California Sunshine Rcfe
RCFE · Memory Care
A Residential Care Facility for the Elderly (RCFE) is a non-medical residential care home licensed by California CDSS under Health & Safety Code §1560. Residents receive help with daily living activities such as bathing, dressing, and medication management. An RCFE with a Memory Care designation is additionally required by California Title 22 (§87705 and §87706) to provide specialized staff training in dementia care, individualized care plans for residents with cognitive impairment, and appropriate supervision protocols — requirements that go beyond a standard RCFE license.
5837 Mitchell Canyon Ct. · Clayton, 94517
Quick facts
Quality snapshot
Updated April 25, 2026Compared to 182 California RCFE memory care facilities of similar size, over the last 36 months.
Source: California Department of Social Services, Community Care Licensing Division. View raw inspection records →
Quality grade· click to show how this was calculated
Severity38thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency6thDeficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
Quality grade· click to show how this was calculated
Weighted citations per bed
Repeat deficiencies as share of total
Deficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
California Sunshine Rcfe scores C−. Better than 48% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: 38th percentile. Repeats: top 0%. Frequency: bottom 6%.
Each metric is converted to a 0–100 percentile within the peer set (higher = better). The composite grade averages all four. Peer set: CA / rcfe_memory_care / small beds (182 facilities).
Citation severity over time
↓ improvingWeighted severity score per month · 24 months
Weighted score (24mo)
54
Last citation
May 25
Finding distribution
11 total · 36 monthsScope × Severity (CMS A–L)
The rules that apply to this facility
California Title 22 requirements for this facility, with the specific regulation and a suggested question for each.Rules this facility has been cited for are shown first.
What dementia-care training must staff complete?Cited Apr 202222 CCR §87705 / HSC §1569.625
Because this facility markets dementia or Alzheimer's care, state law mandates higher training standards:
- 12 hours initial dementia training — 6 hours before a staff member works independently with residents, 6 more within the first 4 weeks.
- 8 hours annual dementia in-service — required every year thereafter.
- Administrator CE — the administrator must include 8 hours of dementia-specific continuing education in every 2-year recertification cycle.
Training must cover individualized care plans, behavioral expressions, appropriate supervision, and the facility's dementia care philosophy.
Ask on tour: Ask how dementia training records are kept — families may request documentation.
What must this facility report to the state — and how fast?Cited Apr 202222 CCR §87211 / WIC §15630
- ImmediateElopement, fire, epidemic outbreak, or poisoningImmediately
- 2 hoursAbuse with serious bodily injury2-hour phone report + 2-hour written report — to the California Department of Social Services (CDSS), Adult Protective Services, and law enforcement
- 24 hrsAbuse without serious bodily injuryWithin 24 hours
- Next dayDeath of a residentPhone by next working day; written within 7 days
- Next dayInjury requiring medical treatment beyond first aidPhone by next working day; written within 7 days
- WrittenBankruptcy, foreclosure, eviction, or utility shutoff noticeWritten notice to CDSS and residents — $100/day penalty (max $2,000) for failure
Your enforcement lever:Incidents that aren't reported on time are themselves a separate violation. If you believe a reportable event wasn't filed, you can submit a complaint directly to the California Department of Social Services (CDSS).
How many staff must be on duty overnight?22 CCR §87415
Based on 6 licensed beds:
One qualified staff member must be on call and physically on premises at all times overnight.
Violation pattern to watch for:A facility that documents a staff member as "on call" but with that person physically off-site — when the law requires on-premises presence — is in violation of this section.
Ask on tour: Ask the facility to walk you through their overnight staffing plan and confirm whether on-call staff are on premises or off-site.
What health conditions can this facility legally accept or refuse?22 CCR §87612–87615
Restricted — allowed with physician order + care plan
- Supplemental oxygen
- Insulin and injectable medications
- Indwelling or intermittent catheters
- Colostomy / ileostomy
- Stage 1 and Stage 2 pressure injuries
- Wound care (non-complex)
- Incontinence
- Contractures
Prohibited — facility must refuse or discharge
- Stage 3 or Stage 4 pressure injuries
- Feeding tubes (PEG, NG, or J-tube)
- Tracheostomies
- Active MRSA or communicable infections requiring isolation
- 24-hour skilled nursing needs
- Total ADL dependence with inability to communicate needs
A hospice waiver (HSC §1569.73) can allow continued care for residents on hospice who would otherwise fall into a prohibited category.
Ask on tour: Ask whether your loved one's specific care needs are restricted or prohibited, and what the facility's process is if needs change after admission.
How does CDSS enforce these rules?22 CCR §87755–87777 / HSC §1569.58
- 1Notice of DeficiencyWritten citation with a correction deadline. Facility must submit a Plan of Correction.
- 2Civil PenaltyStarts at $50/day for non-serious; $150/day for serious deficiencies — immediately, with no grace period. Repeats escalate to $150 first day + $50/day, then $1,000 first day + $100/day.
- 3Suspension of AdmissionsFacility cannot accept new residents until violations are corrected.
- 4Temporary Suspension or RevocationEmergency suspension for imminent danger; full revocation after administrative hearing.
- 5Exclusion OrderAdministrator and operator can be barred from all CDSS-licensed facilities — not just this one.
See how these rules have been applied to this specific facility:
View state inspection record and citationsState records
California Dept. of Social Services · Community Care Licensing- License number
- 079200335
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Sylvia Usa, Llc
Inspections & citations
7
reports on file
19
total deficiencies
4
Type A (actual harm)
3
dementia-care citations
InspectionMay 20, 2025Type A7 deficiencies
Plain-language summary
On May 20, 2025, inspectors made an unannounced routine annual inspection and found the facility generally clean and safe, with working smoke and carbon monoxide detectors, grab bars, and fire equipment in place. However, inspectors identified several documentation and training problems: two residents were missing required medical assessments, TB tests, or care plans; two staff members lacked required health screenings; no staff on duty had current CPR and First Aid certification; and one resident's medical file was outdated and did not match their actual condition. The inspector also observed that knives, cleaning supplies, and gardening tools were left unlocked during the initial tour, though the manager locked them immediately when notified.
View full inspector notes
On 5/20/2025 at 11:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Manager, Mateaki Ofahengaue and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, and outdoor area. Smoke and carbon monoxide detectors were observed. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 112.1 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mats/materials in the bathrooms. Resident rooms were observed to be cleaned and fully furnished. Fire extinguisher was observed to be full. First Aid kit is complete. Last fire drill was conducted on 3/15/2025. LPA reviewed 2 residents and 3 staff files starting at 12:30PM. LPA reviewed a sample of resident's medications during inspection. At 11:30AM, LPA observed unlocked knives drawer, unlocked cleaning supplies in bathrooms, and unlocked gardening tools in the backyard. Manager locked up the items during inspection. At 12:40PM, LPA observed R1 does not have admission agreement on file. At 12:45PM, LPA observed R2 does not have medical assessment and TB test on file. At 12:50PM, LPA observed R1 and R2 does not have current reappraisal needs and service plan on file. (Continue on LIC809C...) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 At 1:15PM, LPA observed S2 and S3 does not have health screening and S2 does not have TB test on file. At 1:20PM, LPA observed no staff on duty have current CPR and First Aid training. At 2:00PM, LPA observed R1's medical assessment states that R1 is bedridden and on hospice care. LPA was informed by manager that R1 is no longer on hospice care. The facility does not have a bedridden fire clearance. Interview with R1 revealed that R1 can move side and side independently. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Mateaki. A copy of this report, civil penalty, and appeal rights were provided.
Regulation
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
Inspector finding
Based on observation, the licensee did not comply with the section cited above by having unlocked knives, cleaning supplies, and unlocked gardening which poses an immediate health and safety risk to persons in care. POC Due Date: 05/21/2025 Plan of Correction 1 2 3 4 Manager locked up the items during inspection. Deficiency cleared. Civil penalty of $250 is being assessed for a repeat violation.
Regulation
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after e…
Inspector finding
Based on record review, the licensee did not comply with the section cited above by not having health screening and TB test which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility agreed to obtain health screening for S2 and S3, and TB test for S2. Facility will submit documents to CCLD by POC date.
Regulation
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staf…
Inspector finding
Based on record review, the licensee did not comply with the section cited above by not having current CPR and First Aid training for staff which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility has agreed to obtain current CPR and First Aid training for S2 and S3. Facility will submit documents to CCLD by POC date.
Regulation
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.
Inspector finding
Based on record review, the licensee did not comply with the section cited above by not having medical assessment and TB test for R2 which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility has agreed to obtain medical assessment and TB test for R2. Facility will submit documents to CCLD by POC date.
Regulation
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will rece…
Inspector finding
Based on record review, the licensee did not comply with the section cited above by not having current reappraisal needs and service plans for residents which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility has agreed to obtain current needs and service plans for R1 and R2. Facility will submit the documents to CCLD by POC date.
Regulation
(d) The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This does not apply to rate increases which have specific notification requirements as specified in Health and Safety Code section 1569.655.
Inspector finding
Based on record review, the licensee did not comply with the section cited above by not having admission agreement for R1 which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility agreed to obtain R1's admission agreement and submit a copy to CCLD by POC date.
Regulation
(b) The licensee shall obtain an updated medical assessment when required by the Department.
Inspector finding
Based on interview and record review, the licensee did not comply with the section cited above by not having an updated medical assessment for R1 with current ambulatory status which poses a potential health and safety risk to persons in care. POC Due Date: 06/13/2025 Plan of Correction 1 2 3 4 Facility agreed to obtain an updated medical assessment for R1 with current ambulatory status and submit a copy to CCLD by POC date.
ComplaintMay 20, 2025· UnsubstantiatedNo deficiencies
Inspector: Grace Luk
Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.
Plain-language summary
This was a complaint investigation into claims that staff failed to provide appropriate care, resulting in skin tears on a resident. The investigator found no preponderance of evidence to substantiate the allegations, though the facility was noted to lack a current care plan documenting the resident's specific needs.
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Staff failed to provide appropriate care resulting in resident skin tears Facility did not have a current appraisal needs and service plan for R3 to indicate specific care needs. Interview with resident (R3) revealed that R3 can reposition and turn independently, but staff have assisted R3 in transfers. R3 stated staff will provide assistance when asked. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted with Mateaki. A copy of this report provided.
InspectionJune 12, 2024Type A4 deficiencies
Inspector: Tonica Syess-Gibson
Plain-language summary
During a routine annual inspection on June 12, 2024, inspectors found four safety issues: medication left unlocked in the kitchen, a swimming pool gate without a secure lock, cleaning supplies left unlocked and accessible in a bathroom, and a resident's bed equipped with only a half bed rail instead of a full rail. The facility was given until June 19, 2024 to submit documentation showing how these problems were corrected.
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On 06/12/2024 at 11:10AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct an Annual 1-Year required inspection. LPA met with Maupuku Ofahengaue, Caregiver and explained the purpose of the visit. Maupuku, caregiver contacted the administrator via telephone and explained my purpose of visit. Crystal Vaka, Administrator, arrived at 11:54AM. Administrator currently holds a certificate #6051305740 Expires 04/03/2025. The facility’s fire clearance was approved for six (6) Non ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and four (4) bathrooms. LPA did observe an enclosed swimming pool in the backyard. A comfortable temperature is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 103.9 degrees Fahrenheit. Residents' bathrooms are equipped with grab bars and nonskid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/24/2023. Emergency Disaster Plan was last posted on 09/01/2023. First aid kit was observed to be complete. Fire drill last conducted on 09/01/2023. Continued LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continue from LIC809 LPA reviewed all three (3) residents records and three (3) staff records were reviewed. LPA also reviewed a sample of medication LPA requested the following documents to be submitted to CCLD by 06/19/2024. · LIC 200 Application for a Community Care Facility ..... · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (last page) · Liability Insurance · Updated Facility Sketch LPA observed the following deficiencies: At 11:46AM LPA observed unlocked medicine in cabinet located in the kitchen area At 12:00PM LPA observed a swimming pool in the back yard with unsecured lock around the gate At 12:10PM LPA observed an unlocked cabinet the common bathroom with windex and pine sol and fabuloso antibacterial multi purpose cleaner on counter near sink At 12:28PM LPA observed resident in room #2 in a medical bed with a Half (1/2) bed rail Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy the appeal rights, and the report provided.
Regulation
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
Inspector finding
Based on observation, the licensee did not comply with the section cited above in having cleaning solutions such as windex and pine sol in an unlocked cabinet in common bathroom and fabuloso antibacterial multi purpose cleaner on counter near sink which poses an immediate health, in a safety or personal rights risk to persons in care. POC Due Date: 06/13/2024 Plan of Correction 1 2 3 4 Administrator removed the cleaning solutions and placed in a locked cabinet during visit. Deficiency cleared
Regulation
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: 2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
Inspector finding
Based on observation, the licensee did not comply with the section cited above in having medications in an unlocked cabinet located in the kitchen which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 06/13/2024 Plan of Correction 1 2 3 4 Staff immediately locked cabinet with medication during visit. Deficiency cleared.
Regulation
(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools or similar bodies of water, when not in active use by residents, through fencing, covering or other means.
Inspector finding
Based on observation, the licensee did not comply with the section cited above in having an unsecured lock around the fence of the pool which poses a potential health, safety risk to persons in care. POC Due Date: 06/19/2024 Plan of Correction 1 2 3 4 Administrator agreed to purchase a secure lock and provide photos to CCLD by POC date.
Regulation
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.
Inspector finding
Based on observation, the licensee did not comply with the section cited above in having a medical bed in Resident's room#2 that extends from the head half the length of the bed without a medical order or order summary which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/19/2024 Plan of Correction 1 2 3 4 Administrator agreed to provide an email of the order summary and or Physician orders for medical bed for resident in room#2 to CLLD by POC date
InspectionApril 14, 2023Type B1 deficiency
Inspector: Paris Watson
Plain-language summary
A routine annual inspection on April 14, 2023 found that the facility's bedrooms, bathrooms, kitchen, and safety equipment including fire detectors and carbon monoxide detectors were in good condition, with appropriate temperature controls, grab bars, and secured medications. The inspector identified deficiencies in resident record-keeping: three residents' files were missing required documentation forms, and one resident's file had not yet been transferred from a previous facility. The facility was given a deadline to correct these documentation issues.
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On 4/14/2023 at 12:30 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Crystal Vaka and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Crystal including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPA observed locked gate around pool. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was purchased on 9/25/2022. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/22/20223. Report continues on 809 C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 At 12:45 PM LPA reviewed 4 residents records. At 1:10 PM LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 2:40 PM, LPA reviewed a sample of 3 resident’s medications. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: -At approximately 1:06 PM LPA observed resident files were incomplete. Resident 1 R1), R2 and R3 files are missing LIC 601, and LIC 603A. LPA observed R4 file to be empty, Administrator stated that their file was still at their previous facility and has not been brought to this facility. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided. .
Regulation
87506(a) Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff
Inspector finding
Based on record review the licensee did not have completed resident files for R1, R2, R3 and R4 which poses/posed a potential health, safety or personal rights risk to persons in care. R1, R2 and R3 files are missing LIC 601, and LIC 603A. R4 file was observed to be empty and did not obtain the required forms. POC Due Date: 05/01/2023 Plan of Correction 1 2 3 4 Administrator will complete the required LIC forms, place them in the resident files and provide a photographic proof to CCL by POC d…
InspectionDecember 8, 2022No deficiencies
Inspector: Paris Watson
Plain-language summary
On December 8, 2022, the state conducted a routine annual infection control inspection at the facility and found no deficiencies. Inspectors verified that the facility had adequate food supplies, proper cleaning and disinfection practices, accessible hand sanitizing stations, appropriate personal protective equipment for staff, and current safety equipment including fire extinguishers and smoke detectors. The facility's visitor policies, screening procedures, and infection control documentation were also found to be in place.
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On 12/08/2022 at 9:35 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Caregiver, Maupuka and explained the purpose of the visit. LPA spoke with Administrator, Crystal Vaka, on the phone. Administrator joined the visit approximately an hour later. During the Infection Control Inspection, LPA toured facility with Maupuka and Crystal including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient two day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. A sign-in policy, hand sanitizer, and thermometer were observed at screening station. Social distancing and hand washing posters were observed . Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Facility staff were observed to be wearing proper PPE. Facility has a 30 day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. Smoke and carbon monoxide detectors were observed and maintained. First Aid kit was complete . Fire extinguisher was observed serviced. LPA observed facility passages inside and out free of obstruction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
ComplaintApril 21, 2022· MixedType B5 deficiencies
Inspector: Daisy Panlilio
Plain-language summary
A complaint investigation found that staff failed to seek medical attention for a resident after he fell on a wet floor and suffered a black eye and swelling above his eyebrow on November 7, 2020. The facility also substantiated complaints that the resident had experienced multiple falls while in care and that feces were found smeared on his room wall, which staff cleaned after a visitor reported it. The facility was cited for these violations and required to submit a plan of correction.
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Allegation: Facility failed to seek resident medical attention for fall Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, staff failed to seek resident (R1) medical attention for fall (11/07/20). Administrator stated R1 has loose urination and tended to urinate on the floor instead of his commode. R1 tripped on his walker and fell on his face due to the wet floor. R1’s black eye and lump above his left eyebrow did not show until after 2 days. Neutral witness (W1) confirmed staff did not seek medical attention for R1 when fall incident occurred. The preponderance of evidence has been met. Therefore, this allegation is substantiated. Allegation: Resident has sustained several falls while in care Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, staff (S1) confirmed with LPA that resident had several falls which he logged on the computer (9/13/20, 9/23/20, 10/18/20, 10/19/20 and 11/07/20. The preponderance of evidence has been met. Therefore, this allegation is substantiated. Allegation: Resident’s room has feces on the wall Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, staff (S1) confirmed with LPA that he cleaned R1’s alleged fecal matter smeared on R1’s wall on11/06/20 as instructed by neutral witness (W1) who visited facility unannounced on official business. The preponderance of evidence has been met. Therefore, this allegation is substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POCs) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided via email.
Regulation
Residents in all residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
Inspector finding
This requirement was not met as evidenced by resident sustaining unexplained injury which posed a potential health & safety risk to residents in care.
Regulation
The plan of operation shall address the needs of residents with dementia, including: (1) Procedures for notifying the resident’s physician, family members and responsible persons who have requested notification, and conservator, if any, when a resident’s behavior or condition changes
Inspector finding
This requirement was not met as evidenced by staff failing to seek medical attention for resident's fall which posed a potential health & safety risk to residents in care.
Regulation
The plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials.
Inspector finding
This requirement was not met as evidenced by resident sustaining several falls which posed a potential health & safety risk to residents in care.
Regulation
Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...
Inspector finding
This requirement was not met as evidenced by staff not reporting incidents to the licensing office which posed a potential health & safety risk to residents in care.
Regulation
Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
Inspector finding
This requirement was not met as evidenced by fecal smears on resident's wall which posed a potential health & safety risk to residents in care.
ComplaintJune 11, 2021Type A2 deficiencies
Inspector: Daisy Panlilio
Plain-language summary
This was a routine infection control inspection conducted in June 2021. The inspector found that the facility had proper screening procedures, vaccination records, and emergency supplies in place, but noted two issues: one staff member was not wearing a face mask during the visit, and a cabinet containing toxic chemicals and medications was left unlocked in the main hallway—the inspector advised staff to lock it immediately. The facility was also reminded that their annual licensing fee was overdue.
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On 06/11/21 at 10AM, Licensing Program Analyst (LPA) conducted an infection control annual inspection and explained the purpose of the visit with S1 and S2. LPA observed Administrator was not available during visit. LPA observed one central entry point designated for universal entry screening at the main entrance. LPA observed COVID-19 signages in common areas. LPA observed hand sanitizer, gloves and face masks available outside the main entrance. LPA observed S2 wearing face mask and S1 not wearing face mask during visit. LPA advised S1 to wear a face mask at all times while working at the facility. Facility has a completed mitigation plan in place dated 02/01/2021 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with staff as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks and no touch temperature probe. Per staff, the designated infection control leader is the administrator. LPA observed locked medication cabinets located near the kitchen area. LPA observed unlocked toxic chemical cabinet (Disinfectants, Febreze air freshener, Lysol, Windex, PRN medications, WD 40) in the main hallway. LPA advised staff to lock the toxic chemical cabinet during visit. Continued on next page LIC 809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since March 2021.There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Facility room temperature was maintained at 74 degrees Fahrenheit. Fire extinguisher was observed fully charged and last inspected on 08/27/20. Smoke and Carbon monoxide detectors were operational. A written Emergency/Disaster plan dated 03/01/2021 was posted in a common hallway leading to the kitchen. Centrally stored medications were locked in kitchen cabinets. Sharp objects were locked in the kitchen drawers. LPA also advised staff to let administrator know that their annual fee is past due and needs to be paid as soon as possible to avoid additional late fees. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct these deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided.
Inspector finding
Toxic chemicals were stored unlocked in the cabinet located in the main hallway leading to residents' bedrooms. Deficient Practice Statement 1 2 3 4 Based on observation, toxic chemicals were stored in an unlocked hallway cabinet which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 06/11/2021 Plan of Correction 1 2 3 4 S2 corrected deficiency during visit. Lock was placed on the cabinet by S2 where toxic chemicals are stored.
Regulation
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall…
Inspector finding
During visit, LPA observed S1 did not wear a face mask which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/11/2021 Plan of Correction 1 2 3 4 S1 corrected deficiency during visit. S1 wore a face mask and was reminded by LPA to wear a face mask at all times while at the facility.
Federal summary
CMS Care CompareNot a CMS-certified facility
California RCFEs (residential care facilities for the elderly) are licensed by the state, not by CMS. CMS data only applies to skilled nursing facilities or to CCRCs that operate a licensed SNF wing.
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