Nursing HomeInspections

Royal Oaks Manor-Bradbury Oaks

Nursing home in Duarte, CA

Medicare & Medicaid certified4★ overall (CMS)

Call (626) 359-9371Send a messageMap ↗

Public-record details

Address
1763 Royal Oaks Drive, Duarte, CA 91010
Phone
(626) 359-9371
Listed under
Nonprofit, 4–5 star overall rating, Part of a retirement community
Medicare CCN
555503
Overall star rating
4 of 5 ★★★★☆
Health inspection rating
3 of 5
Staffing rating
5 of 5
Quality measures rating
4 of 5
Certified beds
48
Average residents per day
43
Ownership
Nonprofit, corporation
Legal business name
Humangood Socal
Chain
Humangood (17 facilities)
Certified for
Medicare and Medicaid
First approved by Medicare/Medicaid
Apr 15, 1992
Changed ownership in last 12 months
No
Continuing care retirement community
Yes
Located inside a hospital
No
Resident or family council
Resident council
Sprinklers in all required areas
Yes

CMS certification number 555503. Source: CMS Nursing Home Provider Information, Health Deficiencies and Penalties (record). Data as of 2026-09-30.

Inspection record

Most recent standard health inspection: Jan 2, 2026. CMS lists 42 health citations for this facility across its last three standard inspection cycles and complaint inspections (Nov 2, 2023 to Jan 2, 2026): 6 from complaint inspections, 2 at the “actual harm” level or higher.

InspectionCitationSeverity
Jan 2, 2026Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights
D
Potential for more than minimal harm, isolated
Jan 2, 2026Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning
D
Potential for more than minimal harm, isolated
Jan 2, 2026Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care
D
Potential for more than minimal harm, isolated
Jan 2, 2026Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Pharmacy Service
D
Potential for more than minimal harm, isolated
Jan 2, 2026Honor 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…
Resident Rights
E
Potential for more than minimal harm, pattern
Jan 2, 2026Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care
E
Potential for more than minimal harm, pattern
Jan 2, 2026Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service
E
Potential for more than minimal harm, pattern
Jan 2, 2026Provide and implement an infection prevention and control program.
Infection Control
E
Potential for more than minimal harm, pattern
Dec 1, 2025Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care · complaint inspection
E
Potential for more than minimal harm, pattern
Dec 1, 2025Make sure that a working call system is available in each resident's bathroom and bathing area.
Environmental · complaint inspection
E
Potential for more than minimal harm, pattern
Nov 15, 2024Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care
D
Potential for more than minimal harm, isolated
Nov 15, 2024Provide activities to meet all resident's needs.
Quality of Life and Care
D
Potential for more than minimal harm, isolated

Showing the 12 most recent of 42. Full inspection reports are on Medicare Care Compare.

Severity letters follow CMS's scope-and-severity grid: A–C potential for minimal harm, D–F potential for more than minimal harm, G–I actual harm, J–L immediate jeopardy. Most citations are corrected; a citation is what inspectors found on that date. Source: CMS Health Deficiencies file, processed Aug 1, 2026.

Fines and payment denials

CMS records 0 fines totalling $0 and 1 denial of Medicare payment for new admissions in the last three years.

Apr 15, 2024Payment denial for 15 days from May 14, 2024

Source: CMS Penalties file, processed Aug 1, 2026. Amounts are as CMS reports them and may reflect later reductions or appeals.

Staffing

Total nurse staffing per resident per day
4.81 hours
Registered nurse (RN) time per resident per day
0.61 hours
Nurse aide time per resident per day
2.67 hours
Total nurse staffing on weekends
4.44 hours
Nursing staff turnover (yearly)
31%
RN turnover (yearly)
38%
Administrators who left in the past year
0

From payroll-based staffing data the facility submits to CMS. Hours are per resident per day.

A citation is what inspectors found on one date; most are corrected within weeks. Look for patterns — the same problem cited in several inspections — and for anything at the G–L level (actual harm or immediate jeopardy). The full inspection narrative (Form CMS-2567) is linked from Medicare Care Compare, and your state long-term care ombudsman can tell you about complaints.

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