Home›Browse›California›Fresno›Pacific Gardens Nursing and Rehabilitation Center

Nursing homeFAID #1089

Pacific Gardens Nursing and Rehabilitation Center

577 S. PEACH AVE., FRESNO, CA, 93727

(559) 251-8463

188 licensed beds

CMS rates Pacific Gardens Nursing and Rehabilitation Center 3 out of 5 overall. Federal inspectors issued 71 citations across 11 inspections in the last three years, with $30,654 in fines. Listing last updated 2026-11-06.

★★★★★3/5CMS Five-Star overall2/5 health inspections4/5 staffing5/5 quality measuresSource: CMS Care Compare

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Photo of PACIFIC GARDENS NURSING AND REHABILITATION CENTER

Photo via Google · Pacific Gardens Nursing & Rehab

Address

577 S. Peach Ave.

Fresno, CA 93727

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Public record summary

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Bed capacity

188

CMS facility ID

056207

Care type

Nursing home

County

Fresno

Facility name

Pacific Gardens Nursing and Rehabilitation Center

Street address

577 S. PEACH AVE.

City / state / ZIP

Fresno, CA 93727

Phone

(559) 251-8463

Website

pacificgardensnursingcenter.com

About this facility — Pacific Gardens Nursing and Rehabilitation Center

Pacific Gardens Nursing and Rehabilitation Center is a Medicare/Medicaid-certified skilled nursing facility in Fresno, California. It is licensed for 188 beds — well above the median for skilled nursing facilities in California (98 beds).

It is one of 213 senior care facilities in Fresno and 1,165 skilled nursing facilities across California. Families comparing options should weigh inspection history, ownership record, and litigation — not just the tour — before deciding.

It is listed as part of The Ensign Group, a group of 347 facilities on this site.

Federal inspectors have cited Pacific Gardens Nursing and Rehabilitation Center 71 times across 11 inspections in the last three years, including 7 food-safety citations, and CMS has imposed $30,654 in fines. Every citation is listed, dated, and graded in the inspection record below.

This listing draws on federal CMS Nursing Home Compare records, and was last updated on November 6, 2026. Background reports are compiled from primary sources — state inspection files, federal CMS data, corporate registrations, and court records — at the time of order.

Facility background

What the public record shows.

Ownership & operator

Parent company

The Ensign Group

Ownership type

For profit - Limited Liability company

Registered owners & officers

Burnam, Soon

Officer — since 2024

Chandar, John

Governing body · Operational control · Additional disclosable party — since 2025

Ensign Services Inc

Additional disclosable party — since 2025

Keetch, Chad

Officer — since 2011

Malley, Roman

Governing body · Operational control · Additional disclosable party — since 2025

Monette, Cory

Officer — since 2024

Port, Barry

Director — since 2018

Sato, Ami

Officer — since 2024

Willits, Adam

Officer — since 2024

Regulatory standing

Federal court records

11 naming its parent company — view the cases (a listed case is not a finding of wrongdoing)

Licensed / certified since

1970-07-06

CMS overall rating

3 of 5 stars

Health deficiencies

19 at the last standard inspection

Federal fines

$30,654 total

Last standard inspection

2026-04-24

Nurse staffing

4.1 hours per resident per day

Cost & payer profile (FY2023 cost report)

Average billed charges

$416 per day (≈ $12,650/month). Private-pay prices typically track billed charges; Medicare and Medicaid pay set rates.

Payer mix (resident days)

9% Medicaid · 20% Medicare · 71% private/other

Occupancy

86% (fiscal year 2023)

Vs. state median

19% below the CA median of $514/day — full state cost breakdown

Services & coverage

Licensed beds

188

Medicare

Accepted

Medicaid

Accepted

Wheelchair accessible

entrance and parking

Visiting hours

Daily Open 24 hours

Compiled from CMS Nursing Home Compare; owners/officers from the CMS Ownership dataset; cost & occupancy from the facility's own CMS cost report; hours/accessibility via Google · last verified 2026-11-06. Facilities can submit a correction.

Inspection record

Every citation, dated and graded.

Kitchen & food safety

Federal surveyors inspect the kitchen at every standard visit. This facility has 7 food-safety citations on its three-year record — flagged below among the inspections.

2026-04-24Health inspection18 citations

F-0552

D · No harm found

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

Corrected 2026-05-15

F-0554

D · No harm found

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2026-05-15

F-0605

D · No harm found

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

Corrected 2026-05-15

F-0656

D · No harm found

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2026-05-15

F-0658

E · No harm found

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

Corrected 2026-05-15

F-0677

D · No harm found

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2026-05-15

F-0692

D · No harm found

Provide enough food/fluids to maintain a resident's health.

Corrected 2026-05-15

F-0700

D · No harm found

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.

Corrected 2026-05-15

F-0755

E · No harm found

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

Corrected 2026-05-15

F-0757

E · No harm found

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

Corrected 2026-05-15

F-0759

E · No harm found

Ensure medication error rates are not 5 percent or greater.

Corrected 2026-05-15

F-0760

D · No harm found

Ensure that residents are free from significant medication errors.

Corrected 2026-05-15

F-0761

E · No harm found

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.

Corrected 2026-05-15

F-0803

E · No harm foundFood safety

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Corrected 2026-05-15

F-0805

D · No harm foundFood safety

Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

Corrected 2026-05-15

F-0806

D · No harm foundFood safety

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

Corrected 2026-05-15

F-0812

D · No harm foundFood safety

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

Corrected 2026-05-15

F-0880

D · No harm found

Provide and implement an infection prevention and control program.

Corrected 2026-05-15

2026-04-01Health inspectionComplaint-triggered1 citation

F-0658

D · No harm foundFrom a complaint

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

Corrected 2026-04-03

9 earlier / fire-safety inspections (52 citations)

2025-08-27Health inspectionComplaint-triggered1 citation

F-0621

D · No harm foundFrom a complaint

Treat residents equally regarding transfer, discharge, and provision of services for all residents, regardless of payment source

Corrected 2025-10-01

2025-02-07Health inspection19 citations

F-0550

D · No harm found

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

Corrected 2025-03-11

F-0578

E · No harm found

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.

Corrected 2025-03-11

F-0584

E · No harm found

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.

Corrected 2025-03-11

F-0625

D · No harm found

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2025-03-11

F-0656

D · No harm found

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2025-03-11

F-0657

D · No harm found

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Corrected 2025-03-11

F-0658

D · No harm found

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

Corrected 2025-03-11

F-0687

D · No harm found

Provide appropriate foot care.

Corrected 2025-03-11

F-0688

G · Actual harm

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.

Corrected 2025-03-11

F-0689

D · No harm found

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

Corrected 2025-03-11

F-0732

D · No harm found

Post nurse staffing information every day.

Corrected 2025-03-11

F-0757

D · No harm found

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

Corrected 2025-03-11

F-0760

D · No harm found

Ensure that residents are free from significant medication errors.

Corrected 2025-03-11

F-0761

E · No harm found

Corrected 2025-03-11

F-0802

E · No harm foundFood safety

Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

Corrected 2025-03-11

F-0812

E · No harm foundFood safety

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

Corrected 2025-03-11

F-0842

D · No harm found

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2025-03-11

F-0880

E · No harm found

Provide and implement an infection prevention and control program.

Corrected 2025-03-11

F-0924

E · No harm found

Put firmly secured handrails on each side of hallways.

Corrected 2025-03-11

2024-11-26Health inspectionComplaint-triggered2 citations

F-0658

D · No harm foundFrom a complaint

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

Corrected 2024-12-29

F-0726

D · No harm foundFrom a complaint

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.

Corrected 2024-12-29

2024-10-04Health inspectionComplaint-triggered2 citations

F-0812

F · No harm foundFood safetyFrom a complaint

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

Corrected 2024-11-01

F-0925

F · No harm foundFrom a complaint

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Corrected 2024-11-01

2024-03-15Health inspectionComplaint-triggered1 citation

F-0686

G · Actual harmFrom a complaint

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Corrected 2024-04-01

2023-11-30Health inspection4 citations

F-0554

D · No harm found

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2023-12-28

F-0584

D · No harm found

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.

Corrected 2023-12-28

F-0692

D · No harm found

Provide enough food/fluids to maintain a resident's health.

Corrected 2023-12-28

F-0695

E · No harm found

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

Corrected 2023-12-28

2026-04-24Fire-safety inspection10 citations

K-0293

F · No harm found

Have properly located and lighted "Exit" signs.

Corrected 2026-04-29

K-0342

F · No harm found

Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.

Corrected 2026-05-05

K-0345

F · No harm found

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

Corrected 2026-04-30

K-0352

C · No harm found

Properly install and monitor supervisory attachments on automatic sprinkler systems.

Corrected 2026-04-30

K-0353

F · No harm found

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2026-05-01

K-0363

E · No harm found

Install corridor and hallway doors that block smoke.

Corrected 2026-04-28

K-0372

E · No harm found

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2026-05-05

K-0781

D · No harm found

Have restrictions on the use of portable space heaters.

Corrected 2026-04-28

K-0918

C · No harm found

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

Corrected 2026-05-07

K-0923

E · No harm found

Have proper medical gas storage and administration areas.

Corrected 2026-05-05

2025-02-07Fire-safety inspection4 citations

K-0293

F · No harm found

Have properly located and lighted "Exit" signs.

Corrected 2025-02-13

K-0345

F · No harm found

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

Corrected 2025-02-27

K-0353

C · No harm found

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2025-02-14

K-0761

D · No harm found

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

Corrected 2025-02-14

2023-11-30Fire-safety inspection9 citations

K-0293

D · No harm found

Have properly located and lighted "Exit" signs.

Corrected 2023-12-30

K-0324

D · No harm found

Provide properly protected cooking facilities.

Corrected 2023-12-30

K-0353

F · No harm found

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-12-30

K-0355

D · No harm found

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

Corrected 2023-12-30

K-0363

D · No harm found

Install corridor and hallway doors that block smoke.

Corrected 2023-12-30

K-0781

D · No harm found

Have restrictions on the use of portable space heaters.

Corrected 2023-12-30

K-0918

F · No harm found

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

Corrected 2023-12-30

K-0919

D · No harm found

Meet requirements for the use of electrical equipment.

Corrected 2023-12-30

K-0920

D · No harm found

Ensure proper usage of power strips and extension cords.

Corrected 2023-12-30

Federal penalties

2025-02-07Fine$30,654

Citations and penalties from the CMS Provider Data Catalog (three-year survey window, refreshed monthly). Severity codes follow the federal scope/severity grid; “Immediate jeopardy” is the most serious grade CMS issues. CCN 056207.

Quality of care & staffing

How it compares in California.

Inspection citations, 3 years

More than 59% of nursing homes in the state

State median: 65

Federal fines, 3 years

$30,654

More than 78% of nursing homes in the state

State median: $0

Nurse staffing, hours per resident per day

4.1

Higher than 34% of nursing homes in the state

State median: 4.3

Nursing staff turnover, annual

37%

Higher than 53% of nursing homes in the state

State median: 36%

Resident outcomes

On 21 federal quality measures, this facility does better than the California average on 10 and worse on 4. Differences within 10% of the average are shown as near average.

Long-stay residents	This facility	State	US	Compared with state
Need for help with daily activities has increased	6.7%	10.2%	13.5%	Better than state
Lose too much weight	5.6%	4.1%	5.1%	Worse than state
With a catheter inserted and left in their bladder	0.7%	0.7%	0.7%	Near state average
With a urinary tract infection	0.7%	1.2%	1.5%	Better than state
Have depressive symptoms	1.9%	7.6%	13.5%	Better than state
Were physically restrained	0.0%	0.3%	0.1%	Better than state
Experiencing one or more falls with major injury	1.8%	1.6%	3.2%	Worse than state
Assessed and appropriately given the pneumococcal vaccine	99.6%	98.7%	93.7%	Near state average
Ability to walk independently worsened	11.1%	8.9%	12.7%	Worse than state
Received an antianxiety or hypnotic medication	7.7%	13.7%	19.5%	Better than state
Assessed and appropriately given the seasonal influenza vaccine	100.0%	97.9%	95.3%	Near state average
With pressure ulcers	5.0%	4.3%	4.5%	Worse than state
With new or worsened bowel or bladder incontinence	5.6%	9.8%	18.3%	Better than state
Received an antipsychotic medication	5.5%	12.3%	15.4%	Better than state
Hospitalizations per 1000 long-stay resident days	1.58	2.21	1.81	Better than state
Outpatient emergency department visits per 1000 long-stay resident days	0.98	1.50	1.69	Better than state

Short-stay residents	This facility	State	US	Compared with state
Assessed and appropriately given the pneumococcal vaccine	90.7%	94.6%	82.3%	Near state average
Newly received an antipsychotic medication	1.0%	1.3%	1.5%	Better than state
Were assessed and appropriately given the seasonal influenza vaccine	91.8%	93.1%	80.1%	Near state average
Were rehospitalized after a nursing home admission	22.0%	22.6%	23.4%	Near state average
Had an outpatient emergency department visit	10.6%	11.1%	11.8%	Near state average

Source: CMS MDS and Medicare claims quality measures, measure period 2025Q3-2026Q2. Averages are computed from all nursing homes reporting each measure.

Cited more than once

The same rule cited at separate inspections can point to a problem that wasn't fully fixed.

F-0658 4 inspections. Ensure services provided by the nursing facility meet professional standards of quality.
F-0812 3 inspections. Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
K-0293 3 inspections. Have properly located and lighted "Exit" signs.
K-0353 3 inspections. Inspect, test, and maintain automatic sprinkler systems.
F-0554 2 inspections. Allow residents to self-administer drugs if determined clinically appropriate.
F-0656 2 inspections. Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Verify & compare

Where to check, and what's nearby.

Who to contact in California

Licensing: California Department of Public Health, Center for Health Care Quality, Licensing and Certification
File a complaint: 844-538-8766 · Online
Long-Term Care Ombudsman: 800-231-4024. A free advocate for residents and families.
Adult Protective Services: 833-401-0832. Some states send facility cases to licensing instead. In an emergency, call 911.
Eldercare Locator: 800-677-1116, a federal service for local aging help.

Nearest emergency hospitals

Community Regional Medical Center, about 3.5 miles. CMS rating 1 of 5.
Fresno Va Medical Center (va Central California Healthcare System), about 4.1 miles. CMS rating 5 of 5.
Saint Agnes Medical Center, about 7.3 miles. CMS rating 2 of 5.

Source: CMS Hospital General Information. Straight-line distance.

Nearby facilities with inspection records

Vintage Gardens, Fresno, less than 0.1 miles. 11 state visits on record.
Evergreen Care Center, Fresno, about 0.2 miles. CMS rating 3 of 5.
Sgs Care Home Ii, Fresno, about 0.6 miles. 2 state visits on record.
Orchard Post Acute, Fresno, about 0.7 miles. CMS rating 3 of 5.
Haven Assisted Care, Fresno, about 0.7 miles. 18 state visits on record.

Visitor reviews

What people say on Google.

4.444 ratings on Google

★★★★Susan Mott · 2026-03-05 · via Google
“My MIL was rehabbing here for 6 weeks in January and Feb. with some fairly complex medical needs and our family was very pleased with her care. The CNA’s are hard working and so caring. Neetu, Sindy , and Kiran were amazing. Harpret our RN was always available and helped us with whatever we needed. Jennifer in scheduling was our conduit to Kaiser and she went above and beyond with scheduling appo…”

★★★★★David Okazaki · 2026-03-29 · via Google
“After spending a week at CMRC, my mother was transferred to Pacific Gardens which quickly became her Happy Place to be for her recovery. PG is super clean, safe and well staffed. You can immediately sense the pleasant and calm environment and positive vibes amongst the staff and patients. Special thanks and kudos for going out of their way in caring for my mother to Nancy, Leah, Mallely, MARTHA,…”

★★★★★Vicki Ruiz · 2026-05-03 · via Google
“I was in December for rehab post op surgery. I received excellent care from everyone from all the CNA’s and Nurses who took care of me. All the staff was very friendly, cheerful and supportive, housekeeping staff were great at keeping the room clean. PT,OT were great in helping me get on my feet again and walking. Special shout out to my CNA Martha, my wound care nurse Jessica. I would recommend P…”

Ratings and reviews are from Google and reflect visitor opinions, not our verification. See all reviews on Google

Inside your report

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Ownership & corporate history

Primary tier

Prior operators & transfers

Corporate network & affiliates

Owners' other facilities

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Inspection citations — last 5 years

Locked

The 71 citations above are shown free. The report takes each one and explains it in plain English — what the tag requires, how serious the scope/severity grade really is, whether it recurred across surveys — plus the five-year pattern a single inspection can't show.

Civil & criminal lawsuits

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Active civil suits

Federal dockets

CDC infection data

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Original records

Sources we pull for this facility.

Source

CMS Nursing Home Compare

data.cms.gov Provider Data Catalog

Last verified 2026-11-06

Source

Google Business Profile

Photos, reviews & hours

Displayed with attribution · refreshed on re-run

Source

Secretary of State filings

Entity & officer search

Pulled when a report is ordered

Source

PACER federal dockets

pacer.uscourts.gov

Pulled when a report is ordered