Monrovia Gardens Healthcare Center — Monrovia, CA

This page sets out what the federal inspection record says about Monrovia Gardens Healthcare Center, a 96-bed nursing home at 615 W. Duarte Rd., Monrovia, California. Every figure below is copied from data the Centers for Medicare & Medicaid Services (CMS) publishes about nursing homes that take Medicare or Medicaid. We have not added our own judgment to it.

The record at a glance

Federal ID (CCN)	055367
Legal business name	Ag Monrovia, LLC
Listed chain or group	Cambridge Healthcare Services
Address	615 W. Duarte Rd., Monrovia, CA 91016
Phone listed with CMS	(626) 358-4547
Ownership type	For profit – Limited Liability company
Certified beds	96
Average residents per day	79.6
Certified since	December 31, 1971
Overall CMS rating	1 out of 5
Health inspection rating	1 out of 5
Staffing rating	3 out of 5
Quality measures rating	3 out of 5
Total nursing staff turnover	50.5%
Most recent standard inspection	December 19, 2025

CMS scores nursing homes from one to five stars. The health inspection rating is set relative to other nursing homes in the same state, so a one-star home is in the bottom fifth in California, not the bottom fifth nationally. Staffing and quality measure ratings are scored against national thresholds.

Inspectors have cited this home 82 times since January 2024

1 of those was at severity level G or above — what CMS calls actual harm. 49 came from complaints rather than routine inspections. Every one of them is listed below, with its date and what the rule required.

Was somebody in your family at Monrovia Gardens Healthcare Center? Tell us what you saw. We will read the whole record for this home — including the parts not shown on this page — and tell you plainly what it says and what your options are. You can write to us here without anyone hearing you.

Inspection citations since January 2024

CMS records 82 health citations at this facility from inspections between May 9, 2024 and June 23, 2026.

Inspected	Tag	What the rule requires	Scope and severity	Status
Jun 23, 2026	F0757	Ensure each resident’s drug regimen must be free from unnecessary drugs. (complaint)	E — Pattern, Potential for more than minimal harm	Correction date Jun 25, 2026
Jun 23, 2026	F0552	Ensure that residents are fully informed and understand their health status, care and treatments. (complaint)	D — Isolated, Potential for more than minimal harm	Correction date Jul 13, 2026
Jun 4, 2026	F0676	Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. (complaint)	D — Isolated, Potential for more than minimal harm	Correction date Jun 5, 2026
Mar 3, 2026	F0698	Provide safe, appropriate dialysis care/services for a resident who requires such services. (complaint)	D — Isolated, Potential for more than minimal harm	Correction date Mar 23, 2026
Mar 3, 2026	F0687	Provide appropriate foot care. (complaint)	D — Isolated, Potential for more than minimal harm	Correction date Mar 23, 2026
Mar 3, 2026	F0657	Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (complaint)	E — Pattern, Potential for more than minimal harm	Correction date Mar 23, 2026
Jan 24, 2025	F0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (complaint)	G — Isolated, Actual harm	Correction date Feb 20, 2025

The wording in the third column is CMS’s own plain-language summary of the federal rule that was cited, not a description of what happened. This table shows every one of the 1 citation at actual-harm level or above, plus the 6 most recent of the rest. The other 75 are in the CMS file linked below.

How to read scope and severity

Every citation gets a letter from A to L. The letter carries two things at once: how serious the problem was, and how many residents it reached.

Severity	Isolated	Pattern	Widespread
Immediate jeopardy to resident health or safety	J	K	L
Actual harm	G	H	I
No actual harm, potential for more than minimal harm	D	E	F
No actual harm, potential for minimal harm	A	B	C

“Immediate jeopardy” is CMS’s term for a situation that has caused, or is likely to cause, serious injury, harm, impairment or death. It requires the home to act at once.

What this page does not tell you

• A citation is an inspector’s finding against a federal rule. It is not a court judgment, and the facility may be disputing it. Citations marked “under dispute” above are in CMS’s formal review process.
• Citation counts partly reflect how often a home was inspected and how many complaints were filed about it. A home with more citations has not automatically given worse care than one with fewer.
• Bigger homes have more residents, more staff and more inspections, so they tend to accumulate more citations.
• None of this says anything about the care any one resident received. A home with a clean record can still fail somebody, and a home with a bad record can be caring for your mother well.
• This is a snapshot. CMS updates these files monthly, and the figures here are from the file dated August 1, 2026.

Where this comes from

• Ratings, ownership, beds and penalties: CMS Provider Information dataset (4pq5-n9py), file dated August 1, 2026.
• Citations: CMS Health Deficiencies dataset (r5ix-sfxw), file dated August 1, 2026, filtered to inspections on or after January 1, 2024.
• This facility on the government’s own site: Medicare Care Compare.
• Retrieved August 29, 2026. Our method is set out in Editorial policy and How we count.

For the facility

If anything on this page is wrong, out of date or missing context, we will correct it. Monrovia Gardens Healthcare Center and anyone acting for it can reach the watchdog team through our corrections and right of reply page. We publish the response alongside the record.