Monteverde Manor Ii
RCFE
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 assistance with daily living activities such as bathing, dressing, meals, and medication management in a home-like setting. RCFEs are not hospitals or skilled nursing facilities — they do not provide round-the-clock medical care.
2640 Muirfield Circle · San Bruno, 94066
Quick facts
Quality snapshot
Updated April 25, 2026Compared to 214 California RCFE 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
Severity0thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency1thDeficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
Quality grade· click to show how this was calculated
Weighted citations per bed
Repeat deficiencies as share of total
Deficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
Monteverde Manor Ii scores D. Better than 34% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 0%. Repeats: top 0%. Frequency: bottom 1%.
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_general / small beds (214 facilities).
Citation severity over time
↑ worseningWeighted severity score per month · 24 months
Weighted score (24mo)
189
Last citation
Apr 26
Finding distribution
29 total · 36 monthsScope × Severity (CMS A–L)
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 health conditions can this facility legally accept or refuse?Cited Apr 202622 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.
What training are all staff required to complete?22 CCR §87411
All direct-care staff must complete:
- 10 hours initial training within the first four weeks of employment.
- 4 hours annual in-service every year thereafter.
- Administrator certificate from a CDSS-approved program — 80 hours for first-time, 40 hours renewal every 2 years.
Ask on tour: Ask when the last staff training was completed and how it's tracked.
How many staff must be on duty overnight?22 CCR §87415
Based on 6 licensed beds:
One qualified staff member must be on call and physically on premises at all times overnight.
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 must this facility report to the state — and how fast?22 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).
How does CDSS enforce these rules?22 CCR §87755–87777 / HSC §1569.58
- 1Notice of DeficiencyWritten citation with a correction deadline. Facility must submit a Plan of Correction.
- 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.
- 3Suspension of AdmissionsFacility cannot accept new residents until violations are corrected.
- 4Temporary Suspension or RevocationEmergency suspension for imminent danger; full revocation after administrative hearing.
- 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 citationsState records
California Dept. of Social Services · Community Care Licensing- License number
- 415600660
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Monteverde Manor Llc
Inspections & citations
5
reports on file
29
total deficiencies
24
Type A (actual harm)
Other visitApril 16, 2026Type A12 deficiencies
Plain-language summary
During an unannounced annual inspection on April 16, 2026, inspectors found three violations: medication cabinets were unlocked and accessible to residents, a bedridden resident was placed in a room not approved for bedridden residents, and two staff members did not have required criminal background clearances. The facility was assessed $1,500 in civil penalties, and the two staff members without clearances were removed from the facility.
View full inspector notes
On April 16, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers Remus Buensuceso and Maria Buensuceso and LPA explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable at this time. Chemical, and sharps cabinets were observed to be locked and inaccessible to residents in care. However, Medication cabinets were unlocked and accessible to residents in care. The facility is approved for 1 bedridden resident in room 4,and LPA observed resident #6 (R6) who was deemed to be bedridden on the LIC 602 was residing in room 2 that was not approved for bedridden resident. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Emergency drills were reviewed to be adequate. 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 A review of (6) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. During the review of staff files, LPA observed staff #1 (S1 ) and Staff #2 (S2) did not have a criminal background clearance. LPA spoke with the administrator who brought additional staff members to the facility and S1 and S2 were removed. Civil penalty is being assessed today for the following citations in the amount of $1500 - 87202(a)(2) Bedridden Persons- $500 - 87412(a)(13)(B) Criminal Background Clearance- $1000 The following forms and documents were requested to submitted to CCL by 4/27/2026: - liability insurance, Administrator Certification, LIC 500 and Lease Agreement Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in addition civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.
Regulation
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as Based on documents reviewed, LPA observed R6 is bedridden, however, R6 was residing in a room that was not approved for bedridden resident which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will submit a plan of correction to ensure compliance by 4/17/2026.
Regulation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed the hot water temperature in the kitchen and the resident bathroom/shower room was measured above 150 degree F which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will submit a plan of correction to ensure compliance by 4/17/2026.
Regulation
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on records review, LPA observed S2 did not have a health screen which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction to CCL by 4/17/2026.
Regulation
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance …
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S1 and S2 did not have criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction to CCL by 4/17/2026.
Regulation
(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S2 did not have any training prior to providing care to the residents which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction by 4/17/2026 to ensure compliance.
Regulation
(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as upon entering the facility until the completion of the inspection, LPA did not observe any activities for the residents. LPA observed 4 residents were in bed, and 2 residents were on the couch in the living room (one was watching TV and the other one was sleeping). which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of C…
Regulation
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as During the tour of the facility, LPA observed medications were unlocked and accessible to residents in care.which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will submit a plan of correction to CCL by 4/17/2026 indicating the action(s) that the facility will take to ensure centra…
Regulation
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on records review, LPA observed R3 did not have a pre-placement appraisal which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction to CCL by 4/17/2026 to ensure compliance and will provide a copy of the pre-admission appraisal to CCL by 4/27/2026.
Regulation
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, th…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on records review, LPA observed R1 and R4 did not have an updated reappraisal which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction to CCL by 4/17/2026 to ensure compliance and will provide a copy of the reappraisal for R1 and R4 to CCL by 4/27…
Regulation
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physicia…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on observation and record review, LPA observed R3 and R5 have half bedrails by the head of the bed without a physician's order which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will develop a plan of correction to ensure compliance and will provide a copy of the plan to CCL…
Regulation
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivisi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on records reveiw and interview, LPA observed S1 did not have annual training which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/17/2026 Plan of Correction 1 2 3 4 The administrator will provide a plan of correction to ensure compliance by 4/27/2026.
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. (3) Ability to maintai…
Inspector finding
Based on observation, interview and record review, the facility has multiple repeat violations from the annual inspections from 2024, 2025 and 2026. Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on observation, interview and record review, the facility has multiple repeat violations from the annual inspections from 2024, 2025 and 2026 which poses an immediate health, safety or personal…
InspectionApril 9, 2025Type B1 deficiency
Plain-language summary
A continuation inspection was conducted on April 9, 2025, as part of the facility's annual inspection process, during which inspectors reviewed staff files, documents, and toured the facility. One deficiency was found related to state regulations. The facility was notified of the finding and given information about appeal rights.
View full inspector notes
On April 9, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced continuation visit for an annual inspection that was conducted April 1, 2025. LPA met with caregiver, Ilfonso Maning and explained the purpose of today's visit. The administrator arrived and assisted with the inspection. During today's visit: LPA reviewed 3 staff files, reviewed documents and conducted facility tour that was provided by the caregiver. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.
Regulation
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivisi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R2 and R3 did not have documentation to proof that their annual training was completed in 2024 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/16/2025 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and will provide a copy of training records for R2 and R3 by 4/16/2025.
Other visitApril 9, 2025No deficiencies
Plain-language summary
This was a follow-up visit on April 9, 2025 to verify that the facility had fixed deficiencies found during the annual inspection in April 2025. All previously cited issues, including fire clearance, building alterations, admission procedures, resident agreements, postural supports, and resident reassessments, were corrected. No new deficiencies were found during this visit.
View full inspector notes
On April 9, 2025, Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit for the annual inspection that was conducted on April 1, 2025. LPA met with caregiver, Ilfonso Maning and explained the purpose of today's visit. The administrator arrived and assisted with the visit. During today's visit, LPA toured the common areas, garage, bath/shower room, dining room, living room, resident room, etc., reviewed plan of correction documents that were submitted by the administrator/licensee. The following deficiencies , which were cited on 4/1/2025 are corrected: - 87202(a)(2) Fire Clearance - 87305(a) Alterations to Exiting Buildings or New Facilities - 87456(a)(2) Evalution of Suitability for Admission - 87507(a) Admissions Agreement - 1569.695(c) Other Provisions - 1569.695(d) Other Provisions - 87608(a)(3) Postural Supports - 87463(a) Reappraisals A copy of the Cleared Plan of Correction Letters were provided the administrator/licensee. No deficiency cited today. This report is reviewed and a copy is provided.
InspectionApril 1, 2025Type A8 deficiencies
Plain-language summary
During a routine inspection on April 1, 2025, inspectors found that the facility had a bedridden resident living in an unapproved bedroom, used its garage as a staff sleeping and storage area with a broken door, and could not document that emergency drills had been completed as required. The facility also failed to maintain current liability insurance and received civil penalties for these violations and repeat violations involving how bedridden residents are housed, building alterations, and emergency preparedness. The inspector will return to complete the inspection and verify corrections.
View full inspector notes
On April 1, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, ILdefonso Maning and explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Chemicals, medication and sharps cabinets were observed to be locked and inaccessible to residents in care. A tour of the resident bedrooms and restrooms was conducted. The facility is approved for 1 bedridden resident in room 4, however, LPA observed resident #5 (R5) who is bedridden and is residing in room 1 that is a non-approved bedridden room. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. There are 5 residents present. 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 Garage area was toured. LPA observed the facility has been converted into a storage space and for staff members to rest/sleep. LPA observed 2 beds in the garage with personal items around it and according to staff #1 (S1) staff members sleep and take rest breaks and the garage door has been broken for a long time. Fire extinguishers were inspected on 10/4/2024. Facility was not able to provide documentation to proof that emergency drills were completed accordingly. A review of (5) resident files was conducted and noted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL by 4/2/2025 - liability insurance Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in addition civil penalties. Civil penalty is being assessed today for the following repeat violations: - 87202(a)(2) Bedridden Persons - 87463(a) Reappraisals - 87305(a) Alterations to Existing Building - 1569.695(c) Other Provisions/Disaster Preparedness LPA will return on another day to complete the inspection. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.
Regulation
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on the LIC602, R5 bedridden is but residing in room #1 that is not approved for bedridden which poses an immediate health, safety or personal right risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and if the plan is to convert room 1 into a bedridden room, the administrator shall indicate i…
Regulation
(a) Prior to construction or alterations, all facilities shall obtain a building permit.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed the garage has been converted into a non-functioning garage as evidenced by 2 beds for staff to sleep/rest, many storage boxes, every cluttered the garage door is no longer working which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compli…
Regulation
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R4 did not have a pre-admission appraisal which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 4/2/2025. The administrator shall have a copy of the completed pre-admission appraisal by 4/8/2025.
Regulation
(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R4's admission agreement was blank which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 4/2/2025. The administrator shall have a copy of the completed admission agreement by 4/8/2025.
Regulation
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill,…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator did not have documents to proof that drills were conducted accordingly which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and provide a copy of the plan to CCL by 4/2/2025. The administrator shall provide proof to conduct …
Regulation
(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator was not able to provide document to proof that this was completed which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and provide a copy of the plan to CCL by 4/2/2025.
Regulation
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physicia…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1, R4 and R5 have bed rails without a written order from the physician which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/02/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and provide a copy of the plan to CCL by 4/2/2025. The administrator will obtain a copy of written order for the resi…
Regulation
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, th…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1, R2 and R3 did not have an updated appraisal which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/07/2025 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and provide a copy of the plan to CCL by 4/7/2025. The administrator will complete a reappraisal for R1, R2, and R5 by 4/8/2025.
InspectionApril 17, 2024Type A8 deficiencies
Inspector: Murial Han
Plain-language summary
During a routine annual inspection on April 17, 2024, inspectors found several violations: a bedridden resident was placed in a room not approved for bedridden care, cleaning chemicals were stored in an unlocked cabinet accessible to residents, the facility was operating an unpermitted staff living space in the garage, and emergency drill documentation could not be provided. The facility also had staffing issues including one employee working without required criminal background clearance. The state is assessing civil penalties for these violations and has required corrections by April 22, 2024.
View full inspector notes
On April 17, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, ILdefonso Maning and explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication and sharps cabinets were locked located in the kitchen area and inaccessible to residents in care. A tour of the resident bedrooms and restrooms was conducted. The facility is approved for 1 bedridden resident in room 4, however, LPA observed 1 bedridden resident is residing in a non-approved bedridden room. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. There are 6 residents present, and 3 staff but 1 staff left during the inspection due to lack of criminal background clearance. 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 A review of (5) facility resident records was conducted. A review of (4) facility staff records was conducted. Garage area was toured. LPA observed half of the garage was blocked off by green partition with two tents inside; each tent consisted of a mattress and around the tents, there were toiletries, clothing, shoes, etc. The administrator acknowledged that the facility altered this space as facility staff living space without permit. The garage area also housed the washing machine and dryer for this facility's use at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be unlocked and accessible to the residents at this time. Fire extinguishers were inspected on 10/26/2023. Facility was not able to provide documentation to proof that emergency drills were completed accordingly. The following forms and documents were requested to be updated and submitted into CCL by 4/22/24 - control of property, and liability insurance Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Civil penalty is being assessed today for repeat violation, lack of criminal background clearance for one staff, a bedridden resident is residing in a room that is not cleared by fire marshal and 2 out of 4 staff members were not associated. Civil penalty will continue to accrue until corrected. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.
Regulation
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above resident #1 (R1) is deemed to be bedridden and is residing in a room that is not approved for bedridden person which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will developed a plan to ensure residents are residing in a room that is approved by the fire marshal based on their med…
Regulation
Prior to construction or alterations, all facilities shall obtain a building permit.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed facility garage has been altered into living space for 2 staff members which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will remove all the livable supplies, items, toiletries, etc. in the garage and submit proof of completion to CCL by 4/18/2024. LPA administrator …
Regulation
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed toxins and chemicals in the garage were unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and will provide copy of photos to CCL by 4/18/2024.
Regulation
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed 3 out of 4 staff files did not contained completed health screening which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and on the plan, it shall indicate when these 3 staff will complete their health screening. The administrato…
Regulation
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance:
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as one staff did not have criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure all staff are criminally background cleared prior to employment and will provide a copy of the plan to CCL by 4/18/2024.
Regulation
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill,…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as facility was not able to provide documents for the drills which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/18/2024 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 4/18/2024
Regulation
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permi…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed 2 out of 4 staff were not associated which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/24/2024 Plan of Correction 1 2 3 4 The administrator will associate both staff and provide proof to CCL by 4/24/2024 that it has been completed.
Regulation
(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to:
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed 3 out of 4 residents files did not contained pre-admission appraisal which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/24/2024 Plan of Correction 1 2 3 4 The administrator will develop a plan to ensure compliance and a copy of each resident's completed pre-admission and/or appraisal service needs to CCL by 4/24/20…
Federal summary
CMS Care CompareNot a CMS-certified facility
California RCFEs (residential care facilities for the elderly) are licensed by the state, not by CMS. CMS data only applies to skilled nursing facilities or to CCRCs that operate a licensed SNF wing.
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