Bedsores and Nursing Home Neglect

A bedsore is what the federal nursing home rules call a pressure ulcer. Both federal and California law make preventing them part of a nursing home's basic care, so a new pressure ulcer is something the facility must be able to explain. Our nursing home abuse and neglect page covers these claims in general.

This guide explains the rules a nursing home must follow, the records that show whether it did, and how a bedsore case fits within California's elder abuse and neglect laws.

How is a bedsore case looked at, step by step?

Document the wound. Note when you first saw it, where it is, and what staff said about it. Take dated photos with your parent's permission where they can give it.
Get the records. Ask in writing for the full chart. A provider must send copies within 15 days of a written request from the patient or the patient's personal representative (Health and Safety Code 123110).
Compare the care to the rules. The federal standard asks whether, based on a comprehensive assessment, the resident received care consistent with professional standards to prevent pressure ulcers, and, once one formed, treatment to promote healing, prevent infection and prevent new ones (42 CFR 483.25(b)(1)).
Look at staffing. Every skilled nursing facility must employ an adequate number of qualified personnel to carry out all of its functions (Health and Safety Code 1599.1(a)).
Report it. Complaints go to the Department of Public Health's district office; for Sonoma and Marin County that is the Santa Rosa office at 2170 Northpoint Parkway, (707) 576-6775. The county ombudsman can help as well, and our Sonoma County page lists other local agencies.
Weigh the claims. A bedsore can support a negligence claim, a claim of neglect under the Elder Abuse Act, and a residents' rights claim under Health and Safety Code 1430(b). Each has different elements and remedies.

What do the rules require, and which records show it?

Requirement	Source	Records to ask for
Care to prevent bedsores, good personal hygiene, and measures to prevent and reduce incontinence	Health and Safety Code 1599.1(b)	Care plan, bathing and hygiene records, incontinence care records
No new pressure ulcer unless the resident's clinical condition shows it was unavoidable	42 CFR 483.25(b)(1)(i)	Admission skin assessment, comprehensive assessment, risk assessments, repositioning and turning records
Treatment of an existing pressure ulcer to promote healing, prevent infection and prevent new ones	42 CFR 483.25(b)(1)(ii)	Wound care notes, measurements and photos, treatment orders, doctor notification
Acceptable nutrition and enough fluids	42 CFR 483.25(g)(1) and (2); Health and Safety Code 1599.1(c)	Weight records, meal and fluid intake charts, dietitian notes
Enough qualified staff	Health and Safety Code 1599.1(a)	Staffing schedules and assignment sheets for the weeks before the wound appeared
Medical care for physical health needs	Welfare and Institutions Code 15610.57(b)(2)	Physician orders and notes, hospital transfer records

When is a pressure ulcer "unavoidable"?

The federal rule puts the exception in its own words: a resident must not develop a pressure ulcer "unless the individual's clinical condition demonstrates that they were unavoidable" (42 CFR 483.25(b)(1)(i)). That exception is tied to the resident's condition, and the rule measures the facility's care against its own comprehensive assessment and professional standards of practice. A facility that says a wound could not have been prevented should be able to show what the assessment found, what the care plan called for, and that staff carried it out.

That is why the records matter more than the label. Turning schedules with gaps, weight loss that no one acted on, or a wound noted days before a doctor was told can show care that fell short, whatever the facility calls it. Records that were changed after the fact raise a different issue: willful material falsification or omission in a resident's health record is subject to its own civil penalty for skilled nursing facilities (Health and Safety Code 1424.5). Since 2026, a court that finds a facility intentionally altered or destroyed evidence may also lower the standard of proof in an Elder Abuse Act claim. Our guide on what changed in 2026 when a care facility destroys records explains that rule.

Is a bedsore neglect, or medical malpractice?

This question matters because the Elder Abuse Act's added remedies do not cover ordinary professional negligence. The Judicial Council's directions for CACI 3103 note that the Act does not extend to professional negligence by health care providers unless the provider had a substantial caretaking or custodial relationship with the elder, involving ongoing responsibility for basic needs.

A nursing home that turns, bathes, feeds and toilets a resident around the clock has that kind of relationship. A decision the Judicial Council cites under CACI 3103 explains that neglect under the Act refers not to substandard medical services but to the failure of those responsible for an elder's basic needs and comforts "to carry out their custodial obligations." Missed repositioning and unanswered skin changes can fit that description, while a surgical error is a different kind of claim. To reach the Act's added remedies, a family must also prove recklessness, oppression, fraud or malice by clear and convincing evidence; see what the Elder Abuse Act adds to a claim.

What does the state do with a complaint about a bedsore?

Once the Department of Public Health receives a complaint, it must tell the complainant within two working days which inspector is assigned and make an onsite inspection within 10 working days, or within 24 hours when there is a threat of imminent danger of death or serious bodily harm. It must complete the investigation within 60 days, with one extension of up to 60 days allowed, and notify the complainant in writing (Health and Safety Code 1420).

If it finds a violation, it issues a citation. For skilled nursing facilities, a class A citation carries $3,500 to $25,000, or $15,000 to $60,000 if a resident died, and a class AA citation, for a violation that was a substantial factor in a death, carries $30,000 to $120,000 (Health and Safety Code 1424.5). A citation does not compensate the resident, but it can help show what went wrong.

What changes the answer?

The wound was there on admission. The facility is not responsible for a wound it inherited, but it must still give treatment to promote healing, prevent infection and prevent new ulcers (42 CFR 483.25(b)(1)(ii)). The admission skin assessment becomes key evidence.

The resident was in assisted living. Assisted living is a non-medical setting licensed by the Department of Social Services, and the state may order a resident's relocation when a health condition cannot be cared for within the license (Health and Safety Code 1569.54). See who regulates nursing homes and assisted living.

Sedating drugs reduced her movement. Residents have the right to be free from psychotherapeutic drugs used for discipline or convenience or as a chemical restraint, outside a limited emergency (Health and Safety Code 1599.1(k)). See whether a nursing home can sedate a parent without consent.

The resident died. For cases filed since January 1, 2026, a survival claim generally cannot include pre-death pain and suffering, but that limit does not affect claims under the Elder Abuse Act (Code of Civil Procedure 377.34(f)). See elder abuse claims after a parent has died.

The facility is a hospital's skilled nursing unit. A distinct-part skilled nursing unit of a hospital counts as a long-term health care facility (Health and Safety Code 1418(c)), but the 2026 records rule does not apply to facilities owned or operated by a general acute care hospital (Welfare and Institutions Code 15657.02(b)(2)).

What could this look like? An example

For example, imagine a 79-year-old man admitted to a Sonoma County skilled nursing facility after a stroke. His admission skin assessment shows intact skin and rates him at high risk for pressure injuries, and his care plan calls for repositioning every two hours and a special mattress. Five weeks later his wife finds a deep wound on his tailbone. The chart shows the mattress was never ordered, the turning record has blank nights, and his weight dropped eight pounds with no dietitian note.

His wife requests the full chart, which must be sent within 15 days, files a complaint with the Santa Rosa office, and calls the ombudsman. A lawyer reviewing the case would compare the care plan to what the records show was done, and look at the staffing schedules for those nights. The resident's own claims could include negligence, neglect under the Elder Abuse Act if recklessness could be proven by clear and convincing evidence, and a residents' rights claim for the violations of his rights. This example is made up to show how the rules fit together; it says nothing about any real case.

What mistakes do families make with bedsores?

Accepting "it was unavoidable" without asking to see the assessments and care plan.
Waiting for the next care conference instead of reporting a deep or worsening wound now.
Asking only for wound care notes, and not for turning records, weights and staffing schedules.
Not keeping their own dated photos and notes of the wound's size and appearance.
Assuming the case is only medical malpractice, when the Elder Abuse Act may also apply.

What should we do this week?

Ask the nurse to show you the wound and tell you when it was first recorded.
Ask that the doctor be told and that a treatment plan be written.
Send a written request for the full chart, including assessments, turning records, weights and wound notes.
File a complaint with the Department of Public Health and call the county ombudsman.
Keep a dated log of what you see and who you speak with. For the full first-week list, see what to do this week if you suspect nursing home neglect.
Note the dates for any deadline; see how long a family has to bring an elder abuse claim.

Frequently asked questions

Are "bedsores," "pressure ulcers" and "pressure injuries" the same thing?

In everyday speech, yes. The federal nursing home rule uses "pressure ulcers," and California's patient's bill of rights uses "bedsores" (42 CFR 483.25(b)(1); Health and Safety Code 1599.1(b)).

Does this apply to every nursing home in California?

California's bedsore rule in section 1599.1(b) applies to skilled nursing and intermediate care facilities. The detailed federal standard in 42 CFR 483.25 applies to facilities that take Medicare or Medi-Cal.

What is a residents' rights claim worth for a bedsore?

The licensee can be liable for up to $500 per violation, plus costs and attorney's fees, considering how serious each violation was and the risk of pain or indignity it created (Health and Safety Code 1430(b)). See the residents' rights claim against a nursing home.

Can we bring a claim if the wound healed?

Possibly. Harm is an element of a neglect claim (CACI 3103), and a wound that healed may still have caused pain and required treatment. A residents' rights claim looks at the violations themselves (Health and Safety Code 1430(b)).

Who can bring the claim if our parent cannot?

The resident's legal representative, personal representative or successor in interest can bring a residents' rights claim (Health and Safety Code 1430(b)), and the same statute makes the licensee liable for its employees' acts.

What if a bedsore led to a fall or an infection that sent him to the hospital?

Each harm can be part of the claim if the facility's failure helped cause it. Falls in a different setting are covered in our guide on falls in assisted living.

If your loved one developed bedsores in a nursing home, contact Young Law Group today at (707) 343-0556 or through our contact page for a free consultation.

Are bedsores a sign of nursing home neglect in California?