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Nursing HomeMedicaid Investigative

Villa Del Rio

On Medicare Special Focus status, a serious quality warning. Visit in person and ask tough questions before deciding.

7002 Gage Avenue, South Montebello · Bell Gardens, CA 9020112 bedsLicensed & Active
1/5
Medicare
Inspection
Quality
Staffing
Google rating
3.6/5

based on 26 Google reviews

5
4
3
2
1
Villa Del Rio Nursing Home in Bell Gardens, CA — Street View
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7/ 10
critical Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Special Focus Facility (under heightened CMS scrutiny)
  • Low overall rating (1/5 stars)
  • Above-median deficiencies (34 vs median 13.0)
  • High staff turnover (58%)

Bottom 25% in CA · Critically understaffed (RN) · Worst in ROLLINS-NELSON HEALTHCARE MANAGEMENT chain · $155,218 in fines · Special Focus Facility (CMS)

Source: Medicare data

What this means for your family

While some families report high levels of compassion from specific nursing staff, recent reviews indicate serious concerns regarding facility cleanliness and hygiene. If you choose this facility, we recommend closely monitoring the cleanliness of the resident's room and inquiring about the protocols for medical discharge signatures.

Google Reviews

Google Reviews

26 reviews on Google
Families should be aware of significant concerns regarding hygiene and administrative delays in discharging residents. While some long-term residents receive compassionate care from specific nursing staff, recent reviews highlight issues with facility cleanliness and staff responsiveness.

Quality Themes

Tap a score for details
Food5.0Staff6.0Clean1.0ActivitiesN/AMedsN/AMemoryN/AComms2.0ValueN/A

Strengths

  • Compassionate and caring nursing staff
  • Positive long-term resident experiences
  • Strong team unity during crisis periods

Concerns

  • Poor facility hygiene and odor (mentioned by 2 reviewers)
  • Administrative delays in patient discharge

Rating Trends

Tap a year to see what changed

234'14(1)'17(1)'19(3)'21(2)'23(1)'25(2)'26(1)

Distribution · 26 analyzed

5
15
4
2
3
1
2
0
1
8

How They Respond to Reviews

0%response rate

Questions for Your Tour

  • 1With the small, intimate size of 12 residents, how does the team ensure that each person receives personalized attention during meal times and daily care?
  • 2I noticed the facility is very active in responding to feedback; what specific steps has the team taken recently to address and resolve recent state inspection findings?
  • 3Could you walk me through the protocol for handling a medical emergency or a sudden change in health status during the overnight hours?
  • 4What kind of daily activities or social outings do you organize to help the residents stay engaged with one another?
  • 5How does the staff manage the balance of providing necessary clinical care while still maintaining a warm, home-like atmosphere for the residents?
  • 6What is the process for communicating important updates or changes in a resident's condition to their family members?

Personalized based on this facility's data


Key Review Excerpts

My 97 year old grandma has been there for a couple years now and she is well cared for. Yes its not as nice as other facilities, but the staff there are very friendly and nice and they do take very good care of the residents especially during the pandemic.

Long-term resident's family · 2022★★★★★

Wonderfully helpfull staff. Warm and enviting. Caring and compassionate. Great food. Completely professional management and nursing staff.

Resident's family · 2021★★★★★

The man hall smells like a pee hole , most of d cnas look like they only there to make a paycheck , not willing to help the patient, doing a half ass job all d time, sometimes they don't change the diapers for hours on the patients , and this is only the beginning... shame , shame shame ..

Resident's family · 2016☆☆☆☆
Source: 26 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.24hrs
32%
Registered nurses for medical care
Total Nursing
3.72hrs
91%
All nurses + aides combined
Staff Turnover
59%
Lower is better (< 30% = good)
RN Turnover
33%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 15 measures

Medicare Rating
1/ 5
Better Than Avg

13

measures

Worse Than Avg

1

measures

Mixed Results

1

measures

Long-Stay Residents
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility1.1%
Better than Avg
Here
1.1%
US
19.4%
CA
10.7%
Los angeles
9.7%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility3.7%
Better than Avg
Here
3.7%
US
15.3%
CA
10.5%
Los angeles
9.5%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility20.0%
Worse than Avg
Here
20.0%
US
19.5%
CA
13.7%
Los angeles
10.8%
😔

Residents with depression symptoms

↓ Lower is better
This Facility5.0%
Better than Avg
Here
5.0%
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.

💉

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 vaccinated for the flu

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
95.5%
CA
98.2%
Los angeles
97.8%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility97.4%
Better than Avg
Here
97.4%
US
79.8%
CA
93.2%
Los angeles
92.5%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility99.2%
Better than Avg
Here
99.2%
US
81.8%
CA
94.2%
Los angeles
94.5%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

37deficiencies
6penalties
Well above state avg (15.4)
45 complaint-triggered
$155,218 in fines

Villa Del Rio shows concerning patterns of repeated safety violations and frequent family complaints. The facility has struggled most with resident safety and accident prevention, infection control, and medication management across multiple surveys spanning three years. While all deficiencies show correction dates, the same safety and infection control issues keep recurring, suggesting persistent systemic problems. Families have filed numerous complaints resulting in 40 deficiencies, indicating ongoing quality concerns that warrant careful consideration before choosing this facility.

Feb 27, 2026Complaint
2
0658Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

0657Potential for harm · IsolatedCorrected

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.

Feb 11, 2026Complaint
4
0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0914Potential for harm · IsolatedCorrected

Environmental Deficiencies

Provide bedrooms that don't allow residents to see each other when privacy is needed.

Nov 18, 2025Complaint
2
0658Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

0584Potential for harm · IsolatedCorrected

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.

Aug 26, 2025Complaint
4
0605Potential for harm · PatternCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

0607Potential for harm · PatternCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

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.

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.

Jun 28, 2025Complaint
3
0689Immediate jeopardy · 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.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0921Potential for harm · PatternCorrected

Environmental Deficiencies

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

May 28, 2025Complaint
3
0656Potential for harm · IsolatedCorrected

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.

0697Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe, appropriate pain management for a resident who requires such services.

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.

Federal Penalties

Fine

Jun 28, 2025

$45,078

Fine

Sep 5, 2024

$12,048

Fine

Apr 4, 2024

$67,649

Payment Denial

Apr 4, 2024

27-day denial

Fine

Sep 28, 2023

$22,253

Fine

Jun 23, 2023

$8,190

Ownership & Operations

Who Operates This Facility

Owner / Operator

Villa Del Rio

Organization Type

for profit

Chain Affiliation

Chain Name

Rollins-Nelson Healthcare Management

Chain Size

10 facilities nationwide

Chain avg rating: 2.1/5 · Rank 9 of 10 (Worst)

Ownership & Management

Owners

Undisclosed

Ownership Data Not Available · Organization

Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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