Above & Beyond Rcfe, Inc.
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.
23652 Nevada Road · Hayward, 94541
Record last updated April 20, 2026.
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Quick facts
Memory care context
Above & Beyond RCFE, Inc. is a California-licensed Residential Care Facility for the Elderly with a memory care designation, 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 under §87705 or §87706 on two occasions, indicating regulatory oversight of its dementia-care practices. State records show 7 inspection reports with 44 total deficiencies: 20 Type A citations (actual harm) and 24 Type B citations (potential for harm). The most recent inspection was April 8, 2025. The high number of Type A deficiencies warrants careful review of the facility's compliance history before visiting.
Questions to ask on your tour
Based on Above & Beyond Rcfe, Inc.'s state inspection record.
State records show 20 Type A deficiencies (actual harm citations) across 7 inspections — can you walk me through what specific incidents led to these citations and what corrective actions were implemented?
The facility has been cited twice under §87705 or §87706 for dementia-care requirements — what were the specific deficiencies, and how has the facility changed its dementia care practices in response?
With 44 total deficiencies documented by CDSS, how has the facility's leadership or ownership changed its oversight, training, or staffing since these citations were issued?
Given the 6-bed capacity, what is the staff-to-resident ratio during overnight hours, and how do you ensure adequate supervision for residents with dementia who may wander or require redirection?
The most recent inspection was April 8, 2025 — were any new deficiencies identified, and what is the current status of any required corrective action plans?
State records
California CDSS · Community Care Licensing Division- License number
- 019201119
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Above & Beyond Rcfe, Inc.
Inspections & citations
7
reports on file
44
total deficiencies
20
Type A (actual harm)
2
dementia-care citations
Other visitApril 8, 2025No deficiencies
Inspector: Jill Clancy-Czuleger
Inspector notes
On 11/18/2022 at 09:15 am during the course of another visit, Licensing Program Analyst (LPA) J. Clancy-Czuleger discovered that the person that is listed as the administrator no longer works at the facility. The new administrator was designated in May 2022. The licensee did not notify the Department, in writing, within thirty (30) days of administrator starting. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted With Caregiver Evan Park. A copy of this report and appeal rights provided.
InspectionMarch 28, 2025Type B13 deficiencies
Inspector notes
On this day, 4/08/25, at 11:45 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 3/28/25. LPA met with staff, Larry Poblete, Evangelien Porter and Gerald Cayle Garcia, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, who arrived at around 12:25 pm. Max Neri, administrator (ADM) arrived at around 1:00 pm. Disaster drill record on file was dated 1/10/25. There's no record as proof drills were conducted on previous quarters. LPA reviewed 5 staff and 5 residents' files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 12:20 pm, staff (S2) does have LIC501 Personnel Record, LIC503 Health Screening, TB test and 40 hours required training on file. -at 12:35 pm, staff (S4) is not associated to this facility. Does not have LIC503 Health Screening, TB test, required 40 hours training and first aid certificate on file. -at 12:40 pm, staff (S5) does not have LIC503 Health Screening, TB test, required 40 hours training and first aid certificate on file. .......continued on 809C 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 1:05 pm, resident's (R1) LIC602A indicated ambulatory but resident has major neurocognitive disorder. LIC625 on file is over a year old. -at 1:17 pm, resident's (R2) LIC602A on file dated 2023 indicated bedridden but R2 was observed able to ambulate using walker. LIC602A indicated major neurocognitive disorder. LIC625 is over a year old. -at 1:25 pm, resident's (R3) LIC625 Appraisal/Needs Services Plan not properly filled-up - incomplete; page 2 blank; page 3 no care plan. No doctor's order on file for half bed rails. -at 1:40 pm, resident's (R4) LIC602A is over a year old; does not have Pre-Admission Appraisal and LIC625 Appraisal/Needs and Services Plan. Half bed rails does not have doctor's order on file. -at 2:10 pm, resident's (R5) 2 medications received by the facility not properly recorded on LIC622. Administrator to submit current/updated copies of the following documents by April 22, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610D Emergency Disaster Plan (9 pages). 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
(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 in S4 not associated which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator provided a copy of LIC9182 transfer request while LPA is at the facility. In addition, administrator to submit the documents via email to the Oakland Regional Office by POC date.
87412 Personnel Records (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 in S2 does not having LIC501 Personnel Record on file which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to have the LIC501 completed and submit proof by 4/22/25.
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal.
Based on record review, the licensee did not comply with the section cited above in R4 not having Pre-Admission Appraisal which poses a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to complete the Pre-Admission Appraisal and submit copy by 4/22/25.
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations.
Based on record review, the licensee did not comply with the section cited above in R4 not having LIC625 Appraisal/Needs and Services Plan which poses a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to complete the LIC625 and submit copy by 4/22/25.
(c) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101, Definitions, or bedridden as defined in Health and Safety Code section 1569.72. The assessment shall indicate whether nonambulatory status is based upon the resident's physical condit…
Based on records review, , the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: R1's LIC602A indicated ambulatory but resident has major neurocognitive disorder. R2's LIC602A indicated bedridden but R2 was observed able to ambulate using walker. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administator to have the LIC602As corrected and submit proof by 4/22/25.
(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as speci…
Based on records review, the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: R1 and R2's LIC625 over a year old; R3's LIC625 not properly filled-up. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to do re-appraisal and properly fill-up the LIC625. Self-certification to be submitted by 4/22/25.
(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 records review, the licensee did not comply with the section cited above in not having records showing drills were conducted on previous quarters which pose a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to read the Regulations and submit self-certification ensuring drills are conducted at least quarterly.
87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as t…
Based on record review, the licensee did not comply with the section cited above in S4 and S5 not having first aid certificate on file which pose a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to have the staff reqistered for training and submit copies of certificates by 4/22/25.
87412 Personnel Records (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: (11) A health screening as specified in Section 87411, Personnel Requirements - General.
Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having LIC503 on file which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to have the staff health screened and submit proof by 4/22/25.
87411 Personnel Requirements - General (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) m…
Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having TB test on file which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to have the staff TB tested and submit copies of test results by 4/22/25.
§1569.625 Staff training; legislative findings; contents: (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall comp…
Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having the 40 hours required training on file which pose a potential health, safety and/or personal rights risk to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to have the staff complete the training and submit proof by 4/22/25.
87506 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
Based on record review, the licensee did not comply with the section cited above in R5’s 2 medications received by the facility not properly recorded on LIC622 which posed a potential personal rights risk to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to correct the LIC622 and submit proof by 4/22/25.
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. (3) A writt…
Based on records review, the licensee did not comply with the section cited above in R3 and R4’s half bed rails not having doctor's order on file which pose a potential safety and/or personal rights risk to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 Administrator to obtain doctor's order and submit copies by 4/22/25.
InspectionMarch 23, 2024Type A6 deficiencies
Inspector notes
On this day, March 28, 2024, at 4:10 pm., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Virginia Rulete and Blesilda Yamat, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, and Max 'Mike' Neri, administrator (ADM). The licensee authorized to have the staff to be with LPA in touring the facility. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were observed in operating condition. Hot water temperature in the common bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced 3/06/25. LPA observed the following: -at 4:25 pm, medications in the refrigerator in unlocked garage. -at 4:27 pm, unlocked kitchen shears and medication (Aspirin) in the kitchen cabinet. -at 4:28 pm, kitchen cabinets where sharps and cleaning supplies are kept do not have an appropriate lock. -at 4:30 pm, Vitamins and perineal skin protector in cabinet without lock in the area adjacent to the dining area. ...continued on 809C (page 2) 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 Page 2 -at 4:42 pm, shaving cream in one of the residents' rooms. -at 4:43 pm, razor in food tray in another resident's room. -at 4:44 pm, disinfectant and sanitizing sprays in the common bathroom. -at 4:50 pm, hot water in the common bathroom was at 134.1 degrees Fahrenheit. -at 5:02 pm, Isopropyl alcohol and urinary tract infection (UTI) pain reliever in the drawer in another residents' room. -at 5:04 pm, piece of metal, mattress, bed frame and bed rail in the backyard. -at 5:05 pm, rake outside the storage in the backyard. -staff (S1) is fingerprint cleared, however, not associated to this facility. Administrator to submit copies of the following updated/current documents by April 11, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with licensee and ADM over the phone. Licensee authorized Virginia Rulete to sign and receive this report. Due to time constraint, LPA to come back to continue the inspection. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
(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 hot water at 134.1 degrees Fahrenheit which poses an immediate health and/or personal rights risks to persons in care. POC Due Date: 03/29/2025 Plan of Correction 1 2 3 4 Administrator to have the temperature adjusted within Regulations range and submit proof by 3/29/25.
(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 the following which pose an immediate health, safety and/or personal rights risks to persons in care: medications in unlocked garage; unlocked kitchen shears and medication (Aspirin) in the kitchen cabinet; kitchen cabinets where sharps and cleaning supplies are kept do not have an appropriate lock; unlocked Vitamins and perineal skin protector; shaving cream, Isopropyl alcohol, UTI pain reliever and razor in re…
(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents.
Based on observation, the licensee did not comply with the section cited above in a rake outside the storage in the backyard which poses an immediate safety and/or personal rights risks to persons in care. POC Due Date: 03/29/2025 Plan of Correction 1 2 3 4 Staff temporarily locked the rake in the garage. Administrator to do the following and submit proof by 3/29/25: 1. Put the rake in the storage. 2 In-service the staff and submit copy of training topic with attendees signatures.
(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.
Based on observation, the licensee did not comply with the section cited above in rotten broccoli which poses an immediate health and/or personal rights risks to persons in care. POC Due Date: 03/29/2025 Plan of Correction 1 2 3 4 Staff discarded the item. Administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/29/25.
(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 the following pose a potential safety and/or personal rights risks to persons in care: piece of metal, mattress, bed frame and bed rail in the backyard. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Administrator to have the yard cleaned and submit pictures by 4/11/25.
87355 Criminal Record Clearance (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)
Based on interview and review of facility roster in Guardian, the licensee did not comply with the section cited above in S1 not associated which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Administrator to have the staff associated and submit proof by 4/11/25.
InspectionFebruary 20, 2023Type A16 deficiencies
Inspector: Alicia Delmundo
Inspector notes
.On this day, March 23, 2024, at 11:05 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Marlyn Joaquin and Raul Pangilinan, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, who authorized Marilyn Joaquin to be with LPA to start inspection. Licensee and Max 'Mike' Neri, administrator, arrived at 11:35 a.m. and 11:40 a.m.. respectively. Facility submitted the LIC9282 Infection Control Plan on June 29, 2022. LPA started the inspection with Marlyn Joaquin, and continued with the licensee and administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were observed functional. Hot water temperature in the ensuite bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced February 13, 2024. Facility disaster drill records checked. LPA reviewed 5 residents and 4 staff files, and interviewed 2 staff and 2 residents. Medications were checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 11:19 a.m., unlocked medication cabinets. -at 11:20 a.m., residents medications in the refrigerator in the kitchen. ...continued on 809C (page 2) 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 Page 2 -at 11:24 a.m., knives in unlocked kitchen cabinet, and scissors and pizza cutter in kitchen drawers without lock. -at 11:32 a.m., scissors in drawer without lock in the living room. -at 11:34 a.m., medication in unlocked staff room. -at 11:41 a.m., Aleve, Glucosamine. Bengay in one of residents rooms. -at 11:52 a.m., Lysol, Windex, Barbasol in cabinet without lock in the ensuite bathroom. -at 11:55 a.m., hot water at 125.1 degrees Fahrenheit. -at 11:59 a.m., peritoneal cleansers and ointments in the common bathroom.. -at 12:01 p.m., trash cans without lid in one of the residents' rooms and living room. -at 12:06 p.m., Oxygen tanks, pails of paint in unlocked storage in the backyard. -at 12:30 p.m., disaster drills not conducted quarterly; records showed conducted on 1/11/22 and 1/11/24. -at 2:00 p.m., staff (S3) has no LIC503 Health Screening & TB test result on file, Total hours of training on file is only 22 hours. -at 2:30 p.m., staff (S4) not fingerprint cleared and associated. -at 3:15 p.m., resident (R1) LIC602A Physician's Report is over a year old. No LIC625 Appraisal/Needs and Services Plan & doctor's order for half bed rails. -at 3:50 p.m., R2's half bed rails no doctor's order on file,, -at 4:05 p.m., no doctor's order on file for R3's half bed rails. -at 5:00 p.m., R1's 3 medications not recorded on LIC622 Centrally Stored Medication and Destruction Record, Dates filled of other medications incorrectly recorded. -at 5:35 p.m., R2 has 21 medications on facility's hand but there's only 18 on doctor's order, Facility is only giving only 11 medications of which one (muti vitamins) is given twice daily when order is only once daily. Medications received were not properly recorded on LIC622. -at 7:00 p.m., R3 has no LIC622 on file. Doctor's order for calcium carbonate-Vit D3 (600 mg-12.5 mcg(500 unit) but the medication on facility's hand os 600 mg-10 mg (400 unit).No doctor's order for half bedrails. -at 7:05 p.m., no doctor's for R4's half bed rails. ....continued on 809C (pge 3) 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 Page 3 Administrator submitted on this day the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed for staff not fingerprint cleared. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator and licensee. Exit interview conducted. Appeal Rights, LIC421BG Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.
(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 hot water at 125.1 degrees Fahrenheit.which poses an immediate health, safety and/or personal rights risks to persons in care. POC Due Date: 03/24/2024 Plan of Correction 1 2 3 4 Corrected. Administrator adjusted the water temperature to 110 degrees Fahrenheit.
(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.
Based on observation, the licensee did not comply with the section cited above which pose an immediate health, safety and/or personal rights risk to persons in care. LPA observed the following: knives in unlocked kitchen cabinet; scissors and pizza cutter in drawers without lock; Lysol, Windex, Barbasol in cabinet without lock in the ensuite bathroom; peritoneal cleansers and ointments, lighter, scissors in one of the residents rooms; peritnoeal cleaner in the common bathroom POC Due 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:
Based on record review, the licensee did not comply with the section cited above in S4 not fingerprint cleared and associated to the facility which poses an immediate safety and/or personal rights risk to persons in care. A $500.00 civil penalty is assessed. POC Due Date: 03/24/2024 Plan of Correction 1 2 3 4 Administrator to have the staff fingerprinted, and will not allow to work until cleared and associated. Proof to be submitted by 3/24/24.
(4) The licensee shall assist residents with self-administered medications as needed.
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: Plan of Correction 1 2 3 4
(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the …
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: Plan of Correction 1 2 3 4
(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.
Based on observation, the licensee did not comply with the section cited above in cabinets with residents' medications unlocked which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/24/2024 Plan of Correction 1 2 3 4 Staff locked the cabinets. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/24/24.
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are…
Based on record review, the licensee did not comply with the section cited above in staff administering R2's multi vitamins twice daily when doctor's order is once daily; Doctor's order for R3's calcium carbonate-Vit D3 (600 mg-12.5 mcg(500 unit) but the medication on facility's hand os 600 mg-10 mg (400 unit).which poses an immediate health and/or personal rights risk to persons in care. POC Due Date: 03/24/2024 Plan of Correction 1 2 3 4 Administrator to have the medication for R2 administe…
(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following informa…
Based on observation and record review)], the licensee did not comply with the section cited above in having 21 medications on hand for R2 but order on file is only for 18.count which poses an immediate health and/or personal rights risk to persons in care. POC Due Date: 03/24/2024 Plan of Correction 1 2 3 4 Administrator to check with the doctor if the 3 medications are still needed by R2 and obtain doctor's order. Proof to be submitted by 3/24/24.
(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
Based on observation, he licensee did not comply with the section cited above in Aleve, Glucosamine. Bengay in one of the resident's rooms which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/25/2024 Plan of Correction 1 2 3 4 Administrator and staff locked the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/24/24.
(f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof.
Based on observation, the licensee did not comply with the section cited above in trash can without lid which poses a potential health and/or personal rights risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to purchase trash can with foot pedal operated lid, and submit proof of purchase by 4/06/24.
(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General.
Based on record review, the licensee did not comply with the section cited above in S3 has not having LIC503 Health Screening & TB test on file which pose a potential health and/or personal rights risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to have the staff health screened and TB tested, Proof to be submitted by 4/06/24,
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, …
Based on record review, the licensee did not comply with the section cited above in S3 only having total of 22 hours training ofn file which poses a potential health, safety and/or personal rights risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to have the staff complete the training, and submit self-certification by 4/06/24.
(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 in for not conducting drills at least every quater which poses a potential safety risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to have drill conducted, and submit proof by 4/06/24.
(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 for not having doctor's orders for R1,R2, R3 and R4's half bed rails which poses a potential health, safety and/or personal rights risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to obtain doctor's order, and submit copies by 4/06/24.
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care …
Based on record review, the licensee did not comply with the section cited above in R1's LIC602A over a year old & no LIC625 on file which pose a potential health and/or personal rights risk to persons in care. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to obtain an updated LIC602A and complete LIC625 for R1, and submit self-certification.
87506 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
Based on records review, the licensee did not comply with the section cited above for the following which poses a potential personal rights risk to persons in care: R1's 3 medications not recorded & other medications not proeprly recorded on LIC622; R2's medications not properly recorded on LIC622. POC Due Date: 04/06/2024 Plan of Correction 1 2 3 4 Administrator to correct the record, and submit self-certification by 4/06/24,
Other visitNovember 18, 2022Type A5 deficiencies
Inspector notes
On this day, March 26, 2026, at 4:10 pm., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Larry Poblete and LOurdes Deocampo, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee. Licensee and Max 'Mike' Neri, administrator (ADM) arrived at around 4:20 pm. LPA started the inspection with Larry Poblete and continued with Max Neri. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has 2 in 1 smoke and carbon monoxide detector that was tested and observed in operating condition during today's visit. Hot water temperature in the common bathroom was tested an measured at 117 degrees Fahrenheit.. Fire extinguisher was observed fully charge with tag showed serviced March 16, 2026. LPA observed the following: -at 4:16 pm, unlocked central storage for medications. -at 4:19 pm, unlocked scissors in the kitchen drawer. -at 4:25 pm, Cortisone ointments in unlocked staff room. -at 4:27 pm, bleach and Lysol spray in unlocked cabinet in residents' ensuite bathroom. -at 4:28 pm, shower room in ensuite bathroom with mildew. ...continued on 809C (page 2) 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 4:35 pm, Calmoseptine ointments in one of the residents' room. -Staff (S1) who started working on March 8, 2026 is not fingerprint cleared. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section #87355(e)92) for staff who is not fingerprint cleared and will continue for $100.00/day until corrected, and for repeat violations of section #'s 87309(a) and 87309(c) within 12 month period. Failure to submit proof of corrections by plan of correction due dates for other deficiencies cited may also result in civil penalties. Deficiencies, plan and proof of corrections, and civil penalties were discussed with the administrator. Due to time constraint, LPA will come back to continue the inspection. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalties, LIC9098 Proof of Correction form and copy of this report provided.
(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 unlocked scissors in kitchen drawer, and bleach and Lysol spray in in unlocked cabinet in residents' ensuite bathroom which pose an immediate health, safety and/or personal rights risk to persons in care. This is a repeat violation within 12 month period. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 Staff locked the scissors and ensuite bathroom cabinet. In addition, licensee and/or administrator to in-s…
(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents.
Based on observation, the licensee did not comply with the section cited above in Cortisone ointments in unlocked staff room which poses an immediate safety and/or personal rights risks to persons in care. This is a repeat violation within 12 month period. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 Staff locked the room. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/27/26.
(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.
Based on observation, the licensee did not comply with the section cited above inunlocked central storage for medications which poses an immediate health, safety and/or personal rights risks to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 Staff locked medication central storage. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/27/26.
87355 Criminal Record Clearance (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: (2) Obtain a California clearance or a criminal record exemption as required by the Department or
Based on record review, the licensee did not comply with the section cited above in a staff not fingerprint cleared which poses an immediate safety and/or personal rights risks to persons in care. POC Due Date: 03/27/2026 Plan of Correction 1 2 3 4 Staff left the facility while at the facility. Administrator to have the staff fingerprinted and cleared. Proof to be submitted by 3/27/26.
(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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.
Based on observation, the licensee did not comply with the section cited above in shower room in ensuite bathroom with mildew which poses a potential health and/or personal rights risks to persons in care. POC Due Date: 04/09/2026 Plan of Correction 1 2 3 4 Licensee and/or administrator to have the shower room cleaned and submit picture by 4/09/26.
Other visitFebruary 24, 2022Type A4 deficiencies
Inspector: Alicia Delmundo
Inspector notes
Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with staff, Gerald Garcia and Marlyn Joaquin, and informed the purpose of visit. Josefina 'Josie' Booker, administrator, arrived after about 16 minutes followed by Leticia 'Lettie' Velasco, licensee/ Facility has LIC9282 Infection Control Plan and approved LIC808 Mitigation Plan. LPA started inspection with Gerald Garcia, and continued with Josefina Booker. LPA inspected the living room, dining area. family room, kitchen, hallways, residents bedrooms, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station by the front entrance with hand sanitizer, no touch temperature probe. Facility has Visitor's log. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked. Facility has antigen test kits readily available. COVID-19 signages were observed throughout the facility. Bathroom lavatories were observed with liquid soap. Fire extinguisher checked, and observed fully charge with tag showed serviced July 28, 2022. Hot water temperature in the common bathroom was tested. LPA observed the following: 1. Hot water temperature at 134 degrees Fahrenheit. 2. Medications in all 4 residents rooms. .......continued on 809C 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 3. Cleaning supplies in unlocked garage and garage cabinets. 4. Door bell not working. 5. Rusted rake, bed frames, used bed, chicken wire. pieces of wood in the backyard. 6. Disposable face shields and gowns, and N95 respirators not sufficient for 30 days for 7 staff. License and/or administrator to submit the following by March 6, 2023: 1. LIC308 Designation of Facility Responsibility 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of $3M liability insurance. 5. Current N95 fit testing records/certificates Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with licensee and administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
87465 Incidental Medical and Dental Care (h)(1)(C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others
Based on observation, the licensee did not comply with the section cited above. LPA observed medications in 4 out of 4 residents bedrooms and medication cabinet unlocked which poses an immediate safety risk to persons in care. POC Due Date: 02/21/2023 Plan of Correction 1 2 3 4 Staff locked the medications and medication cabinet while LPA is at the facility. In addition, licensee and/or administrator to in-service the staff and submit training topic with attendees signatures by 2/21/23.
87309 Storage Space (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.
Based on observation, the licensee did not comply with the section cited above. LPA observed rusted rake in the backyard and cleaning supplies in unlocked garage and garage cabinets which pose immediate safety risks to persons in care. POC Due Date: 02/21/2023 Plan of Correction 1 2 3 4 Staff locked the rake and medication cabinet, and locked all the cleaning supplies cabinets in the garage. In addition, licesnee and/or administrator to in-service the staff, and submit training topic with att…
87303 Maintenance and Operation (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 temper…
Based on observation, the licensee did not comply with the section cited above for hot water at 134 degrees Fahrenheit which poses an immediate safety risk to persons in care. POC Due Date: 02/21/2023 Plan of Correction 1 2 3 4 Staff adjusted the temperature to 105 degrees while LPA was still at the facility. In addition, licensee and/or administrator to have the temperature regularly checked to ensure temperature is within Regulations range. Proof to be submitted by 2/21/23.
87303 Maintenance and Operation (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. LPA observed the following in the backyard: bed frames, used bed, chicken wire. pieces of wood. LPA also observed the doorbell not working. POC Due Date: 03/06/2023 Plan of Correction 1 2 3 4 Staff locked the items in the storage and fixed the doorbell. In addition, license and/or administrator to in-service the staff and submit training topic with attendees’ signatures by 3/06/23.
Other visitNovember 9, 2021No deficiencies
Inspector: Alicia Delmundo
Inspector notes
Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Leticia 'Lettie' Velasco, applicant, and Albert Leano, administrator. LPA presented the training via Power Point presentation and had a discussion with applicant and administrator. After Component III, LPA conducted Proof of Correction visit and observed the yard cleaned. LPA also observed the central storage for medications, staff room and cabinet for knives, and cabinets in the garage where cleaning supplies are kept were locked. Applicant submitted copies of in-service training and N95 fit testing record on February 22, 2022. Exit interview conducted and copy of this report provided.
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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