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ICF/DD-N (Nursing)License activeMedi-Cal certified

CACHUELA ICF/DD-N HOME

ICF/DD-N (Nursing) · 6 licensed beds · Orange, CA

Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.

Address

CACHUELA ICF/DD-N HOME1721 N GREENGROVE STOrange, CA 92865 · Orange County

Phone: (714) 343-7898

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
CACHUELA ICF/DD-N HOME, INC. · Profit Corp
Administrator
CACHUELA, CLEOPATRA D
CDPH facility ID
060001450
License number
060000454
First licensed
June 12, 1996
Current license
Jun 26, 2026 to Jun 25, 2027
CDPH district office
Orange

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G014
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
September 20, 1996
Last certification survey
March 18, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (non-profit)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.23 · LVN/LPN 1.4 · direct care 4 · all employees 5.63

State citations and penalties (CDPH)

6 penalties, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BPatient Care

    Citation - B · Violations: No violations found · Violation Aug 9, 2024 · Penalty #060020734 · Survey 4WJU11

    Status: Closed

  • Class BAbuse/Facility Not Self Reported

    Citation B (HSC 1424) · Violation Mar 11, 2019 · Penalty #060015089 · Survey N33511

    Status: Closed · Not appealed

    $1,000

  • Class BPatient Care

    Citation B (HSC 1424) · Violation May 5, 2018 · Penalty #060014592 · Survey N1TM11

    Status: Closed · Not appealed

    $1,000

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Jul 31, 2018 · Penalty #060014422 · Survey DI1F11

    Status: Closed · Not appealed

    $1,550

    initially $1,000

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Oct 2, 2009 · Penalty #060006648 · Survey 10OW11

    Status: Closed · Not appealed

    $1,000

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Oct 2, 2009 · Penalty #060006650 · Survey 10OW11

    Status: Closed · Not appealed

    $1,000

Federal inspections (CMS-2567)

26 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Recertification

    Event 22D096-L1 · 8 deficiencies

    Official 2567 ↗
  2. · Recertification

    Event 22D096-H1 · 12 deficiencies

    Official 2567 ↗
  3. · Complaint

    Event T8W711 · no deficiencies cited

    Official 2567 ↗
  4. · Recertification

    Event 7O1F21 · 6 deficiencies

    Official 2567 ↗
  5. · Recertification

    Event 7O1F11 · 6 deficiencies

    Official 2567 ↗
  6. · Complaint

    Event 2POZ11 · 2 deficiencies

    Official 2567 ↗
  7. · Complaint

    Event BXJJ11 · no deficiencies cited

    Official 2567 ↗
  8. · Complaint

    Event 4WJU11 · 7 deficiencies (2 condition-level)

    Official 2567 ↗
  9. · Complaint

    Event I4VR11 · 1 deficiency

    Official 2567 ↗
  10. · Recertification

    Event PGMI21 · 9 deficiencies

    Official 2567 ↗
  11. · Recertification

    Event PGMI11 · 17 deficiencies

    Official 2567 ↗
  12. · Complaint

    Event ZLN311 · no deficiencies cited

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

33 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (recertification): 8 deficiencies(state record)

  2. ReportFederal survey (recertification): 12 deficiencies(state record)

  3. ReportFederal survey (complaint): no deficiencies(state record)

  4. ReportFederal survey (recertification): 6 deficiencies(state record)

  5. ReportFederal survey (recertification): 6 deficiencies(state record)

  6. ReportFederal survey (complaint): 2 deficiencies(state record)

  7. ReportState Class B citation ($1,000)(state record)

  8. ReportFederal survey (complaint): no deficiencies(state record)

  9. ReportFederal survey (complaint): 7 deficiencies, 2 condition-level(state record)

  10. ReportFederal survey (complaint): 1 deficiency(state record)

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.