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

J AND P HOMES - SAN PEDRO

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

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

Address

J AND P HOMES - SAN PEDRO6891 SAN PEDRO CIRBuena Park, CA 90620 · Orange County

Phone: (714) 686-1289

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
J AND P HOMES, INC. · Profit Corp
Administrator
BARRIOS, PRESCILA S
CDPH facility ID
060001990
License number
060000794
First licensed
October 22, 2001
Current license
Nov 22, 2025 to Nov 21, 2026
CDPH district office
Orange

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G414
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
February 21, 2002
Last certification survey
July 16, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Other (specify)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.9 · LVN/LPN 1.4 · direct care 7.8 · all employees 10.1

State citations and penalties (CDPH)

1 penalty, 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 (HSC 1424) · Violation Jul 26, 2002 · Penalty #060001118

    Status: Closed · Not appealed

    $500

Federal inspections (CMS-2567)

14 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 2D0198-L1 · 1 deficiency

    Official 2567 ↗
  2. · Recertification

    Event 2D0198-H1 · 8 deficiencies

    Official 2567 ↗
  3. · Recertification

    Event MVPK21 · 3 deficiencies

    Official 2567 ↗
  4. · Recertification

    Event MVPK11 · 10 deficiencies

    Official 2567 ↗
  5. · Recertification

    Event ZNP921 · 5 deficiencies

    Official 2567 ↗
  6. · Recertification

    Event ZNP911 · 3 deficiencies

    Official 2567 ↗
  7. · Recertification

    Event HK1S21 · 3 deficiencies

    Official 2567 ↗
  8. · Recertification

    Event HK1S11 · 7 deficiencies

    Official 2567 ↗
  9. · Focused Infection Control, Other-Fed

    Event 5H8711 · no deficiencies cited

    Official 2567 ↗
  10. · Recertification

    Event P0FH21 · 7 deficiencies

    Official 2567 ↗
  11. · Recertification

    Event P0FH11 · 1 deficiency

    Official 2567 ↗
  12. · Recertification

    Event GR8521 · 4 deficiencies

    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

16 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): 1 deficiency(state record)

    See this survey →
  2. ReportFederal survey (recertification): 8 deficiencies(state record)

    See this survey →
  3. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  4. ReportFederal survey (recertification): 10 deficiencies(state record)

    See this survey →
  5. ReportFederal survey (recertification): 5 deficiencies(state record)

    See this survey →
  6. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  7. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  8. ReportFederal survey (recertification): 7 deficiencies(state record)

    See this survey →
  9. ReportFederal survey (focused infection control, other-fed): no deficiencies(state record)

    See this survey →
  10. ReportFederal survey (recertification): 7 deficiencies(state record)

    See this survey →

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.