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Nursing HomeMedicaid

Forest Hill Manor Health Center

Meets baseline Medicare standards with room for improvement. A tour and talking to current residents' families is the best next step.

551 Gibson Avenue, Pacific Grove, CA 9395026 bedsLicensed & Active
3/5
Medicare
Inspection
Quality
Staffing
Google rating
3.5/5

based on 10 Google reviews

5
4
3
2
1
Forest Hill Manor Health Center Nursing Home in Pacific Grove, CA — Street View
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What this means for your family

This facility offers strong rehabilitation and therapy services that have helped several patients return home successfully. However, families must be extremely vigilant regarding call light response times and the quality of discharge planning, as multiple reports indicate significant failures in these areas.

Google Reviews

Google Reviews

10 reviews on Google
Families should approach this facility with caution due to significant reports of neglect, delayed response times to call lights, and poor transition planning. While several reviewers praise the skilled nursing and therapy teams for successful rehabilitative outcomes, others describe a disorganized environment with serious communication failures.

Quality Themes

Tap a score for details
FoodN/AStaff6.0Clean5.0ActivitiesN/AMeds8.0MemoryN/AComms2.0Value1.0

Strengths

  • Effective physical and occupational therapy
  • Kind and caring nursing staff
  • Clean and pleasant facility environment
  • Competent medication review processes

Concerns

  • Delayed response to call lights and patient needs
  • Poor communication and lack of transition planning (mentioned by 2 reviewers)
  • Inconsistent following of medical instructions

Rating Trends

Tap a year to see what changed

2343.32024(4)3.92025(7)

Distribution · 11 analyzed

5
7
4
0
3
0
2
1
1
3

How They Respond to Reviews

70%response rate
Good

The owner provides personalized, warm responses to positive reviews, often celebrating patient recovery. For negative reviews, the owner adopts a defensive or corrective tone, attempting to clarify misconceptions or dispute the reviewer's claims.

Questions for Your Tour

  • 1It's wonderful to see how much care you put into responding to feedback from families; how do you typically keep families updated on any changes in a resident's care plan?
  • 2We've heard great things about the physical and occupational therapy here; how often do residents get to participate in these sessions?
  • 3With such a small, intimate community of 26 residents, how do you ensure that call lights and personal requests are answered promptly throughout the night?
  • 4How does the nursing team ensure that specific medical instructions from outside doctors are consistently followed and documented?
  • 5What kind of daily activities or social events do you have planned to keep the residents engaged and connected with one another?
  • 6In the event of a medical emergency after hours, what is the protocol for contacting the family and coordinating with outside physicians?

Personalized based on this facility's data


Key Review Excerpts

The staff was competent, professional, and friendly. The first time we took Dad home, staff members came to the house beforehand to do a brief inspection and provide safety tips.

Long-term resident's family · 2025★★★★★

All the staff were attentive, kind and caring. Their continued care including the physical and occupational therapies helped my mom to return to her home after a short stay.

Rehab patient's family · 2025★★★★★

My mother routinely waits up to 30 minutes or more for help—especially when she needs brief changes. This delay is not only uncomfortable for her but potentially harmful.

Long-term resident's family · 2025☆☆☆☆
Source: 10 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
1.04hrs
OK
Registered nurses for medical care
Total Nursing
5.00hrs
OK
All nurses + aides combined
Staff Turnover
47%
Lower is better (< 30% = good)
RN Turnover
50%
Lower is better (< 30% = good)

This facility meets the national staffing benchmarks. Higher staffing is linked to fewer falls and better day-to-day care.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 3 measures

Medicare Rating
4/ 5
Better Than Avg

3

measures

Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
79.7%
CA
93.2%
Monterey
92.4%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
81.8%
CA
94.2%
Monterey
87.8%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.5%
Better than Avg
Here
0.5%
US
1.6%
CA
1.5%
Monterey
0.8%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

7deficiencies
2penalties
Well below state avg (15.4)
1 complaint-triggered
$11,423 in fines

One family filed a complaint that led to findings of accident hazards and inadequate supervision. Forest Hill Manor consistently struggles with medication management, fire safety systems, and food service across all surveys, with these same issues recurring from 2022 through 2025 despite reported corrections. While all deficiencies show correction dates, the pattern of repeat violations in critical care areas suggests ongoing operational challenges that warrant careful consideration during any visit.

Oct 1, 2025Complaint
1
0689Actual harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Apr 25, 2025Routine
11
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0039Potential for harm · WidespreadCorrected

Emergency Preparedness Deficiencies

Conduct testing and exercise requirements.

0345Potential for harm · WidespreadCorrected

Smoke Deficiencies

Have approved installation, maintenance and testing program for fire alarm systems.

0353Potential for harm · WidespreadCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0712Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

0918Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0755Potential for harm · PatternCorrected

Pharmacy Service Deficiencies

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

0761Potential for harm · PatternCorrected

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.

0550Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

0757Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure each resident’s drug regimen must be free from unnecessary drugs.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Jan 23, 2024Routine
34
0700Potential for harm · WidespreadCorrected

Quality of Life and Care Deficiencies

Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0344Potential for harm · WidespreadCorrected

Smoke Deficiencies

Have an alternate power supply for its alarm system.

0759Potential for harm · PatternCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0324Potential for harm · PatternCorrected

Smoke Deficiencies

Provide properly protected cooking facilities.

0578Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

0645Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

PASARR screening for Mental disorders or Intellectual Disabilities

0655Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0758Potential for harm · IsolatedCorrected

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.

0761Potential for harm · IsolatedCorrected

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.

0801Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

0806Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

0007Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Address patient/client population and determine types of services needed.

0015Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Address subsistence needs for staff and patients.

0023Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish policies and procedures for medical documentation.

0024Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish policies and procedures for volunteers.

0034Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Provide a means of sharing information on occupancy/needs.

0035Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Provide family notifications of emergency plan.

0036Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish emergency prep training and testing.

0037Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish staff and initial training requirements.

0039Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Conduct testing and exercise requirements.

0291Potential for harm · IsolatedCorrected

Egress Deficiencies

Install emergency lighting that can last at least 1 1/2 hours.

0345Potential for harm · IsolatedCorrected

Smoke Deficiencies

Have approved installation, maintenance and testing program for fire alarm systems.

0346Potential for harm · IsolatedCorrected

Smoke Deficiencies

Follow proper procedures when the fire alarm was out of service for more than 4 hours.

0347Potential for harm · IsolatedCorrected

Smoke Deficiencies

Properly provide smoke detection systems in areas open to corridors.

0353Potential for harm · IsolatedCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0354Potential for harm · IsolatedCorrected

Smoke Deficiencies

Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.

0355Potential for harm · IsolatedCorrected

Smoke Deficiencies

Properly select, install, inspect, or maintain portable fire extinguishes.

0363Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

0918Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0919Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Meet requirements for the use of electrical equipment.

0926Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.

Aug 5, 2022Routine
10
0800Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.

0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0552Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Ensure that residents are fully informed and understand their health status, care and treatments.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0755Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0761Potential for harm · IsolatedCorrected

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.

0521Potential for harm · IsolatedCorrected

Services Deficiencies

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

0918Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

Federal Penalties

Fine

Oct 1, 2025

$8,278

Fine

Jun 12, 2023

$3,145

Ownership & Operations

Who Operates This Facility

Owner / Operator

Forest Hill Manor Health Center

Organization Type

for profit

Chain Affiliation

Chain Name

Bvhc, LLC

Chain Size

12 facilities nationwide

Chain avg rating: 3.3/5 · Rank 8 of 12

Ownership & Management

Key personnel

Martin, RichardW-2 Managing EmployeeBoehrer, BryanOfficer / DirectorMartin, RichardOfficer / Director
Source: Medicare provider data

Contact

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References & Resources

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