StarlynnCare

California · Redwood City

Oakmont of Redwood City

RCFE · Memory Care

A Residential Care Facility for the Elderly (RCFE) is a non-medical residential care home licensed by California CDSS under Health & Safety Code §1560. Residents receive help with daily living activities such as bathing, dressing, and medication management. An RCFE with a Memory Care designation is additionally required by California Title 22 (§87705 and §87706) to provide specialized staff training in dementia care, individualized care plans for residents with cognitive impairment, and appropriate supervision protocols — requirements that go beyond a standard RCFE license.

1 East Selby Lane · Redwood City, 94063

Quick facts

Licensed beds127
Memory careYes
Last inspectionMar 2026
Last citationOct 2025
Operated bySunrise of Redwood Opco Llc; Oakmont Mgmt. Grp Llc
Map showing location of Oakmont of Redwood City

Quality snapshot

Updated April 25, 2026

Compared to 33 California RCFE memory care facilities of similar size, over the last 36 months.

Source: California Department of Social Services, Community Care Licensing Division. View raw inspection records →

Quality grade· click to show how this was calculated

Severity
31th

Weighted citations per bed

Repeats
100th

Repeat deficiencies as share of total

Frequency
78th

Deficiencies per inspection

Tick mark at 50% = peer median · higher percentile = better facility

Oakmont of Redwood City scores B. Better than 70% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: 31th percentile. Repeats: top 0%. Frequency: 78th percentile.

Each metric is converted to a 0–100 percentile within the peer set (higher = better). The composite grade averages all four. Peer set: CA / rcfe_memory_care / xl beds (33 facilities).

Citation severity over time

stable

Weighted severity score per month · 24 months

May 24peer medianApr 26

Weighted score (24mo)

40

Last citation

Oct 25

Finding distribution

4 total · 36 months

Scope × Severity (CMS A–L)

IsolatedPatternWidespreadJKLG4HIDEFABCSev 4 · IJSev 3Sev 2Sev 1

View inspections & citations

The rules that apply to this facility

California Title 22 requirements for this facility, with the specific regulation and a suggested question for each.Rules this facility has been cited for are shown first.

What must this facility report to the state — and how fast?Cited Oct 202522 CCR §87211 / WIC §15630
  • ImmediateElopement, fire, epidemic outbreak, or poisoningImmediately
  • 2 hoursAbuse with serious bodily injury2-hour phone report + 2-hour written report — to the California Department of Social Services (CDSS), Adult Protective Services, and law enforcement
  • 24 hrsAbuse without serious bodily injuryWithin 24 hours
  • Next dayDeath of a residentPhone by next working day; written within 7 days
  • Next dayInjury requiring medical treatment beyond first aidPhone by next working day; written within 7 days
  • WrittenBankruptcy, foreclosure, eviction, or utility shutoff noticeWritten notice to CDSS and residents — $100/day penalty (max $2,000) for failure

Your enforcement lever:Incidents that aren't reported on time are themselves a separate violation. If you believe a reportable event wasn't filed, you can submit a complaint directly to the California Department of Social Services (CDSS).

What dementia-care training must staff complete?22 CCR §87705 / HSC §1569.625

Because this facility markets dementia or Alzheimer's care, state law mandates higher training standards:

  • 12 hours initial dementia training — 6 hours before a staff member works independently with residents, 6 more within the first 4 weeks.
  • 8 hours annual dementia in-service — required every year thereafter.
  • Administrator CE — the administrator must include 8 hours of dementia-specific continuing education in every 2-year recertification cycle.

Training must cover individualized care plans, behavioral expressions, appropriate supervision, and the facility's dementia care philosophy.

Ask on tour: Ask how dementia training records are kept — families may request documentation.

How many staff must be on duty overnight?22 CCR §87415

Based on 127 licensed beds:

One awake caregiver on duty, one on-call caregiver physically on premises, and one additional on-call caregiver.

Violation pattern to watch for:A facility that documents a staff member as "on call" but with that person physically off-site — when the law requires on-premises presence — is in violation of this section.

Ask on tour: Ask the facility to walk you through their overnight staffing plan and confirm whether on-call staff are on premises or off-site.

What health conditions can this facility legally accept or refuse?22 CCR §87612–87615

Restricted — allowed with physician order + care plan

  • Supplemental oxygen
  • Insulin and injectable medications
  • Indwelling or intermittent catheters
  • Colostomy / ileostomy
  • Stage 1 and Stage 2 pressure injuries
  • Wound care (non-complex)
  • Incontinence
  • Contractures

Prohibited — facility must refuse or discharge

  • Stage 3 or Stage 4 pressure injuries
  • Feeding tubes (PEG, NG, or J-tube)
  • Tracheostomies
  • Active MRSA or communicable infections requiring isolation
  • 24-hour skilled nursing needs
  • Total ADL dependence with inability to communicate needs

A hospice waiver (HSC §1569.73) can allow continued care for residents on hospice who would otherwise fall into a prohibited category.

Ask on tour: Ask whether your loved one's specific care needs are restricted or prohibited, and what the facility's process is if needs change after admission.

How does CDSS enforce these rules?22 CCR §87755–87777 / HSC §1569.58
  1. 1Notice of DeficiencyWritten citation with a correction deadline. Facility must submit a Plan of Correction.
  2. 2Civil PenaltyStarts at $50/day for non-serious; $150/day for serious deficiencies — immediately, with no grace period. Repeats escalate to $150 first day + $50/day, then $1,000 first day + $100/day.
  3. 3Suspension of AdmissionsFacility cannot accept new residents until violations are corrected.
  4. 4Temporary Suspension or RevocationEmergency suspension for imminent danger; full revocation after administrative hearing.
  5. 5Exclusion OrderAdministrator and operator can be barred from all CDSS-licensed facilities — not just this one.

See how these rules have been applied to this specific facility:

View state inspection record and citations

State records

California Dept. of Social Services · Community Care Licensing
License number
415601114
License type
RESIDENTIAL CARE ELDERLY
License status
LICENSED
License expires
Not yet indexed
Licensed beds
127
Operator
Sunrise of Redwood Opco Llc; Oakmont Mgmt. Grp Llc

Inspections & citations

27

reports on file

4

total deficiencies

4

Type A (actual harm)

ComplaintApril 8, 2026· Unsubstantiated
No deficiencies

Inspector: Komal Curley

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

Plain-language summary

A complaint alleged that the facility was not honoring its billing agreement regarding care fees after management changed from Sunrise Senior Living to Oakmont Management Company. The facility charged higher fees under the new management system but issued a credit of over $10,000 to the resident's account after the concern was raised. The department found insufficient evidence to prove a violation occurred.

View full inspector notes

Although the charge for care fees are being billed at $3,640.75/month, with the credit of $296.75 being applied, the total monthly care fees are $3,344/month. Based on the accounting ledger for R1, in October 2025, R1 was charged $3,640.75/month, however, was credited back $10.038.78. According to documents reviewed and interviews conducted, R1’s care level was higher prior to 7/1/2023 – date of transition and the care point assessed after the transition was at 177, which at the time totaled $3,434, which continued to be charged at that rate until January 2025. The care rate increased from $21 to $22 and all residents were transferred over from the 2024 assessment tool to the 2025 assessment tool for the new rate to take effect. That’s when the 2025 rate for care reflected $3,640.75. Because R1’s account was considered “legacy” his/her care rate was grand fathered in at the locked-in rate for the first 152 points and therefore, would generate a credit difference between the 2024 care rate and 2025 care rate. According to staff interviewed and emails reviewed, R1’s responsible party agreed to this care assessment and care amount of $3,434 on date of transition, 7/1/2023, however, Oakmont Management did not understand why refunds were being requested from R1’s responsible party. On 10/17/25, Oakmont’s Regional Director of Operations emailed R1’s responsible party and indicated that an immediate goodwill credit of $10,038.78 will be returned to R1’s responsible party. Regarding the allegation, facility staff are not honoring the terms and conditions of the admission agreement, according to the reporting party, Resident 1’s (R1’s) the facility is not honoring the billing terms tied to the care point system in the admission agreement with Sunrise Senior Living had. According to staff interviews and documents reviewed, after Oakmont Management Company took over Sunrise Senior Living the billing is different. Sunrise Senior Living calculated care in a different way to Oakmont and the translation of care services from Sunrise's point system to Oakmont's is a computer algorithm based on services provided. There's not a specific dollar per point during the transition from Sunrise. At that time, R1's care services equated to 152 points and that point total doesn't change unless R1 switches to an Oakmont residency agreement. Based on documents reviewed, information collected, and interviews conducted, the department has determined that although the above allegation may have happened or are valid, there is no a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is UNSUBSTANTIATED. Report is reviewed with Administrator, Jennifer Duenas and a copy is provided.

Other visitMarch 17, 2026· Unsubstantiated
No deficiencies

Inspector: Komal Curley

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

Plain-language summary

During an inspection, the facility reported that its call pendant system was down for less than 24 hours. While the system was being repaired, staff increased room checks on residents to every 30 minutes to an hour and implemented additional monitoring to ensure resident safety. The state could not find sufficient evidence to substantiate a violation related to this incident.

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In addition, according to staff interviewed and documentation reviewed, the computer system for the call pendants were down for less than 24 hours. The facility immediately started taking steps to fix this issue as soon as it was brought up. Staff indicated that while the call pendants were in disrepair, the Regional Health Services Director implemented status checks on residents and staff increased resident checks to every 30 minutes to an hour or as needed based on resident needs. Based on documents reviewed, information collected, and interviews conducted, the department has determined that although the above allegation may have happened or are valid, there is no a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is UNSUBSTANTIATED. Report is reviewed with Administrator, Jennifer Duenas and a copy is provided.

Other visitFebruary 26, 2026
No deficiencies

Plain-language summary

On February 26, 2026, state licensing conducted a follow-up visit to confirm that three staff members—including the facility administrator—who had been excluded or had their certifications revoked were no longer working there. The facility confirmed all three individuals are no longer employed. No violations were found during this visit.

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On February 26, 2026, Licensing Program Analyst (LPA) Komal Curley conducted a Case Management-Other visit to the facility. LPA met with Regional Operations Specialist, Caroline Frangieh and explained the purpose of the visit. The purpose of this visit is to follow up on a "Decision and Order" for the exclusion of Staff 1 (S1) and Staff 2 (2) and revocation of administrator certificate for Staff (3). During the visit, Regional Operations Specialist confirmed that S1-S3 no longer are employed with the facility. No citations are issued during the visit. Report is reviewed with Operations Specialist, Caroline Frangieh and a copy is provided.

Other visitNovember 4, 2025
No deficiencies

Plain-language summary

During an unannounced annual inspection on November 4, 2025, inspectors found the facility clean and well-maintained, with resident rooms, bathrooms, and common areas in good condition, proper food storage and temperature control, medications securely locked away, and working safety equipment including carbon monoxide monitors and fire extinguishers. Staff records showed required training was completed, resident medical records were up to date, and emergency drills were being conducted every three months. No violations were cited.

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On November 4, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced annual inspection. LPA met with Regional Operations Specialist, Tammie Sampedro and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a two building facility; Assisted Living (AL) and Memory Care (MC). AL has three floors and MC has two floors. A random sample of resident rooms in AL and MC were toured. All resident rooms were observed clean, odor-free, equipped with all required furniture. Resident bathrooms and communal bathrooms were observed to clean and in good repair. Water temperature throughout the facility measured within regulatory requirements. Communal areas including but not limited to dining room, living rooms, private dining area, etc. were observed free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed two day perishables and seven day non-perishables. Medications, sharps, and chemicals were observed locked an inaccessible to residents in care. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of October 2024. Emergency drills are logged and done every three month. LPA reviewed 5 resident records and 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. Report is reviewed with Regional Operations Specialist, Tammie Sampedro and a copy is provided.

InspectionNovember 4, 2025
No deficiencies

Plain-language summary

On November 4, 2025, a state licensing official conducted an unannounced visit to deliver an immediate exclusion letter, which means a staff member was prohibited from working at the facility. The official met with management to deliver and discuss the letter. No details about the reason for the exclusion were provided in this report.

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On November 4, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case-management visit. LPA met with Regional Operations Specialist, Tammie Sampedro and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude a Staff 1 (S1) from the facility. The letter was given to the Regional Operations Specialist, Tammie Sampedro. This report is reviewed and discussed with the Regional Operations Specialist, Tammie Sampedro and a copy is provided.

Other visitOctober 22, 2025· MixedType A
1 deficiency

Inspector: Komal Curley

Type ACCR §87211(a)(1)

Regulation

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specif…

Inspector finding

This regulation is not met as evidenced by: Based on records reviewed and staff interviewed, there were no incident reports submitted to CCLD regarding the alleged abuse incident that occurred on 10/3/25. The facility was unable to provide any documentation to show that an incident report or an SOC341 was submitted to CCLD which poses an immediate health and safety risk to residents in care.

Other visitOctober 22, 2025Type A
1 deficiency

Plain-language summary

A case management visit on October 22, 2025 found that the facility was not properly documenting or recording checks on a resident, including when the checks happened, who performed them, or what was observed. Staff claimed they were conducting these checks but could not provide details about what they saw during them. The facility was cited for this violation and informed that failure to correct it could result in civil penalties.

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On October 22, 2025, Licensing Program Analyst (LPA) Komal Curley conducted a case management visit in relation to complaint #14-AS-20250113154240. LPA met with Regional Director Specialist, Tammie Sampedro and explained the purpose of the visit. Based on the course of the investigation, the reported resident checks for Resident 1 (R1) were random or every couple of hours and there was found to be no requirement to document or record when the checks were done, who conducted the checks, or what observations were made. Staff were unable to report any observations based on recall but claim these checks for R1 were conducted. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Regional Operations Specialist, Tammie Sampedro and a copy is provided with appeal rights.

Type ACCR §87205(a)(b)

Regulation

87205(a)(b) Accountability of Licensee: The licensee, whether an individual or other entity, shall exercise general supervision…and establish policies concerning its operation in conformance with these regulations…to assure accountability. This requirement is not met as evidenced by:

Inspector finding

Based upon the administrator and facility staff interviews there is no definitive policy or documentation requirements for conducting resident checks as to date, time, observations or who conducted the resident checks for R1 or a means to ensure facility accountability which poses an immediate health and safety risk to residents in care.

Other visitAugust 6, 2025Type A
1 deficiency

Plain-language summary

On August 6, 2025, inspectors conducted a follow-up visit after staff reported that on July 9, 2025, a staff member took a video on a personal phone of a resident sleeping and partially undressed, laughed at the resident, and physically abused the resident in the video. The facility was aware of this incident on July 12, 2025 but did not report it to the state licensing agency until July 17 and July 18, 2025—a five-day delay the administrator attributed to wanting to investigate first. Inspectors cited the facility for violations of state regulations and notified management that failure to correct these violations may result in civil penalties.

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On August 6, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit to follow up on a visit that was conducted on 7/22/25. LPA met with Interim Executive Director, Kathleen Olson and explained the purpose of the visit. On 7/12/25, the Licensee reported that on 7/9/25, it was alleged that Staff 1 (S1) took an unauthorized video of Resident 1 (R1) on S1's personal phone while R1 was sleeping in only his/her pull ups. It was heard on the video that S1 was laughing at R1 and called R1 a mermaid. In the video it was observed that S1 physically abused R1. On 7/12/25, Staff 2 (S2) reported this incident to management and indicated that S1 showed S2 the video. The facility was made aware of this incident on 7/12/25, however the administrator did not notify LPA of this incident until 7/17/25 via telephone. An SOC341 was not submitted to CCLD until 7/18/25 and an incident report was not submitted to CCLD until 7/21/25. The administrator failed to notify CCLD of the alleged abuse incident for 5 days after being aware of the incident. According to the administrator, there was a delay in reporting due to the incident being a hearsay incident and wanted to conduct an investigation prior to reporting to CCLD. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with the Interim Executive Director and a copy is provided with appeal rights.

Type ACCR §87405(d)(2)

Regulation

87405 Administrator - Qualifications and Duties: (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is n…

Inspector finding

Based on interviews and record review, the administrator failed to notify CCLD of a alleged abuse incident that occurred on 7/9/25 and was made aware on 7/12/25, however did not notify CCLD for 5 days after being aware of the incident. Administrator did not submit an incident report to CCLD until 7/21/25 which poses and immediate health and safety risk to residents in care.

Other visitAugust 5, 2025
No deficiencies

Plain-language summary

On August 5, 2025, state licensing staff conducted an unannounced visit to deliver an exclusion letter to a staff member, preventing that person from working at the facility. The interim executive director was notified and provided a copy of the letter.

View full inspector notes

On August 5, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit. LPA met with Interim Executive Director, Kathleen Olson and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude Staff #1 (S1) from the facility. The letter was given to the Interim Executive Director, Kathleen Olson. This report is reviewed and discussed with the Interim Executive Director and a copy is provided.

Other visitJuly 22, 2025
No deficiencies

Plain-language summary

On July 9, 2025, a staff member took a video on a personal phone of a resident who was sleeping and undressed, and the video showed the staff member laughing, name-calling, and physically abusing the resident. Another staff member reported the incident after seeing the video, but the staff member who recorded it resigned before the investigation was completed. The facility reported the incident to regulators on July 12, 2025, and further investigation is ongoing.

View full inspector notes

On July 22, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit in relation to an incident that occurred on 7/9/25, however was reported to CCLD on 7/12/25. LPA met with Interim Executive Director, Kathleen Olson and explained the purpose of the visit. On 7/12/25, the Licensee reported that on 7/9/25, it was alleged that Staff 1 (S1) took an unauthorized video of Resident 1 (R1) on S1's personal phone while R1 was sleeping in only his/her pull ups. It was heard on the video that S1 was laughing at R1 and called R1 a mermaid. In the video it was observed that S1 physically abused R1. on 7/12/25, Staff 2 (S2) reported this incident and indicated that S1 showed S2 the video. An investigation was conducted, however S1 resigned at the time of the investigation. During the investigation, LPA collected documents and interviewed staff. Further investigation is required. Report is reviewed with the Interim Executive Director and a copy of the report is provided.

ComplaintJuly 10, 2025· Mixed
No deficiencies

Inspector: Komal Charitra

Mixed — CDSS found some allegations substantiated and others unsubstantiated during this investigation.

Plain-language summary

This was a complaint investigation into a resident's unexplained hip fracture that occurred while in the facility's care. The facility staff had no record of how the resident fell or was injured, did not notice any changes in the resident's condition before hospitalization, and gave conflicting information about whether the resident was a fall risk — the state found the fracture was substantiated and issued $1,000 in civil penalties. A separate complaint that the resident's room was not being cleaned properly was unsubstantiated, as inspectors found resident rooms to be clean during their visit.

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In addition, staff interviewed had conflicting information on whether R1 was a fall risk or not. Facility staff were unaware of R1's injuries and did not document or notice any changes in condition nor how the injury could have been sustained. Based on medical records, on 10/13/24, R1 was transported to the hospital and three x-ray views of R1's left hip did not show any fracture at the time. Further evaluation with cross-sectional imagining was recommended and conducted on 10/16/24 where a computed tomography (CT) scan was conduct of his/her left hip for a possible fall. Medical documentation indicated that the CT scan showed that R1 had an acute non-displaced fracture through the base of the left superior pubic ramus and through the mid left inferior pubic ramus. Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Failure to correct said deficiencies may result in additional civil penalties. AN IMMEDIATE CIVIL PENALTY OF $500.00 WAS ASSESSED TODAY: $500 FOR THE VIOLATION AS R1 SUSTAINED UNEXPLAINED FRACTURE WHILE IN CARE. A repeat civil penalty of $500 was issued today due to the same violation being cited on 5/27/25. Due to immediate civil penatly of $500 being cited and repeat civil penalty of $500 being cited, total civil penalty being issued today is $1,000 THE INTERIM EXECUTIVE DIRECTOR WAS INFORMED THAT AN ADDITIONAL CIVIL PENALTY IS STILL BEING DETERMINED AND MIGHT BE ASSESSED BASED ON HEALTH AND SAFETY CODE §1569.49. Report is reviewed with the Interim Executive Director and a copy is provided with appeal rights. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Regarding the allegation, facility staff are not cleaning resident's room, according to the reporting party, on 10/13/24, it was observed that R1's room was filthy, with soiled bed linens, old, soiled clothing, and urine pads on the floor. During the investigation, LPA toured the facility and observed a random sample of eight resident rooms including R1's room. Based on observations, rooms toured were observed to be clean, odor-free, and with clean bed linens. During the visit, LPA was notified that R1 was no longer a resident at the facility. According to staff interviewed, there are two housekeepers on shift in the AM and two housekeepers in the PM. Housekeepers are deep cleaning rooms every week, taking out trash from resident's room per shift and doing laundry as needed. In addition, staff interviewed indicated that every shift change, caregivers will check each resident rooms to make beds and collect trash at the beginning and at the end of each shift. Regarding the allegation, facility staff did not communicate with authorized representative(s) on resident changes in health condition, according to the reporting party, the facility staff did not know how or when R1 suffered a fracture and did not notify R1's authorized representative of any injuries or changes in condition. During the investigation, staff were interviewed and R1's charting notes were reviewed. Based on charting notes, there was no notes that indicated R1 had a fall or a change of condition. According to staff interviewed, they were unaware why R1 was sent to the hospital on 10/13/24 and indicated they did not see or here about R1 having a fall before or on 10/13/24. Additionally staff interviewed also indicated that they did not observe any changes in R1's condition or R1 complaining of pain prior to being sent to the hospital. Based on interviews conducted, interviews conducted and documents reviewed, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed with Interim Executive Director and a copy is provided.

Other visitJune 18, 2025
No deficiencies

Plain-language summary

On May 31, 2025, a resident who was managing his own medications told staff he had taken over seven days of medication at once and was having thoughts of harming himself; he was hospitalized for psychiatric evaluation and later diagnosed with early-stage Alzheimer's dementia. When the resident returned to the facility on June 16, 2025, staff assigned a one-on-one caregiver and took over medication management, and the resident began psychiatric and behavioral therapy. No violations were found during the licensing visit on June 18, 2025.

View full inspector notes

On June 18, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit in relation to an incident that occurred on 5/31/25. LPA met with Administrator, Siobhan Surraco and explained the purpose of the visit. The Licensee reported on 5/31/25, the med-tech went to Resident 1's (R1's) room around 7:45pm and R1 reported to the med-tech that he/she took over seven days of medication at one time. R1 told to the med-tech that he/she wanted to hurt himself/herself because he/she was feeling depressed. According to the Licensee, R1 resides in the assisted living community and manages his/her own medications. 911 was immediately called and all required parties were notified. R1 was admitted at the hospital for psychiatric evaluation. During the visit today, LPA interviewed the Administrator, Health Services Director, and Resident Care Coordinator, and reviewed R1's file. R1 was admitted to the facility on 5/21/25 and based on the physician's report dated 5/21/25, R1 was able to manage his/her own prescription and PRN medications and did not show any signs of suicidal ideations. Based on the new physician's report dated 6/11/25 (after incident occurred), R1 has a diagnosis of early onset of Alzheimer's dementia, and is unable to manage his/her own medications. According to staff interviewed, R1 returned back to the community on 6/16/25 and a 1:1 caregiver was implemented throughout the day for 72 hours. Facility staff are conducting status checks. R1 is seeing a psychiatrist and going to behavioral therapy session 5 days a week. Facility is now managing R1's medications and a new reassessment has been conducted. No citations are issued today. Report is reviewed with Administrator and a copy is provided.

ComplaintMay 27, 2025Type A
1 deficiency

Plain-language summary

On May 1, 2025, a resident left the secured memory care unit unattended and was found a half block away from the facility; staff believe this happened during a shift change when the resident exited through two patio doors that were in working condition. During follow-up visits in May, inspectors found that staff were unclear about whether the resident could leave unassisted, and the resident's medical records did not clearly document the resident's ability to leave independently. The facility was cited for failing to prevent the resident from leaving the secured unit without supervision.

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On May 27, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on a case management visit that was conducted on 5/15/25. LPA met with Resident Services Director, Edward DeWitt and explained the purpose of the visit. On 5/15/25, LPA followed up on an incident that occurred on 5/1/25 at 2pm, where care staff reported that they heard the patio door alarm sounding and noticed that Resident 1 (R1) had exited the secured memory care unit without staff supervision. R1 was found a half a block away from the facility. During the visit conducted on 5/15/25, LPA reviewed R1's file, interviewed staff and toured the facility. Based on the file reviewed, LPA observed R1's physician's report to indicate R1 has MCI, however the physician crossed out the section where it indicated whether R1 can leave the facility unassisted or not. Staff interviewed were not clear if R1 can leave unassisted. In addition, staff interviewed indicated R1 left the facility through the memory care outdoor terrace door to the outdoor terrace area and walked to the side of the terrace then left through the second door to get outside the facility. Based on observations, both door were observed to be delayed egress doors and both doors were observed to be in working condition. Staff interviewed were unsure how R1 left without staff noticing but believe that R1 left the facility unassisted during shift change. On 5/22/25, the facility received confirmation from R1's responsible party that R1's physician diagnosed R1 with dementia on 3/5/25. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D due to R1 leaving a secured unit unattended. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with the Resident Services Director and a copy is provided with appeal rights.

Type ACCR §87464(f)(1)

Regulation

87464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This regulation is not met as evidenced by:

Inspector finding

Based on interviews, observations and record reviews, R1 has dementia and left the unit/facility unattended and was found a block away from the facility which poses an immediate health and safety risks to residents in care.

InspectionMay 15, 2025
No deficiencies

Plain-language summary

On May 1, 2025, a resident with mild cognitive impairment left the memory care unit unsupervised through the patio area and was found a half-block away about 20 minutes later with no injuries. During a follow-up inspection in May, staff reported the incident likely occurred during a shift change, and both doors the resident used were functioning delayed-egress doors; the facility could not interview the staff members who were present at the time. No violations were cited, though the inspection notes that further investigation is required.

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On May 15, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that occurred on 5/1/25. LPA met with Administrator, Siobhan Surraco and explained the purpose of the visit. The Licensee reported on 5/1/25 at 2pm, care staff reported that they heard the patio door alarm sounding and noticed that Resident 1 (R1) had exited the secured memory care unit without staff supervision. Staff reported they last saw R1 at around 1:50pm in his/her room. R1 was found a half a block away at around 2:10pm with no injuries and unharmed. During the visit, LPA toured the memory care unit, reviewed R1's file, interviewed the administrator and the Resident Care Director (RCD). Based on medical records dated 11/2024, R1 has mild cognitive impairment (MCI). R1 does not have a history of wandering behaviors based on file reviewed. According to the Administrator, R1 resides at the memory care unit with his/her significant other. R1 left the facility through the memory care outdoor terrace door to the outdoor terrace area and walked to the side of the terrace then left through the second door to get outside the facility. Both doors were observed to be delayed egress doors. Both delayed egress doors were observed to be in functioning condition. According to the administrator and RCD, they are unsure how R1 left without staff noticing but believe that R1 left the facility unassisted during shift change. LPA was unable to interview staff who were present during the incident as they were not present at the facility. Further investigation is required. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.

Other visitOctober 31, 2024
No deficiencies

Inspector: Komal Charitra

Plain-language summary

On October 31, 2024, state inspectors conducted a routine unannounced annual inspection and found no violations. The facility was clean and well-maintained, with adequate lighting, comfortable temperature, properly secured medications and chemicals, working safety equipment, and complete resident and staff records. All bathrooms had grab bars and non-slip mats, the kitchen met food storage standards, and staff training requirements were met.

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On October 31, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Siobhan Surraco and explained the purpose of the visit. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a 3 story facility with Memory Care on the first and half of the second floor and Assisted Living on the other half of the second floor and third floor. LPA toured the facility including but not limited to a random sample of resident rooms on each floor, common areas, and kitchen area. LPA observed some residents doing activities with staff or watching television. A comfortable temperature is maintained in the facility and lighting is sufficient for comfort. Hot water temperature measured between 111-119 degrees F throughout the facility. Overall facility was in clean, odor-free and free from any tripping hazards. Resident rooms and bathrooms observed had all required furnishings, and grab bars and built-in non-skid mats in each bathroom. LPA toured kitchen and observed 2 days for perishables and and 7 days non-perishable. Medications, sharps and chemicals were locked and inaccessible to residents. Emergency drill are being conducted and logged every 3 months. Carbon monoxide monitors are working properly. First aid kits were observed present and complete. Five resident records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. The following documents are requested to be submitted to CCL by 11/7/24: -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan -LIC500 Personnel Report No deficiencies are cited at this time. Report is reviewed with Administrator and copy is provided.

ComplaintMay 10, 2024· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

Plain-language summary

A complaint investigation looked into allegations that residents eloped from the facility and that staff failed to provide feeding, dressing, and hygiene care. Inspectors could not find enough evidence to substantiate any of these claims—some original staff were no longer available, resident accounts differed from staff accounts, and observations of the facility showed hygiene supplies were in place. The investigation concluded there was insufficient evidence to prove the allegations occurred.

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Page 2 - LIC9099C Regarding elopements from the facility, LPA cannot determine if this took place based on information received regarding these alleged incidents. There is not enough information and support to show that residents in fact eloped based on staff, video, and family interviews conducted. At the time of the alleged elopements those original staff that were in place, including memory care directors, are no longer present and cannot be contacted. No elopements were reported to management in order to report an incident to the Department. LPA cannot determine if incident reporting took place for the elopements in question. Regarding staff not feeding, dressing, or providing hygiene needs for residents. LPA conducted interviews and made facility observations. Interviews with staff show that the resident in question regarding not feeding or dressing a resident contradict with complainant information and interviews conducted. It was indicated by staff that the residents have the freedom of choice of getting dressed when getting ready in the morning. The resident in question refused to get ready in the morning and staff can not force a resident to change or do something they do not want to do as it will be against their personal rights. For the same resident LPA cannot determine if the was fed on time as the resident was refusing morning care that morning and staff were turned away by the resident and staff intended on returning to the resident to follow up with morning care and feeding. Regarding staff not providing hygiene needs, LPA toured resident rooms that are occupied and observed toilet paper in place. The resident in question is no longer at the facility at the time of investigation to observe if toilet paper was present. Staff interviewed indicate that if there was no toilet paper it would be provided if needed. Staff do replenish toilet paper everyday and when needed. Based on interviews, observations, and other items reviewed, LPA cannot determine if these allegations took place. These allegations are unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report is reviewed with the administrator Siobahn Surraco and a copy of the report is provided.

ComplaintFebruary 21, 2024· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

ComplaintJanuary 10, 2024· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

ComplaintJanuary 10, 2024· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

Plain-language summary

A complaint was investigated regarding whether families were properly notified during a management transition at the facility in summer 2023. The facility provided emails and documentation showing that responsible parties were contacted via email and through posted notices, with multiple meetings held in June and July 2023 to inform families of the transition. The complaint could not be substantiated based on the evidence collected.

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Page 2 - LIC9099 Meghan indicated that responsible parties emails were used that are on file with the facility, and if there was any issue of a particular family member not being notified, it was possibly due to them not being the responsible party contact so they were not emailed as part of the responsible party group. According to interim executive director Jessica Pryor, she was in place in the facility from Jun30, 2023 up until July 17,or 18, 2023. She stated that she held at least two open discussions and meetings with family members and responsible parties of both memory care and assisted living. She says posts were made through out the facility and says that responsible parties were contacted via email as well. She says there was an open house meeting that took place on July 4, 2023 and another introduction/Q&A the following week after that inviting family members to attend as part of the transition process as the facility transitioned from Sunrise of Redwood City to Oakmont of Redwood City. She provided LPA with email support to show that an email was sent to family members on June 9, 2023 from the previous company Sunrise, and an additional email and posting that was provided to family members around June 30, 2023 in the facility and by email. Due to the items observed and data collected these allegations are unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report if reviewed with interim executive director Jessica Pryor.

Other visitJanuary 10, 2024
No deficiencies

Inspector: Jaime Vado

Plain-language summary

On January 10, 2024, a licensing analyst visited the facility to deliver a corrected complaint report that had been incorrectly marked as confidential and needed to be made public. The analyst met with the interim executive director to review the amended findings. This was an administrative visit to correct a paperwork error, not an inspection or investigation.

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On 1/10/2024 at 1230pm, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - other visit in order to deliver an amended complaint report. LPA met with Interim executive director Jessica Pryor and explained the purpose of today's visit. LPA delivered amended findings for complaint #14-AS-20231205135135. LPA is delivering the report as Public as it was marked as Confidential in error. Report is reviewed with interim executive director Jessica Pryor.

ComplaintDecember 14, 2023· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

ComplaintDecember 14, 2023· Unsubstantiated
No deficiencies

Inspector: Jaime Vado

Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.

Other visitDecember 14, 2023
No deficiencies

Inspector: Jaime Vado

Plain-language summary

This was an unannounced annual inspection on a multi-level facility with a memory care building. The inspector found the facility in good condition: the physical plant is safe and well-maintained, with proper security fencing, locked storage for medications and cleaning supplies, working fire safety systems, clean resident rooms, and appropriate supplies throughout. No violations were cited.

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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with interim administrator Eugenia Smith and explained the purpose of today's visit. LPA was allowed entry into the facility and signed in. This is a multi level facility and a memory care building attached. Annual Fees are current upon review. The physical plant was toured inside and outside to ensure the safety of the residents. Patio area outside of memory care building is observed. Fencing and security doors are in good condition and in place. LPA observed the facility kitchen which is clean, in order, and the observed appliances are in good repair. Knives are stored in the kitchen which is not accessible to residents. Cleaning solutions are also locked in multiple janitor closets through out the facility. Perishable and non-perishable food items are observed as in place. LPA observed the medications as in place and locked in med-carts and in med-rooms. First aid kits are observed as complete and placed through out facility including the kitchen. LPA observed that the facility is equipped with full sprinkler system, fire extinguishers are placed through out the facility inspected in October 2023, smoke detectors/carbon monoxide detectors are observed in place, and central heating system is operable. Facility ambient temperature is comfortable for residents and visitors. PPE and additional food supplies are observed as in place. Main laundry room is observed as operational and laundry rooms for use by residents if they choose to wash their own laundry are observed as safe and operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 108F in resident rooms in assisted living and memory care. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. COVID PPE and resident incontinence supplies are observed in place. The facility does not handle resident monies. Staff and resident files are reviewed and observed as current. The facility is in the process of hiring a permanent administrator. Report is reviewed with Eugenia. No citations issued.

InspectionDecember 14, 2023
No deficiencies

Inspector: Jaime Vado

Plain-language summary

A routine unannounced inspection found the facility in compliance with state requirements. The inspector checked safety systems (sprinklers, fire extinguishers, smoke detectors), medication storage, kitchen cleanliness and food safety, resident rooms, emergency exits, and other operational standards—all were in proper working order with no violations noted. The facility has adequate supplies, locked storage for hazardous items, and appropriate temperature control for resident comfort.

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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced post licensing inspection visit. LPA met with interim administrator Eugenia Smith and explained the purpose of today's visit. LPA was allowed entry into the facility and signed in. This is a multi level facility and a memory care building attached. Annual Fees are current upon review. The physical plant was toured inside and outside to ensure the safety of the residents. Patio area outside of memory care building is observed. Fencing and security doors are in good condition and in place. LPA observed the facility kitchen which is clean, in order, and the observed appliances are in good repair. Knives are stored in the kitchen which is not accessible to residents. Cleaning solutions are also locked in multiple janitor closets through out the facility. Perishable and non-perishable food items are observed as in place. LPA observed the medications as in place and locked in med-carts and in med-rooms. First aid kits are observed as complete and placed through out facility including the kitchen. LPA observed that the facility is equipped with full sprinkler system, fire extinguishers are placed through out the facility inspected in October 2023, smoke detectors/carbon monoxide detectors are observed in place, and central heating system is operable. Facility ambient temperature is comfortable for residents and visitors. PPE and additional food supplies are observed as in place. Main laundry room is observed as operational and laundry rooms for use by residents if they choose to wash their own laundry are observed as safe and operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 108F in resident rooms in assisted living and memory care. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. COVID PPE and resident incontinence supplies are observed in place. The facility does not handle resident monies. Staff and resident files are reviewed and observed as current. The facility is in the process of hiring a permanent administrator. Report is reviewed with Eugenia. No citations issued.

Other visitAugust 16, 2023
No deficiencies

Inspector: Jaime Vado

Plain-language summary

On an unannounced visit, the facility was investigated regarding an incident on August 15, 2023, when a resident was unseen and may have fallen, though exactly what happened was unclear. The facility reported the incident to the state within the required timeframe and notified responsible parties. No violations were found.

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - incident investigation visit. LPA met with administrator Megan Leone and explained the purpose of the visit. Also in attendance is the memory care coordinator Bernadette King. LPA discussed the incident that occurred with R1 was unseen and the circumstances are unclear of what actually transpired in terms of a possible fall that may have occurred on 08/15/2023. The facility is within the required reporting time frame to licensing of the incident and the facility is in the process of submitting an incident reporting to the Department. Responsible parties are to be notified on this day according to the administrator. No citations issued on this day.

Other visitMay 3, 2023
No deficiencies

Inspector: Jaime Vado

Plain-language summary

On May 1, 2023, the facility reported to the Department that some narcotic medications prescribed as needed were found missing during a routine audit on April 29-30, 2023. The facility reported the loss to the Sheriff's Department, is actively investigating the matter, and has confirmed that no residents missed their required doses since the missing medications are being replaced. The narcotics are stored in a triple-locked area accessible only to staff, and no violations were cited as the investigation is ongoing.

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On this day Licensing Program Analyst (LPA) conducted an unannounced case management visit in regards to missing narcotics. LPA met with interim administrator Jennifer Bruhn and explained the purpose of today's visit. Health care manager Jo Marie Ghersi attended the meeting as well to discuss the missing narcotics. It was reported to the Department on 05/01/2023 that over the weekend during routine medication check the Health care manager Jo Marie Ghersi was conducting an audit and discovered the missing narcotics beginning on 04/29/2023 and then again on 04/30/2023. According to Jo the final count of missing narcotics that were prescribed as needed. The facility did report accordingly to the Department on 05/01/2023 and followed with an incident report on 05/02/2023. The facility reported the loss to local Sheriff's Department and was provided a file number for the incident. The facility is actively investigating the situation which included additional medication audits, reviewing the medication administration records, as well as actively looking into their own staff. There is a discrepancy found by the health care manager regarding the crossover signatures on the days in question as being incomplete. The medications are accurately documented on the centrally stored medication log and for each resident. The narcotics are triple locked in the appropriate area of the medication room to ensure the are inaccessible to residents in care. The only persons with access are the staff. Residents' whose medication is missing did not miss any dosage of medication and the facility is replacing those missing items as necessary. Investigation into the matter is ongoing at this time. No citations at this time as this investigation is ongoing. Report is reviewed with interim administrator Jennifer Bruhn.

ComplaintDecember 16, 2021
No deficiencies

Inspector: Jaime Vado

Plain-language summary

This was a pre-licensing inspection of a new memory care facility with two specialized dementia units across three floors. Inspectors toured the building and found the dining areas, kitchen, medication rooms, resident bedrooms, bathrooms, fire safety systems, and emergency equipment all in proper working order, with appropriate safety features like pull cords and non-slip flooring in place. No violations were found, and the facility was recommended for licensure.

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On this day at 1300hrs, Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted a announced prelicensing inspection visit. LPAs met with administrator Abbie Apolinario and senior vice president of operations for new developments Jason Englehorn and explained purpose of today's visit. This is a three floor facility that has two memory care units. There are 5 medication rooms through out the facility and one main kitchen. LPAs toured the entire facility. Temperature is taken and COVID screening questions were asked. Main dining room area is on the ground floor of the facility. Required signs regarding COVID, Ombudsman, and resident council rights are observed. Dining room is fully furnished with tables and chairs. Kitchen is adjacent to the main dining room. Kitchen is inspected as clean and in place. All kitchen appliances are in working order. ANSUL system, fire control panel, fire sprinkler system, and fire detection equipment have been inspected and approved with Redwood City Fire Department. Freezer and refrigeration units are observed as fully operational. Dry goods room is observed as in place adjacent to refrigeration units. Modified diets are accommodated for per kitchen ordering system. There are five resident rooms on the ground floor. Room 105 is observed. Pull cords are in place in all resident bathrooms and bedrooms. Non skid flooring is built in and built in folding shower chair. Furnishings can be provided upon request. Linens and towels are provided to residents. "Reminiscence" dementia area is observed on the ground floor. Room 117 was observed and water temperature is measured at 107F . "Fire doors are equipped on all resident rooms. All rooms are equipped with emergency lighting in rooms and bathrooms. Continued on next page... 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 - Prelicensing Second floor is toured. Room 213 is observed as furnished. Water temperature is measured at 115F. There is a dementia designated area on this floor referred to as the "Terrace Club" for mild to moderate residents with dementia. This area is key pad protected. Rooms are observed as vacant. There are 17 rooms in this area. This area has a designated medication room just for the residents in this area and a steam table for meals prepped by main kitchen to be brought up to this area. PPE and incontinence supplies are observed in this area. LPAs observed room 243 and is designated as shared room with two separate bedrooms but one bathroom. On this floor is a "wellness room" were resident records are stored. Garage area/Lower level is considered a floor. This are houses the laundry room, parking area, emergency food supplies, and laundry room. Laundry room is observed as in order and fully functional. Facility is equipped with emergency back up generator that is rated to run for 72hrs. Component 3 is conducted with administrator. Facility is fully functional and in place. LPA will recommend licensure. No citations issued.

Federal summary

CMS Care Compare

Not 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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