California falls behind on nursing home inspections, federal audit reveals

Corey Schmidt, The Sacramento Bee on Aug 10, 2026

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The system in charge of vetting California’s nursing homes is falling behind on facility inspections.

States receiving Medicaid dollars are required to inspect applicable facilities, such as nursing homes, within a certain time frame. A state auditor report released Wednesday showed The Golden State missed the bar on more than 75% of the inspection surveys reviewed for the 2024-25 fiscal year. The audit looked at 60 inspections by the California Department of Public Health.

California missed deadlines for nursing homes and residential institutions for those with intellectual disabilities, according to the audit report. These facilities should be inspected for recertification about every 16 months.

Inspections help provide oversight and accountability to protect resident health, said Corey Engel, a spokesperson for the California Association of Health Facilities. The audit said inspections ensure facilities adhere to Medicaid requirements that include providing nursing services, accurate medication distribution, dietary services, bed maintenance and professionally-directed activities.

California public health officials declined an interview, but responded within the audit. Department officials said inspections were thrown off by a three-month federal shutdown, reduced staffing capacity and prioritizing high-risk cases.

California facility inspectors will focus on quality-of-care issues going forward, according to the audit report. California officials said this approach “aligns with (the federal government’s) shift toward prioritizing ... high-risk intakes over lower-tier recertification surveys.”

In the report, CDPH said cuts to funding “despite increased expectations ... limit (its) ability to backfill gaps with state resources.”

The Centers for Medicare and Medicaid Services, which did not respond to The Bee’s inquiry, typically monitors corrective actions and audit reports.

California’s largest state worker union, SEIU Local 1000, wants a contract that will help the state recruit and retain skilled public workers, such as these nurse surveyors.

Negotiations are in progress, but the state rejected proposals that would affect the budget, including those aimed at retaining talent, according to a Public Employment Relations Board filing.

“This audit confirms what our members have been saying for years: State workers can’t do the jobs that keep Californians safe if there isn’t enough staff to do the work,” said union President Anica Walls in a statement. “When vacancies go unfilled and workloads continue to grow, these professionals are forced to prioritize the highest-risk situations, and routine inspections fall behind.”

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