California is falling behind on required inspections of nursing homes and residential institutions for people with intellectual disabilities, according to a new state audit that found the state missed the mandated inspection timeline on more than three-quarters of surveys reviewed. The findings raise fresh questions about oversight at facilities that house some of the state's most medically vulnerable residents.
The California State Auditor examined 60 inspections conducted by the California Department of Public Health and found the state missed the required inspection standard on more than 75% of those reviewed, as reported by the Sacramento Bee. Facilities that accept Medicaid dollars, including nursing homes and intellectual disability care institutions, are supposed to be inspected roughly every 16 months, and states receiving those federal funds are required to inspect applicable facilities within that specified time frame, the newspaper's reporting shows.
Those recertification surveys are meant to check that facilities are meeting a range of baseline requirements, including accurate medication distribution, dietary services, bed maintenance, nursing services, and professionally directed activities for residents, according to the same reporting. When those checks lapse, according to Corey Engel, inspections provide oversight and accountability to protect resident health — a warning that underscores what's at stake when the surveys don't happen on schedule.
State Officials Point to Shutdown and Staffing Shortfalls
California Department of Public Health officials said reduced staffing capacity disrupted inspections, and they also pointed to a three-month federal government shutdown as a disruptive factor, the Sacramento Bee reported. That timeline lines up with a documented 43-day federal shutdown between October 1 and November 12, 2025, which halted non-essential federal operations and delayed state survey evaluations nationwide, according to CMS Compliance Group. In response, the Centers for Medicare and Medicaid Services issued updated guidance in January 2026 lowering the recertification frequency scoring threshold for state agencies from 100% to 80% to account for the disruption.
California's struggles are not unique. According to LeadingAge New York, half of state survey agencies nationwide failed to meet the federal requirement of inspecting every active nursing home at least once every 15.9 months in fiscal year 2024, with only 14 state agencies fully meeting the standard. State officials told the Sacramento Bee that shifting toward high-risk intakes over lower-tier recertification surveys aligns with the federal government's own approach, which establishes a tiered survey structure prioritizing immediate jeopardy complaints ahead of routine inspections.
Recruitment Drive Meets Pay-Cut Pushback
California officials said high-risk cases were prioritized over other inspections as vacancies mounted, and the state is now recruiting to fill the gap. As of this month, the California Department of Public Health is advertising for Registered Nurse Surveyors across 15 district offices, offering starting base salaries of $9,022 to $9,293 per month, a $200 monthly retention differential, and a $250 travel incentive for assignments in Los Angeles County, per CalCareers postings.
Labor representatives argue those incentives are undercut by other state policies. Under California's Personal Leave Program, implemented in July 2025, state nurse surveyors face a 3% monthly base pay reduction in exchange for paid leave credits through June 2027, according to CalCareers job listings. SEIU Local 1000 wants a contract that helps the state recruit and retain skilled public workers, including nurse surveyors, and the union and California are currently in contract negotiations, the Sacramento Bee reported. The Sacramento Bee also reported that California rejected proposals affecting the budget, including proposals aimed at retaining talent, according to a labor board filing.
Anica Walls said state workers cannot do the jobs that keep Californians safe without enough staff, and she said unfilled vacancies and growing workloads force professionals to prioritize the highest-risk situations, according to the Sacramento Bee's reporting. Routine inspections fall behind when vacancies go unfilled and workloads continue to grow, the newspaper's sourcing shows. The California Department of Public Health has said funding cuts, despite increased expectations placed on the agency, limit its ability to backfill staffing gaps with state resources.
A Pattern Stretching Back Years
This is not the first time CDPH's inspection practices have drawn scrutiny. A 2018 California State Auditor report warned that oversight gaps at the department contributed to a 31% increase in substandard care deficiencies and a 35% surge in serious harm or death incidents in state nursing homes between 2006 and 2015, according to the California State Auditor. That audit criticized the department for inconsistent licensing and for failing to issue timely citations. Even earlier, a March 2014 investigation found that Los Angeles County health officials had directed inspectors to administratively close nursing home complaints without full investigations in order to clear a backlog of more than 1,200 cases, as reported by KQED.
The stakes of the current backlog are significant given the scale of California's nursing home system. The state has roughly 1,200 licensed skilled nursing facilities caring for more than 400,000 residents annually, with semi-private room costs averaging $140,343 per year and Medi-Cal funding more than half of all stays, according to Brevy Care. Even as routine recertification surveys lagged, the state has moved aggressively against the most severe violations: CDPH initiated license suspensions in June 2025 for seven Los Angeles County nursing home operators that had received two AA citations — the state's highest penalty for violations linked to resident deaths — within two years, according to The Berberian Firm. Only 99 total AA citations have been issued statewide across roughly 1,200 facilities since 2020, per the same report.
Hoodline has previously covered multimillion-dollar jury verdicts against some of California's largest nursing home operators, as well as a Sacramento-area license revocation push tied to a fatal care failure at a memory care facility. Both cases point to the same underlying tension identified in the new audit: a regulatory system stretched thin trying to balance routine oversight against the most urgent, highest-risk complaints. The Centers for Medicare and Medicaid Services typically monitors corrective actions and audit reports going forward, and California facility inspectors have said they will focus on quality-of-care issues as the state works through its backlog.
