • F-0926 Have policies on smoking.
  • F-0880 Provide and implement an infection prevention and control program.
  • F-0919 Make sure that a working call system is available in each resident's bathroom and bathing area.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

How that compares

Citations on file over three years

Compared with the median facility in CA, and nationally. Surveyors differ markedly between states, so the CA figure is the meaningful one.

This facility28CA median19National median11
Citations on file over three years, compared
MeasureCitations
This facility28
Median facility in CA19
Median facility nationally11

Survey history

Citations at each Life Safety survey
162023-0162025-0162026-01
Citations at each Life Safety survey
Survey dateCitations
January 18, 202316
January 17, 20256
January 9, 20266

Most-cited tags

Most-cited tags at this facility
K-03533K-03633K-09202K-05112K-09182K-01612K-09191K-07541
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0353Inspect, test, and maintain automatic sprinkler systems.32026-01-09
K-0363Install corridor and hallway doors that block smoke.32026-01-09
K-0920Ensure proper usage of power strips and extension cords.22025-01-17
K-0511Have properly installed electrical wiring and gas equipment.22026-01-09
K-0918Have generator or other power source capable of supplying service within 10 seconds.22026-01-09
K-0161Use approved construction type or materials.22026-01-09
K-0919Meet requirements for the use of electrical equipment.12025-01-17
K-0754Provide properly sized and located linen or trash receptacles.12026-01-09

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 10
  • Gas, Vacuum, and Electrical Systems Deficiencies 7
  • Miscellaneous Deficiencies 3
  • Egress Deficiencies 3
  • Other 5
Citations by CMS category
CategoryCitations
Smoke Deficiencies10
Gas, Vacuum, and Electrical Systems Deficiencies7
Miscellaneous Deficiencies3
Egress Deficiencies3
Services Deficiencies2
Construction Deficiencies2
Emergency Preparedness Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

January 9, 2026 — 6 citations

Citations issued on January 9, 2026
TagWhat the surveyor checksStatus
K-0161Use approved construction type or materials.Deficient, Provider has date of correction (January 20, 2026)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (January 26, 2026)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (January 20, 2026)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (January 19, 2026)
K-0754Provide properly sized and located linen or trash receptacles.Deficient, Provider has date of correction (January 16, 2026)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (January 26, 2026)

January 17, 2025 — 6 citations

Citations issued on January 17, 2025
TagWhat the surveyor checksStatus
E-0032Provide primary/alternate means for communication.Deficient, Provider has date of correction (February 11, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (January 27, 2025)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (January 27, 2025)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (February 11, 2025)
K-0919Meet requirements for the use of electrical equipment.Deficient, Provider has date of correction (February 11, 2025)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (February 11, 2025)

January 18, 2023 — 16 citations

Citations issued on January 18, 2023
TagWhat the surveyor checksStatus
K-0161Use approved construction type or materials.Deficient, Provider has date of correction (February 17, 2023)
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.Deficient, Provider has date of correction (February 17, 2023)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (February 17, 2023)
K-0293Have properly located and lighted "Exit" signs.Deficient, Provider has date of correction (February 17, 2023)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (February 17, 2023)
K-0346Follow proper procedures when the fire alarm was out of service for more than 4 hours.Deficient, Provider has date of correction (February 17, 2023)
K-0347Properly provide smoke detection systems in areas open to corridors.Deficient, Provider has date of correction (February 17, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (February 17, 2023)
K-0354Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.Deficient, Provider has date of correction (February 17, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (February 17, 2023)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (February 17, 2023)
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.Deficient, Provider has date of correction (February 17, 2023)
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.Deficient, Provider has date of correction (February 17, 2023)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (February 17, 2023)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (February 17, 2023)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (February 17, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.