Facility record report · CMS certification number 555221
SURPRISE VALLEY COMMUNITY HOSPITAL D/P SNF
CEDARVILLE, California · Medicare and Medicaid
Finances, as filed
Not yet extracted for this facility.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated 1 August 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | Ownership Data Not Available | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
Medicare enrollment
Not yet extracted for this facility.
Changes in ownership
No change in ownership appears in the CMS files on record since 20 September 2022.
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 8 May 2025 | 8 May 2025 | 4 | 8 |
| 2 | 18 April 2024 | 18 April 2024 | 4 | 14 |
| 3 | 12 May 2022 | 12 May 2022 | 14 | 6 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
22 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 26 February 2026 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | 27 February 2026 |
| 19 December 2025 | Health | F 0609 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Yes | Deficient, Provider has date of correction | 8 January 2026 |
| 8 May 2025 | Health | F 0657 | Resident Assessment and Care Planning Deficiencies | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 8 May 2025 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | 2 June 2025 |
| 18 April 2024 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | No | Deficient, Provider has date of correction | 8 May 2024 |
| 18 April 2024 | Health | F 0761 | Pharmacy Service Deficiencies | 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. | D | No | Deficient, Provider has date of correction | 2 May 2024 |
| 18 April 2024 | Health | F 0851 | Administration Deficiencies | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | F | No | Deficient, Provider has date of correction | 6 May 2024 |
| 18 April 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | F | No | Deficient, Provider has date of correction | 13 May 2024 |
| 28 December 2023 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Yes | Deficient, Provider has date of correction | 28 December 2023 |
| 5 December 2023 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Yes | Deficient, Provider has date of correction | 18 December 2023 |
| 12 May 2022 | Health | F 0552 | Resident Rights Deficiencies | Ensure that residents are fully informed and understand their health status, care and treatments. | E | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0604 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | D | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | F | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0741 | Quality of Life and Care Deficiencies | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | D | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0756 | Pharmacy Service Deficiencies | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | F | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0758 | Pharmacy Service Deficiencies | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | F | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0838 | Administration Deficiencies | Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. | E | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0867 | Administration Deficiencies | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | E | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0868 | Administration Deficiencies | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | E | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | F | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | E | No | Deficient, Provider has date of correction | 13 July 2022 |
| 12 May 2022 | Health | F 0883 | Infection Control Deficiencies | Develop and implement policies and procedures for flu and pneumonia vaccinations. | F | No | Deficient, Provider has date of correction | 13 July 2022 |
From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.
Penalties
Not yet extracted for this facility.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | Government - Hospital district |
| Legal Business Name | Legal Business Name Not Available |
| Date First Approved to Provide Medicare and Medicaid Services | 1986-04-15 |
| Provider Resides in Hospital | Y |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Modoc |
| Telephone Number | 5302796111 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Resident |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 22 |
| Average Number of Residents per Day | 18.4 |
| Overall Rating | 4 |
| Health Inspection Rating | 4 |
| QM Rating | 5 |
| Long-Stay QM Rating | 5 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.
Every change on this record
No change has appeared in the CMS files since this record began.
How to read this report
Every figure is printed as the CMS file it came from printed it. Each cost-report figure carries the worksheet, line and column of form CMS-2540 it was read from, so a reader holding the same public file can go to that cell; each Care Compare and Medicare enrollment section names its file and the date CMS stamped on it.
A figure the filing does not carry is left out, and so is a figure whose value the filing’s own arithmetic contradicts. Net income is printed with what the form’s own arithmetic shows about it — plainly where it follows from the lines above it, and, where it does not, beside what the form’s own lines leave unaccounted for. An ownership field left empty carries the dated sentence on CMS’s pause of the expanded Form CMS-855A disclosure. A source that holds nothing for this facility says so in its section.
This report carries no percentile and no score, and it does not place this facility above or below another. The five facilities above are the one comparison it draws: the nearest certified bed counts in the same state at the same fiscal year, listed by name. Nurse staffing is printed in its own section, on its own page, apart from the cost-report figures.
How to cite this report
Velarion Records, SURPRISE VALLEY COMMUNITY HOSPITAL D/P SNF — facility record report, CMS certification number 555221. https://velarionrecords.com/facility/555221/report.
- Provider information, inspections, deficiencies and penalties: CMS Care Compare, file dated 1 August 2026.
- Care Compare ownership: CMS file dated 1 August 2026.
- Medicare enrollment ownership: CMS file dated 1 August 2026.
- Nurse staffing: CMS Payroll-Based Journal, quarters 2024Q2 to 2026Q1.
Published by VELARIONAI LLC · Andrew Richardson, founder. Corrections: hello@velarionrecords.com, quoting certification number 555221. Velarion Records publishes these records as filed.
Nurse staffing, quarter by quarter
Hours this facility reported to CMS’s Payroll-Based Journal, one row per quarter, oldest first, each with how its figures are derived and the file it came from.
| Quarter | Quarter ended | Days reported | Resident days | Registered nurse hours | Licensed practical nurse hours | Nurse aide hours | Total nurse hours |
|---|---|---|---|---|---|---|---|
| 2024Q2 | 30 June 2024 | 91 | 1,970 | 2,284.6 | 2,542.6 | 6,596.71 | 11,423.91 |
| 2024Q3 | 30 September 2024 | 92 | 1,807 | 2,589.1 | 2,557.41 | 5,870.9 | 11,017.41 |
| 2024Q4 | 31 December 2024 | 92 | 1,758 | 2,370 | 2,047.35 | 6,475.31 | 10,892.66 |
| 2025Q1 | 31 March 2025 | 90 | 1,798 | 2,492.8 | 2,449.05 | 6,101.9 | 11,043.75 |
| 2026Q1 | 31 March 2026 | 90 | 1,652 | 43.5 | 2,615.59 | 5,387.13 | 8,046.22 |
| Quarter | Registered nurse hours per resident day | Licensed practical nurse hours per resident day | Nurse aide hours per resident day | Total nurse hours per resident day |
|---|---|---|---|---|
| 2024Q2 | 1.159695 | 1.29066 | 3.348584 | 5.798939 |
| 2024Q3 | 1.432817 | 1.415279 | 3.248976 | 6.097072 |
| 2024Q4 | 1.348123 | 1.16459 | 3.683339 | 6.196052 |
| 2025Q1 | 1.386429 | 1.362097 | 3.393715 | 6.142241 |
| 2026Q1 | 0.026332 | 1.583287 | 3.260975 | 4.870593 |
How each quarter is derived, and its file
- 2024Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-04-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-04-01.csv - 2024Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-09-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-09-01.csv - 2024Q4: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-12-31.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-12-31.csv - 2025Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-01-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-01-01.csv - 2026Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2026-01-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2026-01-01.csv