Aegis Assisted Living of Fremont.
Aegis Assisted Living of Fremont is Ranked in the top 48% of California memory care with 10 CDSS citations on record; last inspected Feb 2026.
Memory Care in a 110-Bed Fremont RCFE on Walnut Avenue, reviewed on public record.
© Google Street View
Compared to 91 California facilities with a similar number of beds.
RCFE memory care · 36-month window. Higher percentile = better performance on inspection record. Source: California Dept. of Social Services · Community Care Licensing.
among peers to rank.
Rankings based on 36-month CDSS inspection data. Severity and frequency: fewer citations = higher percentile. Repeat rate: lower repeat citation share = higher percentile.
FACILITY WATCH · BETA
Aegis Assisted Living of Fremont has 10 citations on record. Know the moment anything changes.
New findings, complaint investigations, or status changes — emailed to you free.
Citation history, plotted month by month.
10 deficiencies on record. Each bar is a month with a citation.
Finding distribution
10 total · 36 monthsScope × Severity (CMS A–L)
The rules that apply to this facility.
State requirements with the exact regulation citation, plain-language explanation, and a question to ask on tour. Rules this facility has been cited for appear first.
Plain language
Elopements, fires, epidemic outbreaks, and poisonings must be reported immediately. Abuse with serious bodily injury requires a 2-hour phone report + 2-hour written report to CDSS, Adult Protective Services, and law enforcement. Abuse without serious bodily injury must be reported within 24 hours. A resident death requires a phone call by the next working day and a written report within 7 days. Injuries requiring medical treatment beyond first aid, and bankruptcy/foreclosure/utility shutoff notices, must also be reported. Incidents not reported on time are a separate violation — families may file a complaint directly with CDSS.
Ask on tour
“When was the last incident report filed with CDSS, and may I see your incident log summary for the past 12 months?”
Questions to ask before you visit.
A short pre-tour checklist tailored to Aegis Assisted Living of Fremont's record and state requirements.
State records show one Type B deficiency on file — what was the specific citation, and what corrective action did the facility take?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Eleven complaints were filed with CDSS during the inspection period — how many were substantiated, what were the subjects, and what changes resulted from the investigations?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
With 110 licensed beds, what is the staff-to-resident ratio during overnight shifts, and how do you ensure adequate supervision for memory care residents during those hours?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Every inspection visit, verbatim.
26 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.
2026-02-03Other VisitNo findings
Plain-language summary
On February 3, 2026, the state conducted an unannounced inspection after the facility self-reported that a resident fell on January 3, 2026, while being assisted to the bathroom by a private caregiver; the resident pushed the caregiver away, fell, and was taken to the emergency room with a hip fracture. The resident is currently receiving physical therapy at a skilled nursing facility. No violations were found during the inspection.
Read raw inspector notesClose inspector notes
On 02/03/2026 at 2:10 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director, Leslie Ibo, self-reported the incident on 01/07/2026. LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had and witnessed fall while R1's private caregiver was escorting R1 to the bathroom in R1's room on 01/03/2026. Incident report revealed that R1 attempted to push the private caregiver away which resulted in R1's fall. R1 was sent to the Emergency Room and was diagnosed with a hip fracture. R1 is currently at a skilled nursing facility (SNF). LPA reviewed the following documents including but not limited to R1's Physician's Report, communication log with family and doctor's, service plan, call pendant alert log, private caregiver contact information, Home Health Visit Communication form, staff roster/ schedule, staff contact information, and resident roster. Interview with Ibo indicated that a new physician report will be obtained and sent to CCLD when R1 is discharged from the SNF. Additionally, Ibo followed up with the SNF that revealed that there is no discharge date and R1 is undergoing physical therapy. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Health Services Director, and a copy of this report was provided.
2025-10-07Other VisitType B · 1 finding
Plain-language summary
During a routine annual inspection on October 7, 2025, inspectors found that food was stored in the same closet as antibacterial soap and water supplies in the laundry room, which violates food storage requirements. The facility otherwise maintained adequate lighting, proper water temperatures, functioning smoke and carbon monoxide detectors, secure medication storage, and current fire safety equipment and drills.
“Based on observation, the licensee did not comply with the section cited above by having the emergency food in the same closet as the antibacterial liquid soap and water supply inside the laundry room which poses an immediate health and safety risk to persons in care. POC Due Date: 10/15/2025 Plan of Correction 1 2 3 4 The General Manager agrees to place the emergency food and water supply separate from the cleaning supplies. Proof of correction will be sent to CCLD by POC date.”
Read raw inspector notesClose inspector notes
On 10/07/2025 at 11:15AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with General Manager, Ryan Turner and Health Services Director, Leslie Ibo and explained the purpose of the visit. LPAs toured the facility with General Manager, Ryan Turner, including but not limited to residents' apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents shared bathroom were measured at 114.2, 109.6, 114.3, 112.2, 114, 109.2, and 109.4 degrees Fahrenheit. Hallway temperature measured at 72-73 degree. Residents’ bathrooms are equipped with grab bars with non-skid shower pan. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. At 11:45 AM, LPAs reviewed 8 residents records. At 2:02 PM, LPAs reviewed 8 staff records and 8 of 8 are associated with the facility. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 07/10/2025 and kitchen fire extinguisher was last serviced on 07/10/2025. Emergency Disaster Drill last updated on 09/24/2025. Fire Drill last conducted on 09/20/25. First aid kit was observed to be complete. Liability Insurance is effective from 12/01/2024 to 12/01/2025. Continue to LIC809-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 Continue from LIC809... THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: At 12:42 PM, LPA observed the food supply in the same closet as the antibacterial liquid soap and water supply placed in the laundry room. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with General Manager. Appeal Rights and a copy of this report provided.
2025-08-18Other VisitNo findings
Plain-language summary
On August 18, 2025, state inspectors conducted a follow-up visit to check whether the facility had corrected problems identified at a previous conference in March 2025. Inspectors reviewed the memory care unit, examined resident records, and discussed the facility's fall prevention plan with management. No violations were found.
Read raw inspector notesClose inspector notes
On 08/18/2025 at 9:40 AM, Licensing Program Analysts (LPAs) Patricia Manalo and Kelly Nguyen conducted a case management-legal non-compliance visit and met with General Manager, Ryan Turner and Health Services Director, Brenda Silva. LPAs explained to Turner and Silva the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on March 25, 2025. During the visit, LPA P. Manalo conducted an inspection of the Memory Care unit and reviewed Resident 1 (R1) and Resident 2 (R2) files. Health Services Director and LPAs had a discussion regarding the facility's fall prevention plan. No deficiencies cited. Exit interview was conducted with General Manager and a copy of this report was provided.
2025-07-30Other VisitNo findings
Plain-language summary
On July 30, 2025, licensing staff conducted an unannounced visit to investigate a self-reported fall that occurred at the facility. A resident fell without anyone witnessing it and sustained a wrist fracture; the resident had a pre-existing bone density condition. No violations were found during the investigation.
Read raw inspector notesClose inspector notes
On 07/30/2025 at 12:00PM Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 07/07/2025. LPA met with Care Director, Maryrose Vinarao, and explained the purpose of the visit. LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had an unwitnessed fall and after visit summary indicated that the resident had a wrist fracture. During the visit, LPA reviewed R1's Individualized Service Plan, Medication List, Transfer/Discharge Report and Order Summary Report from previous skilled nursing facility, and After Visit Summary dated 07/06/2025. A review of resident's Individualized Service Plan dated 06/22/2025 and Order Summary Report from previous skilled nursing facility revealed that the resident has a diagnosis of bone density and structure. No deficiencies cited during visit. Exit interview was conducted with Care Director and a copy of this report was provided.
2025-07-10Other VisitNo findings
Plain-language summary
On July 10, 2025, the state conducted an unannounced visit after the facility reported that a resident had an unwitnessed fall and was treated for a closed hip fracture. The resident told the inspector they lost their balance, fell, and staff came shortly after to help them. No violations were found.
Read raw inspector notesClose inspector notes
On 07/10/2025 at 1:05 PM Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 07/03/2025. LPA met with Health Services Director, Brenda Silva, and explained the purpose of the visit. General Manager, Ryan Turner, gave authorization for Silva to sign the report. LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had an unwitnessed fall and after visit summary stated that the resident was treated for a closed hip fracture. During the visit, LPA reviewed R1's Physician's Report dated 01/30/2023 and 07/09/2025, Individualized Service Plan, Individualized Service Assessment, and After Visit Summary dated 07/10/2025. A review of R1's Physician Report revealed that R1 has a diagnosis of osteopenia. R1's Individualized Service Plan dated 06/21/2025 showed that R1 is independent with most Activities of Daily Living's (ADLS). LPA spoke with R1 during the visit. R1 stated that R1 lost their balance and fell on the ground. R1 stated that R1 fell on R1's hips. R1 stated that staff arrived shortly after to assist R1. No deficiencies issued during the visit and a copy of this report provided.
2025-07-01Other VisitNo findings
Plain-language summary
On July 1, 2025, regulators investigated a self-reported incident from June 23 in which a private caregiver was observed holding a resident down on a bed; staff intervened and the resident was not injured. The facility removed the caregiver and will no longer allow them on-site. No violations were cited.
Read raw inspector notesClose inspector notes
On 07/01/2025 at 12:40 PM Licensing Program Analyst (LPA) P. Manalo conducted an unannounced Case Management visit regarding a self-reported restraint abuse that occurred on 06/23/2025. Health Services Director, Leslie Ibo self-reported the incident on 06/23/2025. LPA met with General Manager, Ryan Turner, and explained the purpose of the visit. LPA reviewed the following documents such facility’s Resident Incident Report, Physician’s Fax Report, Progress Notes, and SOC341. LPA also reviewed the AUGi monitoring system during today's visit. LPA interviewed Staff 1 (S1) and Staff (2). Interview with S1 revealed that S1 heard motion in R1’s room and checked the AUGi Monitoring System. AUGi system showed that R1 was laying down and the 1:1 caregiver was holding R1 down on the bed. S1 and another staff member proceeded to intervene. Interview with S2 and Progress Notes for R1 showed that the R1 did not sustain injuries during the assessment. General Manager stated that the private caregiver was sent home and will not be allowed at the facility anymore. LPA will have the facility send the 1:1 Private Caregiver Contract by 04/07/2025. No deficiencies cited during visit. Exit interview was conducted with General Manager and a copy of this report was provided.
2025-07-01Annual Compliance VisitType B · 1 finding
Plain-language summary
On July 1, 2025, inspectors conducted an unannounced visit following a self-reported medication error from June 12, 2025, in which a resident did not receive their morning insulin dose because a safety mechanism on the needle was not removed before administration. The facility notified the resident's physician and family, placed the resident on monitoring, and observed no adverse effects from the missed dose. Deficiencies were cited and the facility was required to submit a plan to correct them.
“Based on record review, the licensee did not comply with the section cited above by having a missed medication for R1's insulin which poses a potential health and safety risk to persons in care.”
Read raw inspector notesClose inspector notes
On 07/01/2025 at 2:25 PM Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported missed medication that occurred on 06/12/2025. Health Services Director, Leslie Ibo self-reported the incident on 06/19/2025. LPA met with General Manager, Ryan Turner, and explained the purpose of the visit. LPA received an incident report that on 06/12/2025 for Resident 1 (R1) that revealed that R1 was not administered the insulin dose in the morning because the second safety on the needle remained intact causing the missed dosage of the medication. R1 was then given the lunch dosage after the incident. LPA reviewed Physician’s Fax Report dated 06/12/2025, Insulin Staff Training, Progress Notes, Aegis Medication Incident Report and June Emergency Paper Medication Administration Record (MAR). Progress Notes indicated that the facility contacted the appropriate parties such as R1’s physician and family. Progress Notes also stated that R1 was placed on monitoring and did not show any side effects from the missed medications. The following deficiencies were 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 with General Manager Appeal Rights and a copy of this report provided.
2025-05-06Other VisitNo findings
Plain-language summary
On May 6, 2025, inspectors visited to follow up on compliance issues identified in a previous March conference and found laundry baskets blocking two residents' doorways in the memory care unit; the facility removed them during the visit. A technical violation was issued for this condition. The general manager and health services director met with inspectors to discuss the findings.
Read raw inspector notesClose inspector notes
On 05/06/2025 at 1:10 PM, Licensing Program Analysts (LPAs) Patricia Manalo and Luisa Fontanilla conducted a case management-legal non-compliance visit and met with General Manager, Ryan Turner and Health Services Director, Leslie Ibo. LPAs explained to Turner and Ibo the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on March 25, 2025. During the visit, LPA P. Manalo conducted an inspection of the Memory Care unit with Turner and observed laundry baskets blocking two resident's door. The facility removed the baskets during the visit. A technical violation was issued during the visit. Exit interview was conducted with General Manager and a copy of this report was provided.
2025-04-07Other VisitNo findings
Plain-language summary
On April 7, 2025, inspectors conducted an unannounced visit to investigate a self-reported fall and spinal fracture involving a resident. The facility's records showed the resident had sustained a fracture before moving into the facility, not as a result of the fall reported at the facility. No violations were found.
Read raw inspector notesClose inspector notes
On 04/07/2025 at 1:25 PM Licensing Program Analysts (LPAs) P.Manalo and and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 03/15/2025. LPAs met with Health Services Director, Leslie Ibo, and explained the purpose of the visit. LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had an unwitnessed fall and after visit summary stated that the resident had a closed T11 fracture. LPAs obtained the following documents such as R1's Physician's Report from move in date, Emergency ID Face Sheet, and After Visit Summary from 03/15/2025. LPAs record review indicated that R1's Physicians Report and Emergency ID Face Sheet indicated that R1 had sustained a unspecified fracture prior to moving in. No deficiencies cited during visit. Exit interview was conducted with Health Services Director, and a copy of this report was provided.
2025-02-20Other VisitNo findings
Plain-language summary
A licensing analyst visited the facility in February 2025 to investigate a complaint from April 2024 about a male resident who entered another resident's bedroom early in the morning and stayed for over an hour while staff did not respond, as well as concerns about memory care residents being left unsupervised in a common area. The executive director reported that he had already discussed these incidents with the complainant and conducted staff retraining on proper supervision in April 2024. No violations were cited during the visit.
Read raw inspector notesClose inspector notes
On 02/20/25 at 2:43PM, Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to conduct a case management visit in response to a priority 1 complaint received on 04/09/24. LPA met with Executive Director (ED) and explained the purpose of the visit. Reporting party (RP) stated that review of video footage on 03/03/24 showed a male memory care resident (R5) entered resident's (R1) bedroom at 0449 hours and stayed there until 0600 hours. RP stated that R1's bedroom had a motion sensor that would alert staff of any movements inside. RP stated that no staff came to remove R5 from R1's room. R5 left the room on his own at 0600 hours. RP also stated she observed memory care residents left unsupervised in the common room of the memory care unit while she was visiting R1 on May 2024. LPA interviewed ED who stated that he discussed the incidents with RP and conducted in-service staff retraining regarding proper care and supervision of residents with dementia on 04/12/24. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
2025-02-20Complaint InvestigationSubstantiatedIJ · 1 finding
Plain-language summary
A complaint investigation found that the facility failed to provide adequate supervision of a resident, who sustained five documented falls since 2022, including two falls that caused fractures of the femur and pelvis. Staff had raised concerns with management that the resident needed one-on-one care due to her high care needs, but management denied receiving these reports and the resident continued to have both witnessed and unwitnessed falls. The state assessed a $500 civil penalty for this failure in supervision and care.
“This requirement was not met as evidenced by staff failing to provide adequate supervision resulting in resident sustaining multiple fractures while in care which posed an immediate risk to resident in care.”
Read raw inspector notesClose inspector notes
ALLEGATION: Neglect/Lack of Supervision – Staff did not provide adequate supervision resulting in resident (R1) sustaining multiple fractures while in care. INVESTIGATION FINDING: Substantiated During investigation, the department conducted interviews of facility staff (Care Director (CD), Regional Health Services Director (RHD), S1, S2) & R1’s responsible party (POA) and reviewed resident (R1) documents. Review of R1’s incident reports showed R1 had sustained 5 documented falls at the facility since she was admitted in 2022. Staff (CD, RHD) both denied receiving reports from care staff that R1 needs a 1:1 caregiver citing R1 higher level of care. Despite having multiple fall prevention methods in place and staff expressing their concerns to management in not being able to provide adequate care, R1 continued to have un-witnessed and witnessed falls in the facility, twice sustaining serious fractures in her femur and pelvis, Based on observations and interviews which were conducted and record review(s), the department has substantiated the allegation that staff did not provide adequate supervision resulting in resident (R1) sustaining multiple fractures while in care. The preponderance of evidence standard has been met. Therefore, the above allegation was found to be substantiated. Immediate civil penalty of $500 assessed during visit for staff failing to provide adequate care and supervision to resident resulting in resident sustaining multiple fractures while in care. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (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. Appeal Rights and a copy of this report provided.
2025-01-15Other VisitNo findings
Plain-language summary
A licensing analyst conducted an unannounced visit on January 15, 2025, following a self-reported incident at the facility involving a resident death that occurred in December 2024. The analyst reviewed medical records, care documentation, and staff schedules and found no violations or deficiencies during the investigation.
Read raw inspector notesClose inspector notes
On 1/15/2025 at 11:15 AM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 01/13/2025. LPAs met with Health Services Director, Leslie Ibo, and explained the purpose of the visit. LPAs obtained the following documents such as R1's Physician's Report, Emergency ID Face Sheet, Physician's Fax Report Notification, Discharge Summary from 12/20/2024, Internal Progress Notes, Care Plan, Individualized Service Assessment, Medication Administration Record (MAR), Appraisal Needs and Services Plan, and Staff Schedule. LPAs requested a copy of the Death Certificate to be sent to CCLD on 02/15/2025. No deficiencies cited during visit. Exit interview was conducted with Health Services Director, and a copy of this report was provided.
2024-12-06Other VisitNo findings
Plain-language summary
On December 6, 2024, inspectors conducted an unannounced visit to investigate a self-reported incident from November 29, 2024 in which a staff member pulled a resident's leg while the resident was in bed. The staff member was terminated on December 5, 2024, before the inspection. No deficiencies were cited.
Read raw inspector notesClose inspector notes
On 12/06/2024 at 8:55 AM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit regarding a self-reported abuse that occured on 11/29/2024. Health Services Director self-reported the incident on 12/05/2024. LPAs met with Executive Director, Ryan Turner, and explained the purpose of the visit. LPAs interviewed R1, R2, Executive Director, and Health Services Director regarding the incident. R1 has dementia diagnosis and lives in the Memory Care Unit. R2 stated that S1 pulled R1's leg while R1 was in bed. LPAs interviewed Executive Director and Health Services Director who stated that S1 was terminated on 12/05/2024 and has been removed from the facility roster. LPAs obtained the following documents such as R1's Physician's Report, S1's Termination Paper, S1's Employee Files, Staff Roster, and Resident Report. No deficiencies cited during visit. Exit interview was conducted with Executive Director and a copy of this report was provided.
2024-10-28Other VisitNo findings
Plain-language summary
This was a routine annual inspection on October 28, 2024, and no deficiencies were found. Inspectors toured the facility including resident apartments, bathrooms, activity areas, and kitchen, and verified that safety features like smoke and carbon monoxide detectors were working, grab bars were installed in bathrooms, medications were locked up, and adequate food supplies were on hand. The facility was asked to submit updated administrative documents by November 4, 2024.
Read raw inspector notesClose inspector notes
On 10/28/2024 at 9:00AM, Licensing Program Analysts (LPAs) P. Manalo and J. Clancy-Czuleger arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Health Services Director, Leslie Ibo and explained the purpose of the visit. Administrator, Ryan Turner, arrived shortly after. LPAs toured the facility with Administrator, Ryan Turner, including but not limited to residents' apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 115 and 114.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars with non-skid shower pan. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. At 9:45 AM, LPAs reviewed 8 residents records. At 10:45 AM, LPAs reviewed 8 staff records and 8 of 8 are associated to the facility. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 08/28/2024 and kitchen fire extinguisher was last serviced on 08/28/2024. First aid kit was observed to be complete. Continue 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... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/04/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
2024-10-28Annual Compliance VisitNo findings
Plain-language summary
A licensing analyst visited the facility in response to an unusual incident report about a missing bottle of narcotic medication discovered during the medication destruction process following a resident's death in October 2024. The facility reported the missing medication to police, conducted an internal investigation, and implemented new safeguards including requiring two staff members to sign off on narcotic medications and weekly audits by nurses. No violations were cited.
Read raw inspector notesClose inspector notes
Licensing Program Analyst (LPAs) Manalo and Clancy-Czuleger arrived unannounced to conduct a case management visit in response to the Unusual Incident Report (UIR) submitted by the facility. LPA's met with Leslie Ibo, Health and Wellness Director and Ryan Turner Executive Director and explained the purpose of the visit. Resident (R1) had passed away on 10/17/2024. On October 20, 2024, Health and Wellness Director (S1) started the process of medication destruction, when it was observed that an unused bottle of narcotics medications was missing. Medtech’s and nurses started to look for the medication. All medication carts and overflow cabinets were searched and still could not find the medications. An internal investigation was conducted, medtech’s and nurses was interviewed. The incident was reported to Fremont Police with the incident event number is P24125430. In-service with wellness team started on 10/22/2024 with the following topics: narcotic count, documentation, medication error, medication destructions and other topics. Regional Health Services Director and General Manager was notified regarding the incident. Our community started to have two staff signing off for the narcotics, nurses will audit narcotics weekly. No deficiency cited. Exit interview conducted and copy of this report provided .
2024-09-25Other VisitNo findings
Plain-language summary
On September 25, 2024, a state licensing analyst made an unannounced visit to deliver an amended inspection form from the previous day's routine inspection. The facility met all standards, and no violations were found.
Read raw inspector notesClose inspector notes
On 9/25/24 at 12:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended LIC9099D page from visit conducted on 9/24/24 . LPA met with Ryan Turner, General Manager and explained the purpose of the visit. LPA delivered amended LIC9099D. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
2024-09-24Complaint InvestigationSubstantiatedType B · 1 finding
Plain-language summary
A complaint investigation found that a staff member blocked residents' bedroom doors with laundry baskets to prevent them from leaving while she worked. The same staff member had previously been fired from this facility in April 2024 for locking a resident in an apartment with a cart blocking the door. The facility has been cited for this violation.
“Based on interviews the licensee did not comply with the section cited above by having a staff person lock residents' in their rooms using a laundry cart which poses a potential health, safety or personal rights risk to persons in care.”
Read raw inspector notesClose inspector notes
S1 stated that while conducting the investigation into the situation S3 admitted to placing the laundry baskets in front of the residents’ rooms to prevent them from wandering while she did her work. LPA reviewed S3’s personnel file and found the S3 was separated from the facility on 4/22/24 for “misconduct: locked the resident in the apt with cart outside the door.” LPA also reviewed the photos that S2 took of the laundry baskets blocking the residents' rooms. Based on LPA document review and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted, a copy of this report and appeal rights provided.
2024-08-19Complaint InvestigationMixedType B · 2 findings
Plain-language summary
This was a complaint investigation that had mixed results: inspectors found insufficient evidence to substantiate some of the allegations, but did find that other allegations violated state regulations. The facility received citations for the substantiated violations and was informed of its appeal rights.
“Based on reports the licensee did not comply with the section cited above by not submitting an incident report involving an injury resident sustained from accidental fall.”
“Based on interviews and records review, the facility did not observe R1 close enough to know that he had a fall resulting in injury.”
Read raw inspector notesClose inspector notes
...Continued from LIC9099-A Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided. 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 ....Continued from 9099 Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22 has been cited. Exit interview conducted. A copy appeal rights, and this report provided.
2024-07-10Complaint InvestigationMixedType A · 3 findings
Plain-language summary
A complaint investigation found that a resident fell twice on June 16, 2022, without staff witnessing either fall, and care staff did not notify the nurse for further assessment after either incident. The facility also failed to report these falls to the state or to the resident's family. Staff could not locate the incident reports when asked to provide them.
“Based on interviews and records review, the facility did not for a resident who had two falls.”
“Based on interviews and records review, the facility did not seek medical attention for a resident who had two falls.”
“Based on interviews and records review, the facility did not report to the department that the resident had bruising and two unwitnessed falls.”
Read raw inspector notesClose inspector notes
...Continued from LIC 9099 The first unwitnessed fall was discovered by S2; documents support that care staff (caregivers) helped R1 up and provided first aid to her finger. The second unwitnessed fall, S1 delayed reported that around 1120 hours, she observed R1 on the floor in front of a chair she was previously sitting on at around 1100 hours. Staff assisted R1 to her feet and, as per interviews, guided her back to the dining area before later presenting her to her family for a visit. Care staff did not notify the nurse on duty for additional assessment for both unwitnessed falls. On the allegation: Staff did not report incident to CCL. Based on interviews and records review the facility did not report to the department that R1 had 2 unwitnessed falls on June 16, 2022. In an interview with S1 said that for both falls reported by S2, facility was not able to find the incident reports or the COC report to provide to CCLD. On the allegation: Staff did not communicate with the responsible party of incident. Based on interviews and records review the facility did not report to R1’s family the residents change of condition or falls that occurred. In an interview with the investigator S1 confirmed that no one updated R1’s family about the investigation. Based on the investigation, above allegations are deemed Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided.
2024-04-11Annual Compliance VisitNo findings
Plain-language summary
An unannounced health and safety inspection was conducted on April 11, 2024, following a priority complaint. The inspector observed 72 residents and 27 staff members throughout the facility, including bedrooms, kitchen, dining areas, and common spaces, and found residents appearing safe and comfortable. No deficiencies were cited.
Read raw inspector notesClose inspector notes
On 04/11/24 at 12:40PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced Health and Safety check due to the department receiving a priority 1 complaint. During the health and safety check, LPA observed a total of 27 staff members and 72 residents at the facility. LPA toured facility with general manager/administrator, including but not limited to bedrooms, kitchen, dining rooms, activities rooms, bathroom, outdoor garden and common areas. LPA observed residents comfortable in their surroundings, eating their lunch meals and relaxing in common areas with family and friends. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
2023-11-15Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
A complaint alleged that staff abused a resident and violated their personal rights. Interviews with staff and residents, along with a review of medical records, found no evidence to support these allegations — residents reported being treated well and having access to phones and call buttons as needed. The complaint was found to be unsubstantiated.
Read raw inspector notesClose inspector notes
Continue from Lic9099 It was alleged that staff abused resident while in care and staff violated residents personnel rights. Based on interviews conducted. All staff have stated that they have not witnessed any residents’ being abused nor their personnel rights being violated. All staff gave residents’ their personal phone and call button to call as they please. Residents’ stated during interview that they are treated well, and staff has not abused them nor violated their personnel rights. Residents’ also stated that staff allows them to use their personal phones, and use the call button for assistance if they need any type of help. LPA review R1’s medical record which indicated R1 sustaining a fall resulting in a hip fracture in November 2021. Based on Interviews and record review conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegations are UNSUBSTANTIATED . Exit interview conducted with GM and HSD, and a copy of this report provided.
2023-09-07Complaint InvestigationMixedType B · 1 finding
Plain-language summary
This complaint investigation found that the facility did not follow proper eviction procedures when removing a resident—staff verbally told the owner the resident needed a higher level of care due to aggressive behavior rather than providing a formal eviction notice as required by law. A second allegation that staff failed to properly supervise the resident, leading to the resident leaving the facility and being walked to a nearby store by staff while 911 was called, could not be substantiated based on the available evidence.
“Based on interviews and record review, the licensee did not comply with the section cited above by not giving R1 a proper eviction notice to be removed from the community which poses/posed a potential health, safety or personal rights risk to persons in care.”
Read raw inspector notesClose inspector notes
Continued from Lic9099. It was alleged that: Licensee did not follow proper eviction procedures for resident. Based on interviews and record review conducted, LPA confirmed with S1 and S2 that R1 was unsafe for the community and R1 needed a higher level of care. S1 and S2 notified Rp about R1’s aggressive behavior and that R1 is a harm to herself, staff and other residents in the community. It was stated by S1 and S2 that R1 did not receive an eviction notice, and that S1 and S2 verbally informed Rp that the community can not meet R1's care needs. Based on LPAs interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC 9099D. Exit interview conducted with ADM, and a copy of this report provided along with appeal rights. 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 Continued from Lic9099. It was alleged that: Facility staff did not properly supervise resident resulting in elopement. Based on interviews conducted, S1, S3, and S4 were supervising R1 while R1 left the facility. Staff did not want to force R1 to come back into the facility and staff walked with R1 to food max store while 911 was called. Rp was informed that R1 left the facility. Rp arrived too food max store and drove S1 and R1 back to the community. No police report was generated. Based on Interviews conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted with ADM, and a copy of this report provided.
2023-09-01Other VisitNo findings
Plain-language summary
This was a routine annual inspection on September 1, 2023, and no violations were found. The inspector toured the 80-bedroom facility, checked safety features including fire and carbon monoxide detectors, reviewed staff and resident records, and verified that medications, food storage, bathrooms, and common areas met standards. The facility was asked to submit updated documentation to the state by the deadline but had no deficiencies to correct.
Read raw inspector notesClose inspector notes
On 9/1/2023 starting at 11:48 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with MaryRose Vinarao, Care Director (CD) and explained the purpose of the visit. The facility’s fire clearance was approved for one-hundred-ten (110) ambulatory residents, which seventy (70) may be non- ambulatory, thirty (30) may be bedridden, and approved for thirty-two (32) hospice residents. Upon entry, LPA observed four (4) staff and eight (8) residents present during inspection. Starting at 12:13 PM, LPA toured facility with CD, including but not limited to eighty (80) bedrooms, eighty (80) bathrooms, kitchen, court yard. The facility consists of 80 total bedrooms which 8 are shared, and seventy-two (72) are private. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. 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 residents’ common area bathroom was measured at 116.0 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 7/25/2023. First aid kit was observed to be complete. Continue on Lic809-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 Continued from Lic809 Starting At 1:27 PM, LPA reviewed 10 of 10 staff records. At 2:09 PM, LPA reviewed 10 of 10 residents' records. At 3:39 PM, LPA reviewed a sample of 10 of 10 residents' medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/8/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 Pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted with CD, and a copy of this report provided.
2023-08-24Other VisitNo findings
Plain-language summary
On August 24, 2023, a state licensing analyst made an unannounced visit to deliver an amended inspection report from July 19, 2023. No deficiencies were found during this visit. The administrator received a copy of the report.
Read raw inspector notesClose inspector notes
On 8/24/2023 starting at 1:42 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit to deliver amended report originally dated 7/19/2023. LPA met with Shashi Madahar, Administrator and informed her the reason for visit. During visit, LPA obtained original report dated 7/19/2023 from Administrator. No deficiencies are being cited on this date. Exit interview conducted, and a copy of this report provided.
2023-07-19Complaint InvestigationNo findings
2023-06-16Other VisitNo findings
Plain-language summary
A Health & Safety inspection was conducted on June 16, 2023, following a priority complaint. The inspector checked the facility's bedrooms, bathrooms, kitchen, and outdoor areas, and found that hot water temperature, food storage, refrigeration, medication storage, smoke detectors, carbon monoxide detector, fire extinguishers, and emergency supplies all met requirements with no deficiencies cited.
Read raw inspector notesClose inspector notes
On 6/16/23 at 1:55 PM, Licensing Program Analyst (LPA) Greg Clark conducted a Health & Safety inspection as a result of a priority 1 complaint. LPA met with Shashi Madahar, Health Service Director (HSD) and explained the purpose of the visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 113.3 degrees F in a vacant bedroom. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Refrigerator temperature was observed at 39 degrees F and freezer was at 0 degrees F. Resident's medications were kept locked in several med carts. Smoke detectors are interconnected with the sprinkler system. Carbon monoxide detector was observed and operational. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 8/01/22. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
5 older inspections from 2021 are not shown in the free view.
5 older inspections from 2021 are not shown in the free view.
Other facilities in Alameda County.
Other memory care facilities in Alameda County with similar care offerings.
Family reviews
No reviews yet — be the first to share your experience
Other memory care options nearby.
More options in neighboring cities
Licensed memory care in other cities within this county region — useful when your search radius crosses city limits.
Other facilities under this operator
Aegis Senior Communities, Llc — as recorded on state license extracts. Each facility still has its own inspection history.