Operation Guardians: Long Term Care Justice and Advocacy


Operation Guardians was established in March 2000 as a project of the California Department of Justice. It is a multi-agency task force established and led by the Attorney General to conduct surprise, on-site inspections of California’s skilled nursing home facilities. This task force is made up of regulatory and law enforcement officials, such as district attorneys, city attorneys, fire marshals, building code inspectors, and geriatric care specialists.  The goal of the Operation Guardians team is to observe skilled nursing facilities in their every day routines to get an accurate measure of how they regularly operate. The team aims to “protect and help improve the quality of care for elderly and dependent adult residents by identifying and correcting violations of applicable federal, state, and/or local laws and regulations.” [1] 

What to Expect

The Operation Guardians team is usually comprised of five people:

  1. Two Special Agents from the Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse;

  2. One forensic auditor from the Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse;

  3. The local fire inspector and/or building code inspector; and

  4. A medical doctor specializing in geriatric medicine.

For their investigations, the Operation Guardians team generally uses the guidelines and survey tools developed by the Centers for Medicare and Medicaid Services, an agency of the United States Department of Health and Human Services. The team typically spends six hours observing the Facility. After auditing the Facility, the Operation Guardians team will meet with Facility administration for an exit interview, during which results of the investigation are shared.  At a later date the Facility will receive a letter documenting non-compliant practices. Additionally, based on the outcome of the initial visit, the Operation Guardians team may choose to conduct a re-visit to ensure the problems identified have been adequately resolved. Re-visit inspections typically last two to four hours and are conducted by a smaller team.

What Are They Looking For?

  • Environmental Observations: The environmental investigation covers all aspects of the physical environment of the Facility. Observations in this area range from fire safety to foul odors and availability of clean linens. 

  • Resident Care Observations: Clinical indicators are reviewed by the medical doctor on the team.  Resident care investigations involve both observations of residents and review of residents’ medical charts.  To assess resident care, the Operation Guardians team typically looks at the completeness of record documentation, the treatment authorization record in comparison with documented care, resident activity documentation, the physical condition of the resident in comparison to what is documented, and the frequency of resident falls. 

  • Administrative Observations: Administrative investigations entail a wide range of operational processes including, but not limited to, documentation in wound logs and nursing notes, the resident’s eligibility for skilled care and Facility contracts.

  • Staffing Observations: The Operation Guardians team reviews the nursing hours per resident day (NHPRD) calculations to ensure that the facility meets the state requirement of 3.2 NHPRD.  This also includes a review of licenses and certifications for all staff.


Operation Guardians reports are generally not released to the public; however, they can be requested and released. Although Operation Guardians reports do not require any corrective actions or response from the Facility, many Facilities choose to respond to the reports with letters citing corrective actions.  The Operation Guardians program does not have any authority to enforce changes within the Facility they do, however, forward their reports as complaints to the California Department of Public Health and other regulatory or law enforcement agencies for further investigation as they see fit.



[1] Bureau of Medi-Cal Fraud & Elder Abuse. Annual Report: Operation Guardians 2001 Annual Report For Northern California. Sacramento, California: California Department of Justice, 2001.