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

GRANADA DIVISION

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

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

Address

GRANADA DIVISION9904 ROSE STBellflower, CA 90706 · Los Angeles County

Phone: (562) 866-7054

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
HARBOR HEALTH CARE, INC. · Profit Corp
Administrator
SHERMAN, STEVEN
CDPH facility ID
960001148
License number
960000599
First licensed
May 30, 1990
Current license
Jan 4, 2026 to Jan 3, 2027
CDPH district office
La Icf/Dd/Clinics

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
05G457
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
June 6, 1990
Last certification survey
January 28, 2026
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.25 · LVN/LPN 1 · direct care 4.25 · all employees 5.5

State citations and penalties (CDPH)

5 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: 483.430(e)(2), W&I 4502(a), W&I 4502(b)(8) · Violation Jan 22, 2026 · Penalty #960023213 · Survey CSK011

    Status: Open

  • Class APatient Care

    Citation A (HSC 1424) · Violation Dec 27, 2016 · Penalty #960013049 · Survey 7ZUJ11

    Status: Closed · Not appealed

    $3,500

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Jun 30, 2002 · Penalty #960000990

    Status: Closed · Not appealed

    $800

  • Class BPatient Rights

    Citation B (HSC 1424) · Violation Aug 27, 2002 · Penalty #960000987

    Status: Closed · Not appealed

    $1,000

  • Class BPatient Rights

    Citation B (HSC 1424) · Violation May 9, 2001 · Penalty #960000915

    Status: Closed · Not appealed

    $1,000

Federal inspections (CMS-2567)

24 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. · Complaint

    Event 2351EE-H1 · 3 deficiencies (1 condition-level)

    Official 2567 ↗
  2. · Complaint, Recertification

    Event CSK011 · 8 deficiencies

    Official 2567 ↗
  3. · Recertification

    Event CSK021 · 8 deficiencies

    Official 2567 ↗
  4. · Complaint

    Event 4BJP11 · 1 deficiency

    Official 2567 ↗
  5. · Complaint

    Event 82D711 · 1 deficiency

    Official 2567 ↗
  6. · Recertification

    Event ITQK11 · 2 deficiencies

    Official 2567 ↗
  7. · Recertification

    Event ITQK21 · 5 deficiencies

    Official 2567 ↗
  8. · Recertification

    Event 64WS21 · 6 deficiencies

    Official 2567 ↗
  9. · Recertification

    Event 64WS11 · 1 deficiency

    Official 2567 ↗
  10. · Recertification

    Event MVZR21 · 9 deficiencies

    Official 2567 ↗
  11. · Recertification

    Event MVZR11 · 3 deficiencies

    Official 2567 ↗
  12. · Complaint

    Event 94T911 · 3 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

30 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 (complaint): 3 deficiencies, 1 condition-level(state record)

  2. ReportState Class B citation ($2,000)(state record)

  3. ReportFederal survey (complaint, recertification): 8 deficiencies(state record)

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

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

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

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

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

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

  10. ReportFederal survey (recertification): 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.