Colonial Acres Residential Care Home.
Colonial Acres Residential Care Home is Ranked in the bottom 11% of California memory care with 49 CDSS citations on record; last inspected Nov 2025.
Memory Care Home in Hayward's Fairview District, reviewed on public record.
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Compared to 152 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.
Rankings based on 36-month CDSS inspection data. Severity and frequency: fewer citations = higher percentile. Repeat rate: lower repeat citation share = higher percentile.
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Colonial Acres Residential Care Home has 49 citations on record. Know the moment anything changes.
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Citation history, plotted month by month.
49 deficiencies on record. Each bar is a month with a citation.
Finding distribution
49 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
Because a facility markets dementia or Alzheimer's care, state law mandates higher training standards: 12 hours of initial dementia training (6 hours before a staff member works independently with residents, 6 more within the first 4 weeks), 8 hours of annual dementia in-service every year thereafter, and an administrator must include 8 hours of dementia-specific continuing education in every 2-year recertification cycle. Training must cover individualized care plans, behavioral expressions, appropriate supervision, and the facility's dementia care philosophy.
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“Can you show me each direct-care staffer's most recent dementia training certificate, and tell me when their next refresher is due?”
Questions to ask before you visit.
A short pre-tour checklist tailored to Colonial Acres Residential Care Home's record and state requirements.
State records show 18 Type A deficiencies indicating actual harm to residents — what were the specific circumstances of these citations, and what corrective actions were implemented?
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Four citations under §87705 or §87706 relate to dementia care requirements — what specific deficiencies were identified, and how has staff training or supervision changed as a result?
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Five complaints have been filed with CDSS — what were the subjects of those complaints, and which were substantiated by state investigators?
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Every inspection visit, verbatim.
11 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.
2025-11-13Annual Compliance VisitType A · 16 findings
Plain-language summary
On November 13, 2025, state licensing conducted an unannounced annual inspection and found multiple safety and care deficiencies: unsecured knives, scissors, razors and cleaning supplies accessible to residents; doors with inadequate locks; a resident's medication stored improperly in a refrigerator; smoke detectors without batteries; hot water temperature too high; an unlocked utility room; staff certifications expired or required training incomplete; residents' medical records and care plans significantly overdue; and incomplete medication records with one resident not receiving a prescribed daily medication. The facility was assessed civil penalties totaling $2,000 and given deadlines to correct the violations.
“Based on observation, the licensee did not comply with the section cited above in carbon monoxide not working due to no battery which poses an immediate safety and/or personal rights risk to persons in care. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Corrected. Licensee put battery while LPA was at the facility.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate safety and/or personal rights risk to persons in care: unlocked knives, kitchen shears, lighter, razor, cleaning agents in the kitchen. THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Staff removed and locked all the items. In addition, licensee to in-service the staff and stated he will have lock installed on the kitchen drawers. Copy of in-service and pictures to be submitted by 11/14/25.”
“Based on observation, the licensee did not comply with the section cited above inunlocked utility room where cleaning supplies are kep which poses an immediate safety and/or personal rights risk to persons in care. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Licensee locked the room. In addition, licensee to in-service the staff.”
“Based on observation, the licensee did not comply with the section cited above in medication on the kitchen counter and resident's medications unlocked in the refrigerator which pose an immediate health, safety and/or personal rights risk to persons in care. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Staff locked the items. Licensee to in-service the staff and submit proof by 11/14/25.”
“Based on observation, the licensee did not comply with the section cited above in loose light switch cover in resident's room which poses a potential safety and/or personal rights risks to persons in care. THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the switch cover fixed and submit picture by 11/27/25.”
“Based on observation, the licensee did not comply with the section cited above in hot water temperature at 121.3 degrees Fahrenheit which poses a potential health and/or personal rights risks to persons in care. THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the water temperature adjusted to a temperature within Regulations range and submit proof by 11/27/25.”
“Based on records review, the licensee did not comply with the section cited above in R2 and R3's medical assessments (Physician's Report) over a year old which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have a medical assessment schedule for R2 and R3 and submit copies of LIC602A by 11/27/25.”
“Based on record review)], the licensee did not comply with the section cited above in R4's LIC625 Appraisal/Needs and Services Plan more than 2 years old which poses a potential health and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the re-appraisal performed and submit copy of LIC625 by 11/27/25.”
“Based on record review, the licensee did not comply with the section cited above in not conducting drills every quarter which poses a potential safety and/or personal rights risks to persons in care. THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have drills conducted and submit copy by 11/27/25,”
“Based on records review, the licensee did not comply with the section cited above in staff (S2 and S5) certificates expired which pose a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have S2 and S5 register for training and submit copies of certificates by 11/27/25.”
“Based on records review, the licensee did not comply with the section cited above in S3 and S4 not having TB test and LIC503 Health Screening on file which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the staff undergo health screening and submit proof by 11/27/25.”
“Based on records review, the licensee did not comply with the section cited above in S3 & S4 not have the required total 40 hours required training which pose a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the staff complete training and submit proof by 11/27/25.”
“Based on records review, the licensee did not comply with the section cited above for not having LIC622 Centrally Stored Medication and Destruction for all the medications received by the facility nor have complete record for medications administered for R5 which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to have the records completed and submit proof by 11/27/25.”
“Based on records review, the licensee did not comply with the section cited above in not having doctor's orders for R1 and R2's half bed rails which pose a potential health, safety andor personal rights risks to persons in care. THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD. POC Due Date: 11/27/2025 Plan of Correction 1 2 3 4 Licensee to obtain doctor's orders and submit copies by 11/27/25.”
“Based on observation, the licensee did not comply with the section cited above in Installing a door hardware operable with code in 2 entrance/exit doors and having dowels in the other entrance/exit door which poses an immediate health, safety or personal rights risk to persons in care. A $500.00 civil penalty is assessed. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Corrected. Licensee removed and replaced the door hardwares and replaced with a 'no-knowledge' type and removed the dowels while LPA was at the facility.”
“Based on record review, the licensee did not comply with the section cited above in not having one of R5's prescribed medications which poses an immediate health and/or personal rights risks to persons in care. POC Due Date: 11/14/2025 Plan of Correction 1 2 3 4 Licensee to have the medication obtained and submit picture by 11/14/25.”
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On this day, November 13, 2025, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Maria Dolores Floriza, and informed the reason for visit. John Ronald Olivarez, licensee, arrived at around 10:56 am. Licensee left at around 4:30 pm. LPA started inspection with Maria Dolores Floriza and continued with licensee. LPA inspected the kitchen, dining area, living/tv room, common areas, bathrooms and staff room. LPA randomly selected 5 residents rooms for inspection. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Hot water temperature in lavatory in one of the resident's rooms was tested. Fire extinguishers were observed fully charge with tags showed serviced September 23, 2025. Disaster drill records reviewed. LPA reviewed 5 staff and 5 residents files, and interviewed 1 resident. Medications checked, and compared with LIC622 Centrally Stored Medication and Destruction Records and doctor's orders. Facility does not handle residents' cash resources. Copies of the following updated/current documents were obtained on this same day: 1. LIC610E Emergency Disaster Plan (9 pages) 2. $3M Liability insurance certificate ....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 Licensee to submit copies of the following updated documents by November 27, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report The following deficiencies were observed, cited from Title 22 California Code of Regulations, and listed on 809Ds: -at 10:45 am and 11:26 am, front and back entrance/exit doors with locks operable with code. -at 11:00 am, resident's medication in the refrigerator. -at 11:02 am to 11:04 am, knives, kitchen shears, razor, lighter in kitchen drawers without locks. -at 11:05 am, knives and cleaning agents in unlocked kitchen cabinets and Vit D3 on kitchen counter. -at 11:23 am, loose light switch cover in one the residents' rooms. -at 11:25 am, hot water temperature at 121.3 degrees Fahrenheit. -at 11:27 am, dowels in another entrance/exit door. -at 11:30 am, unlocked utility room where cleaning supplies are kept. -at 11:40 am, 2 in one smoke/carbon monoxide detector not working due to no battery. -at 12:30 pm, facility does not conduct disaster drill every quarter; records showed last conducted 01/2025 and 04/2025. -at 1:25 pm and 1:50 pm, staff (S2 and S5) CPR/First Aid/AED certificates expired 11/11/25. -at 1:35, to 1:55 pm, staff, S3 & S4, do not have the required total 40 hours required training for 2024 and 2025 respectively. No TB test and LIC503 Health Screening on file. -at 2:30 pm, residents, R1 and R2, half bed rails have no doctor's order on file. -at 2:40, residents, R2 and R3, Physician's Reports/medical assessments are over a year old. -at 2:50 pm, resident, R4, LIC625 Appraisal/Needs and Services Plan is more than 2 years old. -at 3:25 pm, resident, R5, has doctor's order for a medication to be administered daily but facility does not have this medication. Facility does not have LIC622 Centrally Stored Medication and Destruction for all the medications received by the facility nor have complete record for medications administered. A $500.00 immediate civil penalty is assessed for deficiency section 87203 and $250.00 each for repeat violations of the following sections: 87309(a); 87303(a); 87303(e)(2); 1569.695(c); 87565(a)(4); 87608(a)(3). Failure to submit proof of corrections by plan of correction due dates may result in addtional civil penalties. ....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 Deficiencies and plan and proof of corrections were discussed with licensee over the phone, and authorized Maria Dolores Floriza. Exit interview conducted. Appeal Rights, LIC421IM, LIC421FC Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2024-12-20Other VisitType A · 3 findings
Plain-language summary
This was a follow-up investigation visit on December 20, 2024, resulting from a previous complaint about resident care. Inspectors found that a bedridden resident with advanced dementia and a fractured pelvis had an incomplete functional assessment on file and was not being repositioned as needed, and the facility was assessed a $500 civil penalty plus $100 per day until the assessment was completed and repositioning care was documented.
“-Based on record review and interviews, the licensee did not comply with the section above when R1 who is bedridden was admitted and facility does not have bedridden fire clearance.”
“-Based on record review and interviews, the licensee did not comply with the section above when R1 who is dependent on others will all ADLs was admitted which posed a potential health risks to person in care.”
“-Based on records review, the licensee did not comply with the section in R1's incomplete LIC9172 which posed a potential health, safety and/or personal rights risks to person in care.”
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On this day, 12/20/24, at 4:10 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management resulting from the investigation of a complaint (15-AS-20220927100258) by the Department. LPA met with Mary Eileen Legados, administrator (ADM), and informed the purpose of visit. John Ronald Olivarez, licensee, arrived after about an hour. During investigation, the Department observed the following: 1. Resident's (R1) LIC602A Physician's Report dated 1/25/2 2 i ndicated the following: non-ambulatory and bedridden; contractures on lower & upper extremities; advanced frontotemporal dementia; fractured pelvis (unable to rehabilitate). The staff interviewed indicated R1 needs to be repositioned. LIC9020 Register of Facility Clients/Resident was bedridden. 2. LIC602A showed R1 was dependent on others with all activities of daily living (ADLs). 3. R1's LIC9172 Functional Capability Assessment was incompletely filled-up. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil is assessed for deficiency section # 87202(a)(2) and will continue for $100.00/day until corrected. Deficiencies, plan and proof of corrections and civil penalty were discussed with licensee and ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form, and copy of this report provided.
2024-12-20Complaint InvestigationSubstantiatedType A · 1 finding
Plain-language summary
A complaint investigation found that staff failed to prevent a resident with dementia from developing a severe pressure injury that progressed from stage 1 to stage 4 while in care, did not ensure adequate hydration leading to dehydration and a urinary tract infection, did not seek timely medical help (the family called 911), and left the resident soiled in urine for extended periods. The resident was hospitalized in September 2022 with stage 4 pressure injury, septic shock, and dehydration. The facility was cited for violations and assessed a civil penalty.
“-This requirement is not met as evidenced by -Based on records review and interviews, the licensee did not comply with section above for not seeking medical attention for R1 when R1’s pressure injuries progressed which posed an immediate health risk to person in care.”
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Page 2 Allegation: Resident (R1) developed stage 4 pressure injury while in care. R1 was admitted to the facility on 1/08/22, and the Pre-placement Appraisal did not indicate that R1 had a pressure injury, however, the LIC602A Physician’s Report indicated that R1 had contractures to the upper and lower extremities, required continuous bed care, had fragile skin and needed to be repositioned every 2 to 3 hours. John Olivarez, licensee, stated that R1 has dementia, was bed bound and fully contractured when admitted to the facility and that R1 was always in fetal position. Licensee stated R1 was admitted to the facility as it was their hope that R1 could get to the point where R1 could sit up on her own. R1’s pressure injury was reported to him by staff which at the time he believes it was stage 1. The pressure injury worsened Staff (S3) stated she does not believe R1 should be admitted to the facility because S3 felt that R1 needed a higher level of care. R1 has dementia and needed assistance with all activities of daily living, with both feet and hands being contractured, and R1 was difficult to reposition. S3 also stated that the first person to notice the pressure injury was R1’s previous caregiver - when this private caregiver visited R1 and changed R1’s diaper and reported the pressure injury to her. S2 stated having noticed the wound which was approximately the size of a quarter. R1 had home health but S2 was not able to report anything because she never saw them, or she was busy assisting other residents. Between the time R1’s home health was terminated to the time R1 was hospitalized, S2 was cleaning R1’s wound. In September 2022, S2 noticed R1’s wound grown to about the size of a golf ball with soft center and had some pus. Two out of 3 residents interviewed did not know or remember R1 while the other 1 stated R1 can walk but R1’s documents and staff interviewed stated R1 is bedridden. Previous administrator (S1) stated R1’s daughter requested ambulance transportation on September 2022 to the hospital per advice nurse and R1’s doctor. Medical records showed R1 was admitted to the hospital on 9/16/22 and diagnosed with stage 4 sacral pressure injury and unstageable pressure injury at right lateral pelvis. .....continued on 9099C (page 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 FM1 stated when R1 was admitted to the facility, R1’s pressure injury in the sacrum was superficial and eventually healed after home health services for 1 to 2 months. In May 2022, the pressure injury came back and R1 was placed on home health again and was discharged when the wound was not completely healed because the home health nurse felt it was okay to discharge R1 so long as the staff continue to change the dressing and reposition R1. FM1 and FM2 stated that they visited R1 several times a week for 30 minutes to 3 hours and staff did not check R1 unless they asked. FM1 stated she visited R1 on September 2022 on R1’s birthday and R1 was lethargic, unresponsive and barely able to eat. FM1 discussed the pressure injury with R1’s physician and requested for home health service. After 2 days, R1 was visited by a home health nurse and said that the injury was too advanced to treat with home health. FM1 called 9-1-1. Medical records showed R1 was admitted to the hospital on September 16, 2022 and was diagnosed with stage 4 pressure injury in the sacrum and unstageable pressure at right lateral pelvis. Based on interviews and records review, the allegation is substantiated. Allegation: Staff allowed resident to become severely dehydrated while in care. Staff (S2, S3 and S4) interviewed provided differing information in regard to R1 eating and drinking. S3 stated R1’s eating habits were inconsistent and that at the time of admission, R1 ate well and able to drink Ensure and water. S3 stated R1 ate a little, didn’t drink much, and noticed that R1 was dehydrated. S4 stated R1’s appetite and liquid intake were good, and that R1 was able to drink half a glass of water without issue. W1 and W2 stated that when they visited R1 and requested the staff to assist in transferring to wheelchair so that W1 can feed R1, the staff responded with an assumption that R1 will not eat. W1 stated that on their last visit prior to R1’s hospitalization, R1 appeared dehydrated. R1’s family members FM1 and FM2 stated that during heat wave, the facility has electric fans spread out in the facility blowing hot air around. R1 was sweaty, hot and lethargic. FM2 stated she brought misting fan that blows water to keep R1 cool; however, when FM2 visited R1 the fan was off and R1 was sweaty. The staff blamed each other for turning off the fan. R1 was sent out to the hospital and was diagnosed with hypernatremia and septic shock due to UTI among others. Based on information obtained, the allegation is substantiated. ........continued on 9099C (page 4) 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 4 Allegation: Staff did not seek timely medical attention for resident. Medical records showed R1 developed stage 4 pressure injury in the sacrum and unstageable pressure injury at right lateral pelvis and staff did not seek medical attention. It was R1’s family member who called 9-1-1. Allegation: Staff left resident soiled in urine for an unreasonable period of time. FM1, FM2, W1 and W2 stated they observed R1 soaked in urine. W1 stated that on 2 out of the 3 visits to R1, W1 observed R1 wet with urine and on one of these 2 visits, R1 was soaking wet up to the waist and W1 asked S3 for assistance when W1 changed R1. Based on interviews, the allegation is closed as substantiated. Deficiencies are cited from Title 22 California Code of Regulations and listed on 9099Ds. A $500.00 civil is assessed for deficiency section # 1569.269(a)(6) and will continue for $100.00/day until corrected. Deficiencies, plan and proof of corrections and civil penalty were discussed with ADM and licensee. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form, and copy of this report provided.
2024-11-14Other VisitType A · 12 findings
Plain-language summary
During a routine inspection on November 14, 2024, inspectors found multiple safety and medication management problems: entrance doors lacked auditory alarms, medications and cleaning supplies were stored in unlocked refrigerators and cabinets, the facility failed to notify the state about a new administrator, hot water temperature exceeded safe limits, and several residents' medications on hand did not match their doctors' orders in type, strength, or availability. Inspectors also found that bed rails lacked required doctor's orders, disaster drills had not been conducted since July, and care plans for a resident with a pressure injury were not updated.
“Based on observation, the licensee did not comply with the section cited above in hot water at 127.4 degrees Fahrenheit which poses an immediate health and/or personal rights risks to persons in care. POC Due Date: 11/15/2024 Plan of Correction 1 2 3 4 Licensee to have the temperature adjusted within Regulations range and submit proof by 11/15/24.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate safety and/or personal right risks to persons in care: unlocked kitchen cabinet where cleaning supplies are kept; insect killer, laundry soap, Clorox spray, wound cleanser, staff's medications in unlocked staff room POC Due Date: 11/15/2024 Plan of Correction 1 2 3 4 License locked the items and the staff room. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 11/15/24.”
“Based on observation, the licensee did not comply with the section cited above in all 3 entrance/exit doors' auditory signals/device turned off & not working which pose an immediate safety and/or personal rights risk to persons in care. POC Due Date: 11/15/2024 Plan of Correction 1 2 3 4 Corrected. Staff fixed and turned on the auditory signals.”
“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 risk to persons in care: residents medications unlocked in the refrigerator; saline solution, wound and peritoneal cleansers, grooming kit in residents' rooms POC Due Date: 11/15/2024 Plan of Correction 1 2 3 4 Licensee locked all the items. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 11/15/24.”
“Based on observation, the licensee did not comply with the section cited above in broken drawer in resident's room which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Licensee and/or administrator to have the drawer fixed and submit picture by 11/28/24.”
“Based on observation, the licensee did not comply with the section cited above in R2 who had change in condition and admitted back to the facility and LIC625 not updated which poses a potential health, safety and/ or personal rights risks to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Administrator to update R2's LIC625 and submit copy by 11/28/24.”
“Based on record review, the licensee did not comply with the section cited above in not conducting the disaster drill every quarter which poses a potential safety risk to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Administrator to have the drill conducted and submit copy by 11/28/24.”
“Based on records review, the licensee did not comply with the section cited above in 5 out of 5 residents' half bed rails not having doctor's orders on file which pose a potential safety and/or personal rights risks to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Administrator to obtain doctor's order and submit copies by 11/28/24.”
“Based on records review, the licensee did not comply with the section cited above In R2 who has stage 3 pressure injury was admitted back to the facility. which poses a potential health and/or personal rights risk to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Licensee to obtain an updated stage of pressure injury from a wound doctor or wound nurse. If stage is still stage 3, licensee stated he'll submit exception request; otherwise submit an updated copy of wound assessment. Document(s) to be submitted by 11/28/24.”
“Based on record review, the licensee did not comply with the section cited above in R2's LIC602A indicating R2 needs assistance with all ADLs but R2 can feed self. This poses a potential personal rights risk to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Administrator to obtain updated LIC602A and submit copy by 11/28/24”
“Based on interview and record review, the licensee did not comply with the section cited above in not notifying the Department when a new administrator was hired poses a potential health and/ or personal rights risks to persons in care. POC Due Date: 11/28/2024 Plan of Correction 1 2 3 4 Licensee to submit a signed letter along with copies of the new administrator's certificate, LIC501 Personnel Record by 11/28/24.”
“Based on observation and records review, the licensee did not comply with the section cited above in R1 and R5 not having the right medication dosages, not having certain medications, and facility not administering the dosage as precribed which pose an immediate health and/or personal rights risk to persons in care. POC Due Date: 11/15/2024 Plan of Correction 1 2 3 4 Licensee and/or administrator to check with R1 and R5’s physicians for updated doctor’s orders and administer the medications with correct dosage accordingly. If medications are no longer needed, to discontinue administration. Proof to be submitted by 11/15/24.”
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At 12:30 pm on this day, November 14, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with John Ronald Olivarez, licensee, and informed the reason for visit. LPA also met with staff, Maria Dolores Floriza, Macario Balingit, Jackylen Mendoza and Celeste Olivarez. LPA toured the facility inside out with licensee. LPA inspected the kitchen, dining area, living/tv room, common areas, staff and laundry room, bathrooms, side and backyard. LPA randomly selected 6 residents rooms for inspection. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 carbon monoxide detector that was tested and observed in operating condition. Hot water temperature in the common bathroom was tested. Disaster drill records reviewed. Fire extinguishers were observed fully charge with tags showed serviced September 17, 2024. LPA reviewed 5 staff and 5 residents files, and interviewed 2 residents. Medications checked, and compared with LIC622 Centrally Stored Medication and Destruction Records and doctor's orders. Facility does not handle residents' cash resources. The following updated/current documents were obtained on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Licensee or administrator to submit by November 28, 2024 a copy of $3M Liability insurance certificate. ....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 The following deficiencies were observed, cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates may result in civil penalties. -at 12:35 pm, the 3 entrance/exit doors with no auditory signals. -at 12:39 pm, residents medications in 2 refrigerators unlocked. -at 12:44 pm, cleaning supplies/agents in unlocked cabinet in the kitchen. -at 12:47 pm, peritoneal cleanser and broken drawer in residents' room. -at 12:50 pm, wound cleanser in the cabinet under the sink in another resident's room. -at 12:55 pm, wound dressing, saline solution, grooming kit in the night stand drawer in another resident's room. -at 1:01 to 1:03 pm, insect killer, wound cleanser, staff medications, liquid laundry soap, Clorox spray in unlocked staff's room. -at 1:12 pm, water temperature at 127.4 degrees Fahrenheit. -facility has new administrator who took over the position when Adeliza Magallones resigned in September 13, 2024 and licensee failed to notify the Department. -at 2:30 pm, records showed disaster drills last conducted July 6 and 9, 2024. -at 4:00 pm. resident (R2) was discharged back to the facility on 7/2024 with LIC602A Physician's Report indicated stage 3 pressure injury and dependent on others with all activities of daily living (ADLs); however, R2 is able to feed self. LIC625 not updated. -at 5:00 pm, all 5 resident's half bed rails do not have doctor's order on file. -at 5:45 pm, resident (R1) doctor's order for Acetaminophen is 650 mg tablet, 2 tablets PRN but the medication in facility's hand is 325 mg tablet, 2 tablet PRN. Has doctor's order for Vascepa but facility does not have this medication. Order for ducosate sodium is 50 mg 1 capsule daily but medication on hand is 100 mg twice daily. Order for Atorvastatin is 20 mg 1 tablet at bedtime but medication on hand is 10 mg 1 tablet at bedtime and facility administers 10 mg. Order for Amlodipine is 5 mg once daily and the medication on hand is 10 mg once daily. ...continued on 809C (page 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 -at 7:00 pm, resident (R5) doctor's order for prenisolone is 1 mg, 3 tablets daily but medication on hand is 1 mg, 1 tablet daily and facility administers only 1 mg 1 tablet daily. Has PRN order for Senna and Lorazepam and facility does not have these medications. Deficiencies and plan and proof of corrections were discussed with licensee. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2024-06-20Other VisitNo findings
Plain-language summary
During a complaint investigation on June 20, 2024, the facility disclosed health information about a prospective resident to a current resident without authorization. The facility acknowledged this occurred, and while no formal violation was cited, licensing staff issued a technical advisory and discussed the matter with management.
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On this day, June 20, 2024, an LIC9102 Technical Advisory is being issued resulting from investigation of complaint (15-AS-20240617080839) conducted by Licensing Program Analyst (LPA) Delmundo. The license admitted to disclosing health information of prospective resident to prospective roommate (facility resident). LPA discussed the above with the licensee and administrator. No deficiency cited. Exit interview conducted, and copy of this report provided.
2024-06-20Complaint InvestigationUnsubstantiatedNo findings
2024-04-19Other VisitNo findings
Plain-language summary
This was a follow-up inspection on April 19, 2024, to verify that the facility had corrected violations found during an earlier inspection. The facility failed to submit required correction documents by the April 4 deadline and only provided some documents five days late, resulting in additional civil penalties of $500 for the delayed submission.
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On this day, April 19, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct proof of correction (POC) visit. LPA m et with Adeliza Magallones, administrator, and informed the reason for visit. On 4/11/24, LPA conducted the first POC visit for the citations issued on 3/21/24 with POCs to be submitted by 4/04/24. Licensee failed to submit the POCs by the due and civil penalties were assessed on 4/11/24. Most of the documents (POC) requested for one of the deficiencies, section # 1569.269(a)(3), were only submitted by the licensee on 4/16/24. Additional civil penalty is assessed for deficiency section # 1569.269(a)(3). Civil penalty = $100.00/day x 5 days (from 4/12/24 to 4/16/24)= $500.00 Civil penalty was discussed with t he Adeliza Magallones. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, and copy of this report provided.
2024-04-11Annual Compliance VisitNo findings
Plain-language summary
A state inspector made an unannounced follow-up visit on April 11, 2024, to check whether the facility had corrected two previous violations: failing to release documents to a person who had filed a complaint, and failing to provide proof that a full-time administrator was employed after the previous one left and was later rehired. The facility had not submitted the required corrections by the deadline of April 4, 2024, so the state assessed civil penalties of $100 per day starting April 5, and those penalties will continue accruing daily until the facility submits proof of correction.
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct proof of correction (POC) visit. LPA met with Celeste Olivarez, facility consultant, and Adeliza Magallones, administrator, and informed the reason for visit. On 3/21/24, LPA issued citations for the following deficiencies with POCs to be submitted by 4/04/24. Licensee failed to submit the POCs up to this day. Civil penalties are assessed on this day, 4/11/24, and will continue for $100.00/day until POCs are submitted:. 1. Complaint Investigation deficiency section # 1569.269(a)(3). Licensee has not submitted proof that documents were released. nor responded to the reporting party's request and follow-ups. Civil penalty = $100.00/day x 7 days (from 4/05/24 to 4/11/24)= $700.00 2. Case management deficiency section 87405(a). Magallones who stated she quit as administrator on 12/31/23 and came back 4/03/24; however, licensee failed to submit proof that a full time administrator is hired. Civil penalty = $100.00/day x 7 days (from 4/05/24 to 4/11/24)= $700.00. In order to satisfy the POC, licensee to submit the following: signed letter indicating Magallones has been re-hired with effective date she took the position; copy of current administrator certificate; LIC500 Personnel Report POCs and civil penalties were discussed with the Celeste Olivarez and Adeliza Magallones. Exit interview conducted. Appeal Rights, LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction form, and copy of this report provided.
2024-03-21Other VisitType B · 1 finding
Plain-language summary
During an investigation into a complaint, inspectors found that the facility's administrator was working only 3-4 hours per week (Wednesday or Thursday afternoons), far below the required 20 hours per week, and stated she did not intend to meet that requirement due to other full-time employment. The facility was cited for this violation and given a deadline to submit a plan to correct it.
“-Based on interviews, the licensee did not comply with the section abuve for not having administrator in January 2024 and the new administrator working only at most 4 hours per week.”
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While at the facility investigating a complaint (Control # 15-AS-20240314140353), Licensing Program Analyst (LPA) Delmundo obtained information that the facility does not have an administrator. LPA called and spoke with Adeliza Magallones who stated she quit as administrator December 31, 2023, John Ronald Olivarez, licensee, stated that they have a certified administrator, Angeline Bangi. LPA interviewed Bangi who stated she stsrted working at the facility on February 2024 and works only either Wednesday or Thursday from 1:00 p.m. or 2:00 p.m. to 5:00 p.m.. Bangi stated she does not intend to work 20 hours per week as administrator as she has other full time job. Staff (S1) was interviewed and confirmed Bangi only comes ether Wednesday or Thursday and works only 3 or 4 hours per week. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the licensee. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2024-03-21Complaint InvestigationSubstantiatedType B · 1 finding
Plain-language summary
A complaint investigation found that the facility did not provide requested resident records to a family member despite multiple requests made between February and March 2024, including signed authorization forms, emails, and phone calls. The licensee acknowledged receiving the requests but did not respond or return the family member's calls. The facility is required to submit a plan to correct this violation.
“-Based on interviews, the licensee did not comply with the section above for not releasing the requested documents.”
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RP stated several attempts were made starting from February 2, 2024 to March 5, 2024 requesting for R1's documents. Requests via mail and e-mails were made with signed authorization from FM to release the documents to RP. Phone calls were also made by RP, and licensee has not responded to the request. LPA interviewed FM who confirmed she signed the document for the release of the documents to RP. LPA interviewed S1 and S2 who confirmed receiving calls and/or emails from RP and licensee was informed. Licensee stated he received the request but has not responded to the request and emails nor returned RP's calls. Based on information obtained, the preponderance standard has been met, therefore the allegation of "Licensee not providing prompt access to or photocopies of resident (R1) records" is substantiated. Deficiency is cited per Title 22 California Code of Regulations, and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the licensee. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2023-11-09Other VisitType A · 15 findings
Plain-language summary
During an unannounced annual inspection, inspectors found multiple safety violations: medications stored in a broken-lock medicine box in the refrigerator, an expired inhaler stored in a resident's room, an unlocked utility room with bleach and cleaning supplies, an unlocked outdoor storage area with bleach and other cleaning supplies, and expired food with mold in the kitchen. Staff records showed expired first aid certificates for three staff members, one staff member with no first aid training or annual health screening on file, and missing or outdated physician reports and care plans for residents. The facility was also found to not have conducted a required disaster drill in the past year and was missing doctor's orders for bed rails.
“Based on observation, the licensee did not comply with the section cited above for the shower area in the 2 bathrooms with not non-skid mats or strips which pose an immediate safety and/or personal rights risk to persons in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Administrator to purchase non-skid mats or have strips inslalled. Pictures to be submitted by 11/10/23.”
“Based on observation, the licensee did not comply with the section cited above for the expired sour cream which poses an immediate health risk to persons in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Staff discarded the item. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures bu 11/10/23.”
“Based on observation, the licensee did not comply with the section cited above for mediications in the storage box with broken lock and Albuterol soltuon in one of ther residents' rooms which pose an immediate health, safety and/or personal rights risk to persons in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Staff locked the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures bu 11/10/23.”
“Based on record review, the licensee did not comply with the section cited above for facility not having the 4 medications for resident (R1) which were on the list of order which poses an immediate health risk to person in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Administrator to check with the doctor and if no llonger needed. to obtain discontinued order. Otherwise, obtain the medicaitons. Proof to be submitted by 11/10/23.”
“Based on record review, the licensee did not comply with the section cited above for S3 not having the required annual training on file which poses/posed a potential safety and/orpersonal rights risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to have the staff complete the training and submit proof by 11/23/23.”
“Based on record review, the licensee did not comply with the section cited above in 5 out of 5 residents' LIC625 with no signatures of residents' responsible person; it's not clear whether or not the assessment been discussed which pose a potential personal rights risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to meet with the residents' responsible persons and have the LIC625 signed. Self-certificattion to be submitted by 11/23/23.”
“Based on interview and record review, the licensee did not comply with the section cited above for not conducting disaster drills which poses a potential safety risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to have drills conducted and submit copy by 11/23/23,”
“Based on record review, the licensee did not comply with the section cited above for S1, S4 and S5 expired first aid certificates which pose a potential safety and/or personal rights risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to have the staff complete the training and submit copies of certificates by 11/23/23.”
“Based on observation, the licensee did not comply with the section cited above for shave cream, shaver, glucose lancets, and ointment unlocked in resident's room which pose an immediate safety and/or personal rights risk to persons in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Staff locked all the items. In addition, administrator to add to in-service and submit copy of training topic with attendees signatures by 11/10/23.”
“Based on observation, the licensee did not comply with the section cited above for unlocked utility room and storage where bleach and cleaning supplies are kept which pose an immediate health and safety risks to persons in care. POC Due Date: 11/10/2023 Plan of Correction 1 2 3 4 Administrator lock the room and storage. In addition, administrator to add to in-service and submit copy of training topic with attendees signaures by 11/10/23.”
“Based on record review, the licensee did not comply with the section cited above for R1 who is dependent on staff with all activities of daily living which poses a potential safety and/or personal rights risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to submit an exception request with supporting documents by 11/23/23.”
“Based on record review, the licensee did not comply with the section cited above for R3's LIC602A over a year old which poses a potential health and/or personal rights risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to arrange a doctor's appointment and submit a copy of LIC602A by 11/23/23.”
“Based on record review, the licensee did not comply with the section cited above for not having doctor's order on R1's file for half bed rails which poses a potential safety and/or personal rights risks to person in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to obtain doctor's order and submit copy by 11/23/23.”
“Based on record review, the licensee did not comply with the section cited above for R1's LIC622 not recording the dates medications were filled and started which pose a potential health, safety or personal rights risk to person in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to check all the residents' LIC622 and complete accordingly. Self-certification to be submitted by 11/23/23.”
“Based on record review, the licensee did not comply with the section cited above for S3 not having LIC503 Health Screening and TB test on file which pose a potential health risk to persons in care. POC Due Date: 11/23/2023 Plan of Correction 1 2 3 4 Administrator to have the staff TB tested and have the LIC503 completed. Copy to be submitted by 11/23/23.”
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Adeliza Magallones, administrator, and informed the purpose of the visit. LPA also met with Celeste Olivarez, facility consultant, and staff, Mary Eileen Olivarez-Legados, Ethel David, Bonifacio Flores and Maria Dolores Floriza. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Adeliza Magallones and Mary Eileen Olivarez-Legados. LPA inspected the kitchen, dining area, living/tv room, common areas, staff and laundry room. bathrooms, side and backyard. LPA randomly selected 5 residents rooms for inspection. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 carbon monoxide detector that was tested and observed in operating condition. Hot water temperature in one of the common bathrooms was tested and measured at 119.2 degrees Fahrenheit. LPA reviewed 5 staff and 5 residents files, and interviewed 3 staff and 3 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. The following updated/current documents were obtained on this same day: 1. LIC308 Designation of Facility Responsibility 2. Proof of $3M liability insurance coverage Administrator to submit the following updated documents by November 23, 2023 : 1. LIC500 Personnel Report 2. LIC601E Emergency Disaster Plan (9 pages) ......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 Page 2 The following deficiencies were observed and cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties. -at 11:04 am, medicines in the medicine box with broken lock in the refrigerator. -at 11:06 am, expired sour cream with mold. -at 11:19 am Albuterol inhaler solution in the drawer in one of residents rooms. -at 11:24 am, shave cream, shaver glucose lancets, ointment in another resident's room. -at 11:42 am unlocked utility room where bleach and cleaning supplies are kept. -at 11:52 am, unlocked storage in the backyard where bleach and other cleaning supplies are kept. -at 12:30 pm, LPA asked the administrator who stated they haven't conducted disaster drill since last year. -at 2:15 pm, S1's first aid certificate expired 6/05/23 -at 2:50 pm, S3 has no first aid training, no annual training record and no LIC503 Health Screening and TB test record on file -at 3:15 pm. S4 and S5's first aid certificate expired 11/26/21 -at 5:00 pm, R1's LIC602A Physician's Report indicated needs assistance with all ADLs. -at 5:20 pm, R3's LIC602A is over a year old -at 5:30 pm, 5 out of 5 residents' LIC625 AppraisalNeeds and Services Plan do have residents' representative signatures. -at 6:05 pm, R1 has order for 4 medications but facility does not have on hand. Medications filled on 2023 and dates started not recorded on LIC622 Centrally Stored Medication and Destruction Record. No doctor's order on file for half bed rails. Deficiencies and plan and proof of corrections were discussed with the administrator and Mary Eileen Olivarez-Legados. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
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