Falls and unwitnessed fractures in a California nursing home: what the record shows, and what the law says

By our watchdog team · Reviewed by Defend Our Elders · Last checked October 2026

“She fell” is a description, not an explanation

Here is the sentence families hear on the phone: “We’re calling to let you know your mother had a fall.” Sometimes it’s followed by “she’s fine.” Sometimes it’s followed by a hospital name. And sometimes nobody calls at all, and the family finds the bruise, or the fractured hip, days later and has to ask what happened.

What a nursing home rarely volunteers is this: under federal rules, a fall inside a nursing home is never supposed to be a surprise. Every certified home is required to figure out who is at risk of falling — after surgery, on new medication, with dementia, with a walker — write real precautions into that person’s care plan, and then actually follow them. The inspection system has a name for that duty: F-689, the requirement that a home keep residents free of accident hazards and give each one adequate supervision and assistive devices. When inspectors find a home let someone fall who shouldn’t have been left alone, or never reassessed a resident who kept falling, they write a citation under it.

So when somebody’s mother falls in a nursing home, the starting question is not “how sad, she’s fragile.” It’s: what did the home know about her risk, what did it promise to do, and was anybody actually doing it that night?

What the inspection record shows in California

Our watchdogs read the federal inspection file for all 1,165 certified nursing homes in California. Since January 2024, inspectors have written 42,445 citations against those homes; 1,073 findings concluded a resident was actually harmed, and 279 reached immediate jeopardy — the level where a resident’s life or safety was on the line. (Source: CMS Provider Information and Health Deficiencies files dated August 1, 2026.) Falls are one of the most common ways a neglect case starts, because a fall is where thin staffing becomes visible: the call light that went unanswered, the bed alarm that was never set, the two-person transfer done by one person in a hurry.

The pattern is not spread evenly across the state. In Los Angeles County, 369 homes carry 20,566 citations with 572 actual-harm findings, and in Kern County 16 of 17 homes have at least one harm finding on the record — our arithmetic from the same file. Wherever your family lives, the county pages list every home’s record, and every facility page shows its serious findings with the inspection date and severity, straight from the federal file: Los Angeles County · Sacramento County · San Diego County · Orange County · Fresno County · Kern County · or start from the full California directory.

Why “unwitnessed” is the word that matters

An unwitnessed fall means exactly what it sounds like: nobody saw it happen. The resident was found on the floor — next to the bed, in the bathroom, in a hallway — and the home’s account of what happened is a reconstruction, not an observation. For a family, that word should prompt three questions. Who was supposed to be watching? If the care plan said she needed help to the bathroom, why was she making the trip alone? How long was she down? A home that can’t answer wasn’t making its rounds. What happened next? After a fall — especially a head strike for someone on blood thinners — the standard is prompt assessment, monitoring, and a doctor’s call, not helping her back to bed and noting it at shift change.

Repeat falls are their own red flag. One fall is an event; a second and third fall by the same resident means the home’s plan didn’t work and nobody fixed it — which is precisely what the federal rule exists to prevent. And a fractured hip, a broken wrist from catching herself, or bleeding in the brain is not a footnote to a fall: for an older person these injuries can be the turn in the road, which is why inspectors treat a serious fall injury as a signal about the home, not about the resident.

What the law says, in plain English

This is general information, not legal advice about your case — but here is the landscape a California family should know.

The home already owed this duty. Federal rules require every certified nursing home to assess each resident’s fall risk, plan real precautions, and supervise accordingly. A citation under F-689 is an inspector saying, in the government’s own file, that the home fell short of that duty.

California’s Elder Abuse Act has teeth. When neglect caused real harm — and a preventable fall that breaks a hip or injures a brain is often exactly that — California law lets a family hold the home financially responsible, and in serious cases the home can be made to pay beyond the medical bills. What her care plan said, what the staffing schedule shows for that shift, and what the charts say happened between the fall and the hospital usually decide how strong the case is.

The records are the evidence — and you can demand them. The fall-risk assessments, the care plan, the incident report, the staffing logs for that night, the neurological checks afterward. Under California law your family can request them, and the earlier the better — we send that written request for families the same day they ask.

There’s a clock. For most cases it’s generally two years, sometimes less depending on the facts and who ran the facility — and a death changes the arithmetic rather than ending it. Don’t try to calculate it yourself from an article; tell us the dates and we’ll tell you where the clock stands.

What to do this week if there’s been a fall

1. Get the medical side moving first — after any head strike or if she’s on blood thinners, push for imaging now, not at the next care conference. 2. Ask for the incident report and ask two questions: “What does her care plan say about falls?” and “Who was assigned to her last night?” A good home answers instantly. 3. Photograph the scene and the injury, with dates — the bruising pattern, the bed height, where the call light was. 4. Write down the timeline while it’s fresh: when you were called, what you were told, by whom. 5. Talk it through with us. Tell us what happened — we’ll tell you which agency to notify, help you file it, and request the records the same day. It’s free, and you’ll usually hear back by text within 15 minutes.

Questions families ask us about falls

The home says falls just happen with old people. Are they right?

Falls are common; preventable falls are the issue. The federal rule exists because the risk is known and manageable — the home is required to assess it and plan for it, person by person. The question is never “do old people fall,” it’s “did this home do what it promised for this resident.” That’s a question her chart answers, and we can help you get it.

Nobody saw my dad fall. Doesn’t that mean nobody’s responsible?

Often the opposite. If his care plan said he needed supervision or help transferring, an unwitnessed fall is itself the problem — it means the supervision the home promised wasn’t happening when it mattered. The incident report, the staffing log, and the care plan tell that story. Don’t accept “we don’t know what happened” as the end of it.

The home didn’t tell us about the fall — we found out at the hospital. Is that allowed?

Homes are required to notify a resident’s doctor and family promptly when there’s an injury. Finding out days later, or from a hospital, is worth documenting carefully: write down who told you what and when. It also tells you something about the home’s paperwork — which is exactly why we ask for the records early.

She’s fallen three times in two months. What should I be doing?

Ask for a care-plan meeting now and ask what changed after each fall — the home is required to reassess and adjust, not just log it. Repeat falls with no change in the plan is the pattern inspectors cite homes for. Bring a notebook, and if the answers are vague, tell us the dates.

My mom broke her hip in a fall and passed away a few weeks later. Is it too late to do anything?

Not necessarily — a family can often still bring a case after a death, and for an older person a hip fracture is frequently part of that story. The clock matters even more, so don’t wait to find out. Tell us the dates; it costs nothing to learn where you stand.

How do I find out if a home near me has been cited after falls?

Look the home up in our California directory — every page lists the home’s serious findings with dates and severity, plus a link to the full federal file, dated so you know exactly what you’re reading. If you’d rather we look, send us the home’s name and we’ll pull the record.

Where these numbers come from

Statewide and county counts on this page come from the CMS Provider Information and Health Deficiencies files dated August 1, 2026, covering citations issued since January 1, 2024. F-689 is the federal tag for the accident-hazards and supervision requirement in nursing home certification rules. We restate what the record says — read how we count, and if we got something wrong, tell us and we’ll fix it. If your family needs help now, start at our California help page.