La Concepcion Residential Care Home
What is an RCFE with 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.
4419 Jacinto Dr · Fremont, 94536
Record last updated April 20, 2026.
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Quick facts
Memory care context
La Concepcion Residential Care Home is a California-licensed RCFE with memory care designation, operated by Cristina Concepcion and licensed for 6 residents. California Title 22 requires facilities serving dementia residents to meet specific standards under §87705 and §87706, covering individualized care plans, staff training in dementia care, and appropriate supervision. CDSS has cited this facility twice under dementia-care regulations (§87705 or §87706). State records show 6 inspections with 35 total deficiencies: 9 Type A citations (indicating actual harm) and 26 Type B citations (potential for harm). One complaint has been investigated during the period on file. The most recent inspection occurred on May 28, 2025.
Questions to ask on your tour
Based on La Concepcion Residential Care Home's state inspection record.
State records show 9 Type A deficiencies indicating actual harm to residents — what were the specific circumstances of these citations, and what corrective actions were implemented?
The facility has been cited twice under §87705 or §87706 for dementia-care requirements — what were these citations for, and how have you changed dementia-specific practices in response?
With 35 total deficiencies across 6 inspections, what systemic changes has the facility made to reduce recurring compliance issues?
One complaint was investigated by CDSS — was it substantiated, what was the subject, and what follow-up occurred?
As a 6-bed home operated by Cristina Concepcion, how many caregivers are on duty during overnight hours, and what is the protocol when a caregiver is unavailable?
State records
California CDSS · Community Care Licensing Division- License number
- 015601051
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Concepcion, Cristina
Inspections & citations
6
reports on file
35
total deficiencies
9
Type A (actual harm)
2
dementia-care citations
Other visitMay 28, 2025No deficiencies
Inspector: Leslie Ibo
Inspector notes
On 12/22/2021 Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a case management inspection due to another visit. LPA met with S2, LPA called Administrator Cristina Concepcion, Administrator arrived after 20 mins. LPA toured facility inside and outside. LPA observed 4 residents in care, 3 are on hospice and 1 non-ambulatory resident. …Continued 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 The following was observed during facility visit: Disinfectant cleaning was observed accessible to residents in care- cleared S2 do not have fingerprint clearance. S3 is not associated at the facility.- cleared S2 & S3 do not have the following on their employee file; health screening LIC503, TB test, Criminal records statement (LIC508) & employee rights (LIC 9052). No grab bar available for resident in care in bathroom #3. Failed to report unusual incident to CCL office. $500.00 Civil penalty was assessed during the visit. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report was provided.
InspectionMarch 7, 2025No deficiencies
Inspector notes
On 05/28/2025 at 3:05 PM, Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla arrived unannounced to conduct a case management visit. LPAs met with Administrator, Cristina Concepcion, and explained the purpose of the visit. The facility sent an updated Physician's Report for Resident 1 (R1) on 04/11/2025 which indicated that R1 was bed bound. Medical assessment also indicates R1 is non ambulatory. Based on interview conducted with the Administrator, R1 is unable to turn from side to side independently. Staff need to reposition R1. Administrator added that R1 has been bedridden since the time R1 was admitted to the facility. The facility's fire clearance is approved for four (4) may be non ambulatory. Deficiency is cited per Title 22 California Code of Regulations (refer to Lic 809D). Civil penalty of $500 is being assessed for today's visit. Exit interview was conducted with the Administrator. Appeal Rights and a copy of this report were provided.
InspectionMarch 20, 2024Type A14 deficiencies
Inspector: Patricia Manalo
Inspector notes
On 03/07/2025 at 11:30 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Cristina Concepcion, and explained the purpose of the visit. Administrator certificate is current and expires on 12/10/2026. The facility’s fire clearance was approved for only four (4) may be non-ambulatory and hospice waiver of three (3) . LPAs toured facility with Administrator inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 4 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the resident's bathroom was measured at 129.1 degrees Fahrenheit. Both residents’ bathrooms are equipped with grab bars, non-skid mats, and non-skid shower pans. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/25/2024. First aid kit was observed to be complete. At 12:16 PM, LPAs reviewed 4 residents records. At 12:42 PM, LPA reviewed 4 staff records. At 2:00 PM, LPA reviewed two sample of residents' medications. 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 DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:50 AM, LPA observed the hot water temperature measured at 129.1 degrees Fahrenheit. At 12:02 PM, LPA observed oxygen tanks, portable oxygen machine, crutches, commode, bbq pit, etc in the backyard that needs to be removed. At 12:04 PM, LPA observed that the self closing latch was tied with the string to keep it locked. At 12:15 PM, LPA observed a knife in one of the kitchen drawers. At 1:12 PM, LPA observed that 24 have incomplete staff files in record. At 1:13 PM, LPA observed the Emergency Disaster Plan incomplete and not filled out. At 1:24 PM, LPA observed that S4 did not have a TB test on file. At 1:30 PM, during record review, LPA observed no drills conducted. At 1:32 PM, LPA observed that S2 to S4 does not have a First Aid Certification. At 1:33 PM, LPA did not observe a complaint poster. At 1:42 PM, LPA observed that S4 was not associated to the facility. At 1:44 PM, LPA observed that R2 and R4 have half bed rail and did not have doctor's order on file. At 1:45 PM, LPA observed that R3 have full bed rails. At 1:47 PM, LPA observed that R1 to R4's files was incomplete on file. The Facility was 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. Civil Penalties Assessed for today's visit. Exit interview conducted with Licensee. Appeal Rights and a copy of this report provided.
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fi…
Based on observation, the licensee did not comply with the section cited above in having the self closing latch tied with the string to lock the gate which poses an immediate health and safety risk to persons in care. POC Due Date: 03/08/2025 Plan of Correction 1 2 3 4 Administrator untied the string during the visit. Deficiency cleared. Civil Penalty of $500 is assessed.
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degre…
Based on observation the licensee did not comply with the section cited above in having the hot water measured at 129.1 degrees which poses an immediate health and safety risk to persons in care. POC Due Date: 03/08/2025 Plan of Correction 1 2 3 4 The licensee agrees to have the hot water temperature measured within range and send proof to CCLD by POC date.
(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.
Based on observation, the licensee did not comply with the section cited above in having a knife found in one of the kitchen drawers which poses an immediate health and safety risk to persons in care. POC Due Date: 03/08/2025 Plan of Correction 1 2 3 4 The licensee agrees to lock the knives in the cabinet and send proof to CCLD by POC date.
(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…
Based on record review, the licensee did not comply with the section cited above in not having a TB test for S4 which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 The licensee agrees to have staff get TB test and send proof to CCLD by POC date.
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
Based on observation, the licensee did not comply with the section cited above in having oxygen tanks, portable oxygen machine, crutches, commode, BBQ pit, etc in the backyard that needs to be removed which poses a potential health and safety risk to persons in care. POC Due Date: 03/21/2025 Plan of Correction 1 2 3 4 The licensee agrees to schedule a bulk removal and send proof to CCLD by POC date.
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.
Based on observation, the licensee did not comply with the section cited above in having the passageway in front of the garage door blocked with toilet paper, TV, ladder, etc which poses a potential health and safety risk to persons in care. POC Due Date: 03/14/2025 Plan of Correction 1 2 3 4 The licensee agrees to clear the passageway and send proof to CCLD by POC date.
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
Based on observation, the licensee did not comply with the section cited above in not having S4 associated to the facility which poses a potential health and safety risk to persons in care. POC Due Date: 03/14/2025 Plan of Correction 1 2 3 4 The licensee agrees to have S4 associated to the facility and send proof to CCLD by POC date.
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
Based on record review, the licensee did not comply with the section cited above in not having First Aid Certification for S2 to S4 which poses a potential health and safety risk to persons in care. POC Due Date: 03/21/2025 Plan of Correction 1 2 3 4 The licensee agrees to obtain First Aid Certification for S2 to S4 and send proof to CCLD by POC date.
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (…
Based on observation, the licensee did not comply with the section cited above in not having the Complaint poster which poses a potential health and safety risk to persons in care. POC Due Date: 03/14/2025 Plan of Correction 1 2 3 4 The licensee ordered the poster on this date and will send proof of the poster by POC date.
(b) Each resident's record shall contain at least the following information:
Based on record review, the licensee did not comply with the section cited above in having R1 to R4 resident files incomplete which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 The licensee agrees to complete all the resident's files and send proof to CCLD by POC date.
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:
Based on record review, the licensee did not comply with the section cited above in not having the Emergency Disaster Plan incomplete and not filled out which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 The licensee agrees to complete the Emergency Disaster Plan and send proof to CCLD by POC date.
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill,…
Based on record review the licensee did not comply with the section cited above by not conducting quarterly drills which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 The licensee agrees to conduct a drill and send proof to CCLD by POC date.
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physicia…
Based on record review the licensee did not comply with the section cited above in half bed rails for R2 and R4 which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 The licensee agrees to obtain the doctor's order for the half bed rails and send proof to CCLD by POC date.
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.
Based on record review, the licensee did not comply with the section cited above in having a full bed rail for R3 which poses a potential health and safety risk to persons in care. POC Due Date: 04/04/2025 Plan of Correction 1 2 3 4 The licensee will send an exception request and send to CCLD by POC date.
InspectionJanuary 20, 2023Type A9 deficiencies
Inspector: Luisa Fontanilla
Inspector notes
Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct annual required inspection and met with Administrator Cristina Concepcion. LPA explained to the Administrator the purpose of the visit. During the visit, LPA inspected the facility inside and out including but not limited to resident rooms, bathrooms, kitchen, dining, garage and backyard. Hot water measured at 138.5 Fahrenheit. There was sufficient supply of perishable and non perishable foods. LPA observed sufficient supply of warm blankets, sheets and towels available for use of the residents. Smoke detectors and carbon monoxide were tested and observed functional. First aid kit was observed to be complete. LPA reviewed 2 resident and 2 staff files. LPA interviewed 2 staff and one resident. The following deficiencies were observed: hot water measured at 135 degrees Fahrenheit Both staff on duty did not have any first aid training window screen/screen door observed taped and with holes no proof of staff training on file unused equipment, commodes, wood planks, etc were observed on the side fire extinguisher was last inspected on 7/8/2021 R2 has dementia and last medical assessment was made in 2022 missing staff and resident records were observed S2 does not have TB test and health screening on file 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.
(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…
Based on file review conducted, the licensee did not comply with the section cited above in having R2 work without TB test and health screening which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/29/2024 Plan of Correction 1 2 3 4 By POC date, Administrator will have S2 get TB test and do health screening and submit proof to CCL.
(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…
Based on file review conducted, the licensee did not comply with the section cited above in not having First aid training for both staff which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 By POC date, both staff will complete first aid training and submit proof to CCL.
Based on observation, the licensee did not comply with the section cited above in having hot water at 135 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/21/2024 Plan of Correction 1 2 3 4 By POC date, Administrator will adjust hot water temperature within range and submit self-certificate of completion to CCL.
Based on observation, the licensee did not comply with the section cited above in having screen door/window with hole/ripped, fire extinguisher not updated with inspection, having commodes, pieces of wood, mattress etc on the side and backyard which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/03/2024 Plan of Correction 1 2 3 4 By POC date, Administrator will submit photo proof of completion to CCL.
Based on file review, R1 who has dementia does not have an updated medical assessment. Last assessment is dated 2022. POC Due Date: 04/03/2024 Plan of Correction 1 2 3 4 Administrator will have R1 obtain an updated medical assessment and submit proof to CCL.
Based on file review, the licensee did not comply with the section cited above in not having proof of staff training which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/10/2024 Plan of Correction 1 2 3 4 By POC date, Administrator will submit to CCL proof of staff training.
Based on file review codnucted, the licensee did not comply with the section cited above in not having doctor's order for R2's 1/2 rails which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/03/2024 Plan of Correction 1 2 3 4 The administrator will submit to CCL doctor's order for R2's 1/2 rails.
Based on file review codnucted, the licensee did not comply with the section cited above in not having complete resident records on file which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/27/2024 Plan of Correction 1 2 3 4 By POC date, Adinistrator will update all residents' files and submit self-certification of completion to CCL.
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill,…
Based on file review, the licensee did not comply with the section cited above in not conducting fire drill which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/29/2024 Plan of Correction 1 2 3 4 Administrator will conduct emergency drill and submit proof to CCL.
ComplaintDecember 22, 2021Type A4 deficiencies
Inspector: Liridon Fici
Inspector notes
On 1/20/2023, at 3:15 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct an Annual Infection Control Visit. LPA was greeted by Christina Concepcio n , Licensee and explained the purpose of todays visit. During the inspection, LPA toured facility including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. LPA observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPA observed paper supplies and PPEs are sufficient. Facility has a sufficient 2-day perishable and 7-days non-perishable food supply. Common areas are disinfected frequently throughout the day. Water temperature is measured at 116.5 Degrees F in common area bathroom. Fire extinguisher was last serviced on 7/8/2021. Facilities room temperature is maintained at 68 Degrees F. First aid kit is complete. Carbon monoxide and smoke detectors are functional. Facility passages inside and out are free of obstruction and does not pose a health and safety risk for persons in care. 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 Continued from Lic809 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 . 1. At 3:35PM, LPA observed two cockroaches in the kitchen drawer. 2. At 3:47PM, LPA observed scissors and knifes located in the kitchen accessible to residents in care. 3. At 4:00PM, LPA observed 4 residents with half bed rails with no physicians order, and 1 full bed rail with no physicians order. Exit interview conducted with Licensee, appeal rights given, along with a copy of this report.
87705(f0(1): Care of Persons with Dementia- (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).
Based on observation, the licensee did not comply with the section cited above by having Scissors in the drawer and knifes in the kitcken pantry unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2023 Plan of Correction 1 2 3 4 Licensee agreed to lock up all scissors and knifes in the pantry in the kitchen. Deficiency cleared.
87608: Postural Supports- (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under …
Based on observation, the licensee did not comply with the section cited above by not requesting an order from R5's physician to get approval for a full bed rail which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 02/03/2023 Plan of Correction 1 2 3 4 Licensee agreed to obtain a physicians order for a full bed rail and to submit proof of the order to CCL by POC due date.
87608: Postural Supports-(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under …
Based on observation, the licensee did not comply with the section cited above by not obtaining physicians order(s) for R1, R2, R3, and R4 for approval for Half bed rails which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 02/03/2023 Plan of Correction 1 2 3 4 Licensee agree to obtain physicians orders for half bed rails for all residents and to submit to CCL by POC due date.
87555(b)(27): General Food Service Requirements- (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
Based on observation, the licensee did not comply with the section cited above by not keeping the facility clean from cockroaches and making sure there are no insects walking around the kitchen which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/27/2023 Plan of Correction 1 2 3 4 Licensee agreed to remove and keep facility cleared from all insects and to submit a self-certification on General food service requirements on keeping the kitchen…
Other visitDecember 22, 2021Type A8 deficiencies
Inspector notes
On 03/13/2026 at 9:00 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Cristina Concepcion and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 4 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/31/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/15/2025. At 9:53 AM, LPA reviewed 4 residents records. At 10:21 AM, LPA reviewed 3 staff records and 2 of 3 have current first aid training and 2 of 3 are associated with the facility. At 12:00 PM, LPA reviewed a sample of resident’s medications. 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 Continued from LIC809… Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/27/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:15 AM, LPA observed knife and scissors unlocked in the kitchen. At 9:22 AM, LPA observed Tylenol, Robitussin, Hydrocortisone Cream, Scissors, etc in R3's room. At 9:30 AM, LPA observed the garage unlocked with disinfectants. At 9:36 AM, LPA observed that one of the side gates is locked with a screw and the other side gate is locked with a screwdriver. At 9:45 AM, record review and observation revealed that the physical plant does not match the approved sketch on file. At 10:59 AM, LPA observed that the residents' files are incomplete such as their Appraisal Needs and Services Plan (LIC625, Identification and Emergency Information (LIC601), and Physician Report (LIC602A) for R3. At 11:13 AM, LPA observed that S2 is not associated with the facility. At 11:19 AM, LPA observed that the staff records are incomplete. S1 is missing First Aid Certification, S2 and S3 are missing Health Screening and TB Test. 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 Continued from LIC809-C... At 11:44 AM, LPA observed that R1, R2, and R4 have half bed rails without a doctor's order. At 12:05 PM, record review revealed that for R1 there is no discontinued order for the Melatonin and doctor’s order for sodium, docusate sodium, smartrx, blood sugar monitoring, etc. At 12:26 PM, record review revealed that the facility has not conducted a fire drill since September 15, 2025. The Facility was 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.
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fi…
Based on observation, the licensee did not comply with the section cited above by having a screw locking one of the sides gate, a screwdriver locking the other gate, and the physical plant of the facility not matching the approved facility sketch which poses an immediate health and safety risk to persons in care. POC Due Date: 03/14/2026 Plan of Correction 1 2 3 4 Administrator removed the screw and screwdriver from both gates. By 03/20/2026, Administrator agrees to send an updated facility s…
(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.
Based on observation the licensee did not comply with the section cited above by having knife and scissors unlocked in the kitchen, Tylenol, Robitussin, Hydrocortisone Cream, Scissors, etc in R3's room, and disinfectants in the garage which poses an immediate health and safety risk to persons in care. POC Due Date: 03/14/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to lock the items and send proof to CCLD.
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
Based on record review, the licensee did not comply with the section cited above by not having S2 associated with the facility which poses a potential health and safety risk to persons in care. POC Due Date: 03/20/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to associate S2 and send proof to CCLD.
(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.
Based on record review, the licensee did not comply with the section cited above. The residents' files are incomplete such as their Appraisal Needs and Services Plan (LIC625), Identification and Emergency Information (LIC601), and Physician Report (LIC602A) for R3 which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to complete all the residents' records and send proof to CCL…
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill,…
Based on record review, the licensee did not comply with the section cited above by not having fire drills conducted since September 15, 2025 which poses a potential safety risk to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to self certify the regulation and conducted a fire drill. Proof of correction will be sent to CCLD.
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physicia…
Based on record review, the licensee did not comply with the section cited above by not having a doctor's order for R1, R2, and R4 half bed rail which poses a potential health and safety risk to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to obtain a doctors' order for R1, R2, and R4 for their half bed rail.
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
Based on record review, the licensee did not comply with the section cited above by having the staff records incomplete. S1 is missing First Aid Certification, S2 and S3 are missing Health Screening, TB Test, and CPR certification which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/23/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator will obtain first aid for S1 and health screening,TB test, and CPR for S2 and S3. Proof of correcti…
(4) The licensee shall assist residents with self-administered medications as needed.
Based on observation, the licensee did not comply with the section cited above by not having a doctor’s order for the Melatonin and a discontinued order for sodium, docusate sodium, smartrx, blood sugar monitoring, etc. for R4 which poses a potential safety risk to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 By POC date, the Administrator agrees to obtain a doctor’s order and discontinued order for the medications and send proof to CCLD.
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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