Pacific Care Home Iii
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.
2880 St. Cloud Drive · 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
Severity9thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency9thDeficiencies 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
Pacific Care Home Iii scores D. Better than 39% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 9%. Repeats: top 0%. Frequency: bottom 9%.
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)
42
Last citation
Mar 26
Finding distribution
11 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.
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 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.
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
- 415600933
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- J & I Llc
Inspections & citations
3
reports on file
11
total deficiencies
6
Type A (actual harm)
InspectionMarch 3, 2026Type A5 deficiencies
Plain-language summary
On March 3, 2026, inspectors conducted a routine unannounced inspection and found the facility in good overall condition—rooms were spacious and clean, bathrooms properly equipped, medications and chemicals securely locked, and emergency safety equipment in place. However, inspectors cited a deficiency because medications were transferred from their original containers into a pill organizer, which violates state regulations. The facility was notified of the violation and given an opportunity to appeal.
View full inspector notes
On March 3, 2026, Licensing Program Analyst(LPA) Murial Han and IB investigator Gina Dutta conducted an unannounced annual inspection. LPA and IB investigator were greeted by caregiver, Emily Soriano. LPA explained the purpose of the visit. Facility supervisor, Moddie Andaya and licensee, Wilhelm Ick arrived shortly thereafter and assisted with the inspection. LPA toured facility and grounds. No accessible bodies of water. 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. LPA observed 5 resident rooms. Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 108- 113 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present. The facility is approved for 3 hospice and 1 bedridden; during today's visit, there are 5 resident and 2 of which are on hospice care. Medications, toxins, chemicals were observed to be locked and inaccessible to residents in care. Emergency drills were reviewed. 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 Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 10/9/2025. A review of (5) 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 tour of the facility, LPA and IB investigator observed the garage consisted of a metal/wooden frame with a folded cushion on top (similar to a Fulton bed), Rosary, clothes with staff clothing, staff medication, shoes, comb, etc. In addition, during the medication review, LPA observed medication was removed from its original containers, and poured into a pill organizer container for the next day. 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 and supervisor. A copy is provided and the appeal rights.
Regulation
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed medication was removed from its original container which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/04/2026 Plan of Correction 1 2 3 4 The administrator will remove the pill organizers and re-educate staff to not remove medication from its original container to administer the medication for later s…
Regulation
(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following informa…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed an over the counter Blink Eye Drop in R2's room without a physician's order which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/04/2026 Plan of Correction 1 2 3 4 The Blink Eye Drop was removed immediately. The administrator will develop a plan of correction to ensure all medications are prescribed an…
Regulation
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed R3 has full bedrails which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/04/2026 Plan of Correction 1 2 3 4 The administrator will change the full rails to half rails with physician's order. The administrator will provide a plan of correction to ensure compliance and re-educate staff members. The admi…
Regulation
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA and IB investigator observed R2, R3 and R4's centrally stored medication records were incomplete and medication was not logged which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/13/2026 Plan of Correction 1 2 3 4 The administrator will provided updated centrally stored medication records to residents identified and a plan to e…
Regulation
87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff,
Inspector finding
LPA and IB investigator observed clothing, Rosary, futon bed, medication, comb, shoes in the garage. Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed clothing, Rosary, futon bed, medication, comb, shoes in the garage which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/17/2026 Plan of Correction 1 2 3 4 The …
InspectionApril 2, 2025Type B2 deficiencies
Plain-language summary
During an unannounced annual inspection on April 2, 2025, inspectors found the facility clean and well-maintained, with spacious resident rooms, functioning safety equipment including smoke and carbon monoxide detectors, properly locked medications, and appropriate hot water temperatures. The facility was operating at capacity with 5 residents, including 3 receiving hospice care, within its approved limit. One deficiency was cited under state regulations; the facility has been notified and given the opportunity to appeal.
View full inspector notes
On April 2, 2025, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregiver, Emily Soriano. LPA explained the purpose of the visit. Facility supervisor, Moddie Andaya and licensee, Wilhelm Ick arrived shortly thereafter and assisted with the inspection. LPA toured facility and grounds. No accessible bodies of water. 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. LPA observed 5 resident rooms. Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 105- 107 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present. The facility is approved for 2 hospice and 1 bedridden; during today's visit, there are 5 resident and 3 of which are on hospice care. Medications, toxins, chemicals were observed to be locked and inaccessible to residents in care. Emergency drills were reviewed. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 10/21/2024. 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) resident files was conducted and noted on the LIC 858. A review of (3) staff files was conducted and noted on the LIC 859. 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 and supervisor. A copy is provided and the appeal rights.
Regulation
(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1, R2 and R3 have oxygen and there is no proof that a report has been made to the local fire jurisdiction which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/09/2025 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 4/9/2025. In addition, A copy of t…
Regulation
(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following condition…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility has an approved hospice waiver for 2 but currently has 3 residents who are on hospice which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/09/2025 Plan of Correction 1 2 3 4 The administrator shall develop a plan to ensure compliance and will provide a copy of the plan to CCL by 4/9/2025.
InspectionApril 23, 2024Type A4 deficiencies
Inspector: Murial Han
Plain-language summary
During a routine unannounced inspection on April 23, 2024, inspectors found that chemicals were stored unlocked and accessible to residents in both the garage and under the kitchen sink, creating a safety hazard. The facility also could not provide documentation that emergency drills had been conducted as required. The facility is being cited for these violations, including a repeat violation from a previous inspection, and was ordered to submit corrective documentation by April 24, 2024.
View full inspector notes
On April 23, 2024 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregiver, Emily Soriano. LPA explained the purpose of the visit. Facility supervisor, Moddie Andaya arrived toward the end of the inspection and assisted with the rest of the inspection. LPA toured facility and grounds. No accessible bodies of water. 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. LPA observed 5 resident rooms. Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 107- 110 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present. During the tour of the garage, LPA observed chemicals were unlocked and accessible to residents. LPA also observed the garage was sectioned off in the middle; one side is for laundry, toxins and chemical storage, etc. and the other side consisted of: futon beds, clothing, plastic shoe storage unit, closet, toiletries, and a blue luggage. Medication cabinet, located in the kitchen area, was reviewed. Chemical was observed to be unlocked underneath the kitchen sink. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Facility was not able to provide documentation that emergency drills were conducted. 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 Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 10/19/2023. A review of (4) facility resident records was conducted; A review of (2) facility staff records was conducted and 1 file was not available for review and according to the supervisor this staff just starting working at this facility yesterday and the file is still at one of the sister facilities. During today's inspection, there were 4 residents and 2 staff present. LPA requested these documents to be submitted by 4/24/2024: a copy of the administrator certification. Civil penalty is being assess today for repeat violation during the annual inspection on 10/14/2023. 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 and supervisor. A copy is provided and the appeal rights
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 garage has livable items such as toiletries, futon beds, personal hygiene items, clothing, shoes, etc. which poses an immediate 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/licensee shall remove furniture, and personal items in the garage and provide photos to CCL by 4/24/2024 to ensur…
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 chemicals in the kitchen area and in the garage are unlocked and accessible to residents which poses an immediate 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/licensee shall develop a plan to ensure compliance and send photos to CCL by 4/24/2024 to ensure all chemicals are locked and in…
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 that emergency drill were conducted which poses an immediate 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/licensee shall develop a plan to ensure drills are conducted accordingly and the plan shall include staff training. The administrator/licensee will pro…
Inspector finding
87755 Inspection Authority of the Licensing Agency Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 1 out of 3 staff personnel file was not available for review during the inspection which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/29/2024 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure staff files ar…
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.
Family reviews
No reviews yet — be the first to share your experience
No published reviews yet. Use the button above to share your experience.