Royal Gardens Healthcare
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 17 Google reviews

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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Low overall rating (2/5 stars)
- Above-median deficiencies (23 vs median 13.0)
- High staff turnover (53%)
Below average in CA · Meets national RN staffing standard · Above recommended total nurse staffing · No penalties on record
What this means for your family
While some individual caregivers are noted for their compassion, the facility has significant, documented issues with medical neglect and unresponsiveness. If you choose this facility, you must implement a rigorous daily check-in schedule to ensure meals are being served and hygiene needs are being met.
Google Reviews
Google Reviews
17 reviews on Google“Families should approach this facility with significant caution due to serious allegations regarding patient neglect, including missed meals, unaddressed pressure sores, and lack of emergency response. While some individual CNAs are praised for their kindness and attentiveness, there are recurring reports of poor communication and staff unresponsiveness to both patients and families.”
Quality Themes
Tap a score for detailsStrengths
- Compassionate individual CNAs
- Clean and fresh environment
- Efficient nursing teamwork
Concerns
- Neglect regarding basic care and hygiene (mentioned by 2 reviewers)
- Unresponsive staff and poor communication (mentioned by 3 reviewers)
- Lack of urgency in medical emergencies (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 20 analyzed
How They Respond to Reviews
Questions for Your Tour
- 1I noticed some families have mentioned how compassionate the CNAs are here; how do you ensure that level of personal care is maintained for every resident?
- 2With the recent inspections, what specific steps has the facility taken to address and resolve the noted deficiencies?
- 3How does the nursing team coordinate communication with families to ensure we are always kept in the loop regarding changes in a loved one's health?
- 4What is the current process for ensuring residents receive timely assistance with personal hygiene and daily grooming?
- 5Can you tell me more about the dining experience and how the facility is working to improve the variety and quality of the meals served?
- 6In the event of a sudden medical change or an after-hours emergency, what is the specific protocol for ensuring a rapid and urgent response?
Personalized based on this facility's data
Key Review Excerpts
“Although he was not there long I saw them be so attentive and so kind to my father, Carol, and Maria. They helped patients not assigned to them and was always gentle and kind with her words.”
“We received a call from a nurse/cna on the 3rd day that my brother was there. Telling us he wouldn't wake up. This was at 10 am, my brother was given medication but not fed breakfast. We call they never answer.”
“I rushed to the front desk and a woman there said she's not a nurse so she cannot do anything. She didn't even try to contact her co-workers to help the patient, she just pointed to room 107 with a nurse in it and told me to talk to her.”
Staffing
Staffing Hours
per resident/day · Medicare 2026This 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 · 17 measures
6
measures
3
measures
8
measures
Residents whose bladder or bowel control got worse
Residents on anti-anxiety or sleep medication
Residents on antipsychotic medication
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents vaccinated for pneumonia
Residents whose walking got worse
Short-stay residents vaccinated for the flu
Short-stay residents vaccinated for pneumonia
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
Royal Gardens Healthcare has a concerning pattern of ongoing issues, with families filing multiple complaints triggering federal investigations. The facility shows recurring problems with medication management, infection control, and pressure ulcer care across multiple years. While most deficiencies are eventually corrected, several serious violations from early 2024 regarding abuse prevention and resident grievances remain unaddressed by the facility.
Apr 16, 2026Complaint5
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
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.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Apr 9, 2026Complaint1
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.
Apr 8, 2026Complaint1
Quality of Life and Care Deficiencies
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Jan 23, 2026Routine20
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Resident Rights Deficiencies
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.
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
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.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Nutrition and Dietary Deficiencies
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Nutrition and Dietary Deficiencies
Dispose of garbage and refuse properly.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Environmental Deficiencies
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Jan 23, 2026Complaint4
Resident Rights Deficiencies
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Jan 13, 2026Complaint1
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ownership & Operations
Who Operates This Facility
Royal Gardens Healthcare
for profit
Chain Affiliation
Serrano Group
11 facilities nationwide
Chain avg rating: 2.3/5 · Rank 9 of 11
Ownership & Management
Owners
Gardens Licensee 4 LLC
Owner · Organization
Bin Mendel LLC
Owner (parent company) · Organization
Bl Cali Partners LLC
Owner (parent company) · Organization
Js Fenton LLC
Owner (parent company) · Organization
Rgf Consulting LLC
Owner (parent company) · Organization
Serrano Group LLC
Owner (parent company) · Organization
Serrano Partners LLC
Owner (parent company) · Organization
Yaame LLC
Owner (parent company) · Organization
Fensterman, Howard
Owner (parent company)
Fensterman, Jordan
Owner (parent company)
Fensterman, Robert
Owner (parent company)
Jacobs, Dov
Owner (parent company)
Leibson, Staci
Owner (parent company)
Taub, Judah
Owner (parent company)
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
17 reviews from families & visitors
Official Website
Visit royalgardenhealth.com
Medicare data downloads
Original nursing home datasets
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