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Nursing HomeMedicaid

Victoria Care Center

Strong Medicare quality ratings; families often praise warm and attentive nursing and rehab staff. Still worth an in-person visit.

3541 Puente Avenue, Baldwin Park, CA 9170649 bedsLicensed & Active
4/5
Medicare
Inspection
Quality
Staffing
Google rating
4.0/5

based on 16 Google reviews

5
4
3
2
1
Victoria Care Center Nursing Home in Baldwin Park, CA — Street View
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What this means for your family

This facility is highly regarded for its rehabilitation services and the warmth of its nursing staff. However, because of documented reports of serious infections and medical neglect, you should prioritize a visit during your stay to personally verify infection control protocols and communication transparency.

Google Reviews

Google Reviews

16 reviews on Google
Families can expect a highly caring and attentive nursing and rehab team, with several reviewers praising the warmth of the staff and the cleanliness of the facility. However, there are serious, critical allegations regarding medical neglect and the contraction of severe infections like MRSA and Covid-19 that must be addressed with management.

Quality Themes

Tap a score for details
Food3.0Staff8.0Clean9.0ActivitiesN/AMedsN/AMemoryN/AComms2.0ValueN/A

Strengths

  • Warm and attentive nursing and rehab staff
  • Clean and well-maintained facility
  • Welcoming and professional administration
  • Effective physical therapy and wound care

Concerns

  • Allegations of medical neglect and preventable injury
  • Risk of facility-acquired infections (MRSA, Covid-19)

Rating Trends

Tap a year to see what changed

2345.0'17(1)5.01.0'19(1)5.02.0'23(4)3.05.0'25(5)5.0'26(2)

Distribution · 18 analyzed

5
13
4
0
3
0
2
0
1
5

How They Respond to Reviews

56%response rate
Generic

The owner relies heavily on repetitive, templated responses for positive reviews, often using identical phrasing for different reviewers. While they attempt to acknowledge negative feedback, the responses remain largely scripted and lack deep personalization.

Questions for Your Tour

  • 1We've heard wonderful things about how professional and welcoming the administration team is; how do you typically handle updates and communication with families regarding a resident's daily care?
  • 2Since the nursing and rehab staff are often noted for being so warm and attentive, how do you ensure that level of personal care remains consistent during shift changes?
  • 3What specific protocols do you have in place to manage infection control and keep the environment safe from things like MRSA or COVID-19?
  • 4Could you tell us a bit about the dining experience and how much input residents have regarding their meal options and schedules?
  • 5In the event of a medical emergency or a sudden change in health status during the night, what is the immediate process for notifying the family and coordinating care?
  • 6What kind of daily activities or social programs are available to help residents stay engaged and connected with one another?

Personalized based on this facility's data


Key Review Excerpts

The nurses and rehab team were all very helpful and supportive during this difficult times. We highly recommend Victoria Care Center, they really care for their patients and everyone was very respectful and always willing to help.

Rehab patient's family · 2025★★★★★

The staff at Victoria Care Center were very welcoming and made my grandma feel at home. She loves the physical therapy team and wound care nurse.

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

The CNAs are wonderful but everyone and everything else is terrible. They medically neglect the residents and now my father needs an amputation.

Long-term resident's family · 2023☆☆☆☆
Source: 16 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.39hrs
52%
Registered nurses for medical care
Total Nursing
4.35hrs
OK
All nurses + aides combined
Staff Turnover
45%
Lower is better (< 30% = good)

RN hours are below the national benchmark. RNs handle complex medical needs and medication, so ask about coverage during your visit.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
5/ 5
Better Than Avg

14

measures

Worse Than Avg

2

measures

Mixed Results

1

measures

Long-Stay Residents
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility2.2%
Better than Avg
Here
2.2%
US
15.5%
CA
11.7%
Los angeles
11.4%
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility7.0%
Better than Avg
Here
7.0%
US
19.4%
CA
10.7%
Los angeles
9.7%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility8.5%
Better than Avg
Here
8.5%
US
19.5%
CA
13.7%
Los angeles
10.8%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility6.0%
Better than Avg
Here
6.0%
US
15.3%
CA
10.5%
Los angeles
9.5%
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
93.4%
CA
98.6%
Los angeles
99.1%
😔

Residents with depression symptoms

↓ Lower is better
This Facility12.5%
Worse than Avg
Here
12.5%
US
12.1%
CA
7.0%
Los angeles
8.7%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

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
79.8%
CA
93.2%
Los angeles
92.5%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility99.1%
Better than Avg
Here
99.1%
US
81.8%
CA
94.2%
Los angeles
94.5%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
1.6%
CA
1.5%
Los angeles
1.5%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

11deficiencies
Near state avg (15.4)
8 complaint-triggered

Victoria Care Center has faced recurring deficiencies in resident rights, safety supervision, and medication management across multiple surveys, with eight complaint-triggered incidents indicating families have reported concerns about care quality. While all issues appear corrected by the facility, the persistent nature of problems with accident prevention, resident treatment rights, and pharmacy oversight suggests ongoing operational challenges that warrant careful evaluation during any visit.

Apr 9, 2026Routine
13
0641Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

0656Potential for harm · PatternCorrected

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.

0657Potential for harm · PatternCorrected

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.

0695Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

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

0732Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

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.

0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0693Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

0756Potential for harm · IsolatedCorrected

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.

0324Potential for harm · IsolatedCorrected

Smoke Deficiencies

Provide properly protected cooking facilities.

0511Potential for harm · IsolatedCorrected

Services Deficiencies

Have properly installed electrical wiring and gas equipment.

0041Minimal · WidespreadCorrected

Emergency Preparedness Deficiencies

Implement emergency and standby power systems.

0912Minimal · PatternCorrected

Environmental Deficiencies

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Jun 12, 2025Complaint
1
0641Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

May 16, 2025Complaint
1
0689Potential for 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.

Feb 16, 2025Routine
10
0578Potential for harm · PatternCorrected

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.

0695Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

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

0700Potential for harm · PatternCorrected

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.

0758Potential for harm · PatternCorrected

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.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0698Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe, appropriate dialysis care/services for a resident who requires such services.

0353Potential for harm · IsolatedCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0355Potential for harm · IsolatedCorrected

Smoke Deficiencies

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

0912Minimal · Pattern

Environmental Deficiencies

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Nov 5, 2024Complaint
1
0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

Jun 13, 2024Complaint
1
0626Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.

Ownership & Operations

Who Operates This Facility

Owner / Operator

Victoria Care Center

Organization Type

for profit

Chain Affiliation

Chain Name

David Johnson

Chain Size

46 facilities nationwide

Chain avg rating: 3.2/5 · Rank 7 of 45 (Best)

Ownership & Management

Owners

Bauman, Irving

Owner

20%

Johnson, Frank

Owner

20%

Puente Partners LLC

Owner · Organization

Chambers, Thomas

Owner (parent company)

Johnson, David

Owner (parent company)

Marmur, Eli

Owner (parent company)

Key personnel

Kaur, RaginiW-2 Managing EmployeeDehghanmanesh, AdrianOfficer / DirectorJohnson, FrankOfficer / DirectorPuente Partners LLCManagerSun Mar Management ServicesManager
Source: Medicare provider data

Contact

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References & Resources

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