Can a Nursing Home Be Held Responsible for Bedsores in California?

What a pressure injury is, and why the stage matters

A pressure injury, also called a bedsore, pressure ulcer, or pressure sore, is skin and tissue damaged by pressure or rubbing that lasts too long and reduces blood flow to the area. It tends to form where bone is close to the skin: the buttocks, hips, heels, ankles, elbows, shoulders, back, and back of the head. A resident who cannot change position without help, cannot control bladder or bowels, is poorly nourished, or has a condition that affects blood flow or mental state is at greater risk.

Clinicians stage pressure injuries by severity. Stage 1 is a red area of skin that does not turn white when pressed. Stage 2 is a blister or open sore. Stage 3 is a deeper crater in which fat may be visible. Stage 4 reaches muscle and bone, and sometimes tendons and joints. Two other categories fall outside the stages: a wound covered by dead tissue, which is unstageable because its depth cannot be seen, and a deep tissue injury, a dark purple or maroon area that can quickly become a Stage 3 or 4 wound.

The stage history often matters as much as the wound itself. A chart that first records a wound at Stage 3 or 4, with no earlier skin assessments describing redness or a blister, raises the question of what staff were checking and when. A wound that worsened while the resident was in the facility puts the treatment that followed under review. Dated photographs, measurements, and the timing of each assessment usually tell that story.

What the nursing home must do

Nursing homes that participate in Medicare or Medi-Cal must meet the federal requirements for long-term care facilities in 42 CFR Part 483 (§ 483.1). For pressure injuries the rule is specific. Based on a comprehensive assessment of the resident, the facility must ensure that the resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop them unless the resident’s clinical condition demonstrates that they were unavoidable. A resident who has one must receive the treatment and services necessary to promote healing, prevent infection, and prevent new ulcers from developing (§ 483.25(b)(1)).

Prevention generally involves assessing each resident’s risk, writing a care plan that addresses it, and carrying the plan out: repositioning, pressure-relieving mattresses and cushions, regular skin checks, prompt incontinence care, and attention to nutrition and hydration. The regulation sets the standard; the chart shows whether the facility met it.

State oversight applies as well. The California Department of Public Health oversees licensed health facilities, including nursing homes, investigates complaints about them, and publishes each facility’s performance history, including complaints, deficiencies found by its inspectors, and enforcement actions, in its Cal Health Find database.

Neglect under California’s Elder Abuse Act

The Elder Abuse and Dependent Adult Civil Protection Act protects people 65 and older (Welfare and Institutions Code § 15610.27) and dependent adults from 18 to 64, a group that includes anyone in that age range admitted as an inpatient to a 24-hour health facility such as a skilled nursing facility (§ 15610.23). Neglect is the negligent failure of a person who has the care or custody of an elder or dependent adult to exercise the degree of care a reasonable person in a like position would exercise. It includes failing to assist with personal hygiene, to provide medical care for physical and mental health needs, to protect from health and safety hazards, and to prevent malnutrition or dehydration (§ 15610.57).

The Act adds remedies when the proof goes further. If neglect is proven, generally by clear and convincing evidence, and the defendant was also guilty of recklessness, oppression, fraud, or malice, the court must award reasonable attorney’s fees and costs, in addition to all other remedies the law provides (§ 15657(a)). Against an employer, such as the company that operates the facility, those remedies also require the proof Civil Code § 3294(b) demands: for a corporation, an officer, director, or managing agent must have known in advance that an employee was unfit and employed the employee with conscious disregard of others’ rights or safety, authorized or ratified the conduct, or been personally guilty of oppression, fraud, or malice (§ 15657(c)).

If the resident has died and that heightened standard is met, the limits that Code of Civil Procedure § 377.34 places on damages in a deceased person’s claim do not apply, so the claim can include the pain and suffering the person endured before death, up to a limit set by statute (§ 15657(b)). The family may also have a separate wrongful-death claim.

Custodial neglect or medical malpractice

A licensed nursing facility is also a “health care provider” as Code of Civil Procedure § 340.5 defines the term, and the Elder Abuse Act uses that definition to draw a dividing line: a claim against a health care provider based on its alleged professional negligence is governed by the laws that apply specifically to professional negligence (Welfare and Institutions Code § 15657.2). Those laws include a different filing deadline (§ 340.5) and a statutory limit on non-economic damages (Civil Code § 3333.2).

Claims about the basic custodial care a facility owes, such as turning and repositioning, hygiene, feeding, hydration, and supervision, can fall under the Elder Abuse Act. Claims about a provider’s professional judgment, such as a physician’s diagnosis or a treatment decision, are usually medical malpractice. Many bedsore cases involve both, and how the evidence fits each category affects the deadlines and the remedies available.

Records and evidence

The facility’s chart is usually the central evidence: admission and risk assessments, the care plan, turning and repositioning records, skin and wound assessments with measurements and stages, wound photographs, nursing notes, physician orders, treatment and medication records, dietary and weight records, staffing records, and incident reports. Hospital records from a transfer often document the wound’s condition on arrival.

Federal rules give a resident the right to access the resident’s own records within 24 hours of a request, excluding weekends and holidays, and to obtain copies on two working days’ notice for a reasonable, cost-based fee (42 CFR § 483.10(g)(2)). After a resident’s death, who may request the chart depends on privacy law and the family’s legal role, so it is worth asking early. Families should also keep their own dated photographs, notes of conversations with staff, and messages with the facility.

Since January 1, 2026, the handling of records can also change the burden of proof. If a judge or arbitrator finds that a skilled nursing facility, or certain licensed residential care facilities, intentionally destroyed, concealed, or altered records it was required to keep, to prevent their use in the case, the court may apply the lower preponderance-of-the-evidence standard to the Act’s enhanced remedies (Welfare and Institutions Code § 15657.02). The rule has conditions and exceptions, including for facilities operated by hospitals.

Reporting suspected neglect, and deadlines

Safety comes first; in an emergency, call 911. Anyone may report suspected abuse or neglect in a long-term care facility to the Long-Term Care Ombudsman program, local law enforcement, or both, and suspected abuse anywhere else to the county Adult Protective Services agency or local law enforcement (Welfare and Institutions Code § 15631). Long-term care facilities must post the number of the local ombudsman office and the statewide ombudsman hotline. A complaint about a nursing home can also be filed with the California Department of Public Health.

Deadlines depend on the claim. Many injury and neglect claims must be filed within two years (Code of Civil Procedure § 335.1), and a wrongful-death claim generally within two years of the death. A professional-negligence claim against a health care provider must be filed within three years of the injury or one year after the injury was discovered, or reasonably should have been, whichever comes first, subject to limited exceptions (§ 340.5). A claim against a public facility generally requires a written government claim within six months (Gov. Code § 911.2). Which rule applies, and when each period began, should be worked out from the complete facts as early as possible.