About Pasadena Palace Tcu
Pasadena Palace Tcu, located in PASADENA, CA, is a for-profit organization that accepts Medicare and Medicaid.
Why Families Choose Pasadena Palace Tcu
- More Nursing Time: Staff spends 4.38 hours per resident daily (National Avg: 3.87).
Key Performance Indicators
- CMS Overall Rating 2 Stars
- Nursing Hours 4.38 hrs
- Safety Record Clean
Chain Affiliations & Network
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Nursing Staff Analysis
Staffing levels are a critical indicator of quality care. We analyze the daily hours of care provided by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs).
Mixed Staffing Levels
Pasadena Palace Tcu provides less care hours than the state average and more than the national average.
Registered Nurses (RN)
Licensed Practical Nurses
Certified Assistants
CMS Quality Ratings
| Category | Rating | Stars |
|---|---|---|
| Overall Rating | 2 |
|
| Health Inspection | 2 |
|
| Quality Measures | 2 |
|
| Staffing | 3 |
|
Health Inspection History
| Inspection Cycle | Score | Date |
|---|---|---|
| Cycle 1 (Most Recent) | 84 | Nov 19, 2025 |
| Weighted Average | 148 | Combined Score |
Detailed Quality Measures
Rates are from CMS quality measures (claims-based and MDS-based) for the reporting period ending Jun 01, 2026. Some measures may be omitted when CMS does not report a numeric rate for this facility.
Medicare claims-based measures
Typically includes short-stay outcomes, hospitalizations, and ED use from Medicare claims.
| Measure | Rate |
|---|---|
| Percentage of short-stay residents who were rehospitalized after a nursi... (QM521) | 18.4% |
| Percentage of short-stay residents who had an outpatient emergency depar... (QM522) | 12.4% |
| Number of hospitalizations per 1000 long-stay resident days (QM551) | 5.6% |
| Number of outpatient emergency department visits per 1000 long-stay resi... (QM552) | 2.5% |
MDS-based measures
Resident assessment data; often used for long-stay care quality.
| Measure | Rate |
|---|---|
| Percentage of long-stay residents whose need for help with daily activit... (QM401) | 23.1% |
| Percentage of long-stay residents who lose too much weight (QM404) | 13.7% |
| Percentage of long-stay residents with a catheter inserted and left in t... (QM406) | 1.9% |
| Percentage of long-stay residents with a urinary tract infection (QM407) | 2.4% |
| Percentage of long-stay residents who have depressive symptoms (QM408) | 2.7% |
| Percentage of long-stay residents who were physically restrained (QM409) | 0.0% |
| Percentage of long-stay residents experiencing one or more falls with ma... (QM410) | 1.4% |
| Percentage of long-stay residents assessed and appropriately given the p... (QM415) | 99.5% |
| Percentage of short-stay residents assessed and appropriately given the... (QM430) | 94.2% |
| Percentage of short-stay residents who newly received an antipsychotic m... (QM434) | 0.9% |
| Percentage of long-stay residents whose ability to walk independently wo... (QM451) | 8.9% |
| Percentage of long-stay residents who received an antianxiety or hypnoti... (QM452) | 13.9% |
| Percentage of long-stay residents assessed and appropriately given the s... (QM454) | 100.0% |
| Percentage of short-stay residents who were assessed and appropriately g... (QM472) | 98.6% |
| Percentage of long-stay residents with pressure ulcers (QM479) | 6.0% |
| Percentage of long-stay residents with new or worsened bowel or bladder... (QM480) | 8.2% |
| Percentage of long-stay residents who received an antipsychotic medicati... (QM481) | 19.3% |
Complaints & Deficiencies
Complaint History by Year
This chart shows the number of complaints filed each year.
Summary:
- 2023: 4 complaints
- 2024: 15 complaints
- 2025: 23 complaints
- 2026: 1 complaint
- Total: 43 complaints on record
Recent Complaints (Since Jan 2023)
| Date | Description |
|---|---|
| Jan 15, 2026 | 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. |
| Dec 12, 2025 | Limit the charges against residents' personal funds for items or services for which payment is made under Medicare or Medicaid. |
| Aug 08, 2025 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. |
| Jun 12, 2025 | Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. |
| Jun 11, 2025 | Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. |
| Jun 11, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| May 11, 2025 | Implement a program that monitors antibiotic use. |
| May 11, 2025 | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. |
| May 11, 2025 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. |
| May 11, 2025 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. |
| May 11, 2025 | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. |
| May 09, 2025 | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. |
| May 09, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| Apr 25, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| Apr 25, 2025 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. |
| Apr 25, 2025 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. |
| Apr 08, 2025 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. |
| Mar 21, 2025 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. |
| Mar 21, 2025 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. |
| Feb 20, 2025 | Provide appropriate treatment and care according to orders, resident?s preferences and goals. |
| Feb 01, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| Jan 31, 2025 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. |
| Jan 31, 2025 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. |
| Jan 31, 2025 | 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. |
| Dec 01, 2024 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. |
| Oct 18, 2024 | 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. |
| Oct 18, 2024 | Ensure that the resident and his/her doctor meet face-to-face at all required visits. |
| Oct 18, 2024 | Provide and implement an infection prevention and control program. |
| Oct 04, 2024 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. |
| Oct 04, 2024 | Provide appropriate treatment and care according to orders, resident?s preferences and goals. |
| Oct 02, 2024 | Ensure services provided by the nursing facility meet professional standards of quality. |
| Sep 19, 2024 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. |
| Sep 19, 2024 | Reasonably accommodate the needs and preferences of each resident. |
| Aug 30, 2024 | Provide and implement an infection prevention and control program. |
| Aug 06, 2024 | 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. |
| Aug 06, 2024 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. |
| May 29, 2024 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. |
| Jan 15, 2024 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. |
| Jan 15, 2024 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. |
| Oct 31, 2023 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. |
| Sep 01, 2023 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. |
| Jul 05, 2023 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. |
| Jul 01, 2023 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. |
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Owner & Operator Information
Business Entity
GEM HEALTHCARE, LLC
Ownership Structure
- GRACE MERCADO Direct: NO PERCENTAGE PROVIDED
- RUPERTO OUANO Direct: NO PERCENTAGE PROVIDED
Management & Direction
- GRACE MERCADO CORPORATE OFFICER
- GRACE MERCADO OPERATIONAL/MANAGERIAL CONTROL
- RUPERTO OUANO CORPORATE OFFICER
- RUPERTO OUANO OPERATIONAL/MANAGERIAL CONTROL
- SAINT CABRINI HEALTHCARE SERVICES LLC OPERATIONAL/MANAGERIAL CONTROL
- YOLANDA SAMBILE CORPORATE OFFICER
Associated Doctors
Local Comparison
| Facility | Distance | Rating |
|---|---|---|
| Clear View Convalescent Center | N/A | 5 |
| Torrance Memorial Med Ctr Snf/dp | N/A | 5 |
| Mount San Antonio Gardens | N/A | 5 |
| Pih Health Good Samaritan Hospital D/p Snf | N/A | 5 |
| Glendale Adventist Medical Center Dp/snf | N/A | 5 |
| Beacon Healthcare Center | N/A | 5 |
| Sun Mar Nursing Center | N/A | 5 |
| East Los Angeles Doctors Hosp | N/A | 5 |
| Long Beach Post Acute | N/A | 5 |
| Presbyterian Intercomm Hosp Dp/snf | N/A | 5 |
Related Analysis
Best Nursing Homes in PASADENA, CA
Compare Pasadena Palace Tcu to the top-rated facilities in the area.
Ownership Details
Complete list of registered owners, including direct and indirect ownership.
Noted Deficiencies
Detailed history of deficiencies with descriptions and correction dates.
Nursing Hours Analysis
Detailed breakdown of staffing hours per resident by role.
Frequently Asked Questions
- Skilled Nursing Care: 24/7 medical supervision and complex medical treatments
- Long-term Residential Care: Assistance with daily living activities for extended stays
- Short-term Rehabilitation: Recovery services after hospital stays or surgeries
- Memory Care: Specialized programs for residents with dementia and Alzheimer's disease
- Level of care needed (skilled nursing vs. long-term care)
- Room type (private vs. semi-private)
- Insurance coverage (Medicare, Medicaid, private insurance)
- Length of stay and specific services required
For current rates and to discuss payment options, contact Pasadena Palace Tcu directly at 6267370560. Their admissions team can help determine coverage and out-of-pocket expenses.
Environment & Cleanliness
- Overall cleanliness and odors
- Resident room conditions
- Common area maintenance
- Safety features and accessibility
Staff & Care Quality
- Staff-to-resident ratios
- How staff interact with residents
- Response time to resident needs
- Staff knowledge and professionalism
Ask to speak with current residents and their families, tour at different times of day, and review the facility's most recent inspection reports.