Sunshine Care Home Facility Llc
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.
2976 Fleetwood Drive · San Bruno, 94066
Quick facts
Quality snapshot
Updated April 26, 2026Compared to 182 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
Severity14thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency30thDeficiencies 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
Sunshine Care Home Facility Llc scores C−. Better than 48% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 14%. Repeats: top 0%. Frequency: 30th 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 / small beds (182 facilities).
Citation severity over time
↑ worseningWeighted severity score per month · 24 months
Weighted score (24mo)
85
Last citation
Jan 26
Finding distribution
18 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 dementia-care training must staff complete?Cited Jan 202422 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 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
- 415601134
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Sunshine Care Home Facility Llc
Inspections & citations
7
reports on file
18
total deficiencies
10
Type A (actual harm)
1
dementia-care citations
Other visitFebruary 24, 2026No deficiencies
Plain-language summary
During a follow-up visit on February 24, 2026, the state confirmed that the facility had corrected three outstanding violations related to personnel records, staff evaluations, and other provisions that had been cited during an inspection in January. The facility had been assessed a $2,500 civil penalty from January 21 through February 3, 2026, which was stopped once corrections were submitted. All violations from the January inspection have now been cleared.
View full inspector notes
On February 24, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced plan of correction visit to follow up on a civil penalty that was assessed. LPA met with caregiver, Don Gonzalez and explained the purpose of the visit. Caregiver called and informed the administrator, Roxanne Eduarte of LPA's visit. On February 3, 2026. LPA conducted an unannounced Plan of Correction visit to follow up on the citations that were issued during the annual visit on January 20, 2026. During the visit, LPA reviewed and validated the plan of correction that was submitted by the administrator and cleared 6 out of 9 citations and the following citations were not cleared: -87412(a) Personnel Records, 87463(a) Reappraisals and 1569.695(c) Other Provisions. Due to the above citations that were not cleared, a civil penalty in the amount of $2500 was assessed from 1/21/2026 through 2/3/2026. During today’s visit, LPA informed the administrator over the phone that the above citations are now cleared. Civil penalties will be stopped on 2/3/2026 as the plan of correction for the above citations were received on 2/3/2026. This report is reviewed and discussed with the caregiver. A copy is provided.
InspectionFebruary 3, 2026No deficiencies
Plain-language summary
During a follow-up visit on February 3, 2026, inspectors found that the facility had corrected six previous violations but failed to fix three others: staff health screening documentation was not completed or scheduled, resident care assessments were not completed for three residents, and an emergency drill was not documented as completed. The facility was assessed a total civil penalty of $2,500 that will continue to accrue daily until these issues are corrected.
View full inspector notes
On February 3, 2026 Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit for the annual inspection that was conducted on January 20, 2026. Upon entry, LPA met with caregiver, Don Gonzalez and explained the purpose of today's visit. Caregiver called and informed the administrator, Roxanne Eduarte of LPA's visit and arrived shortly thereafter. During today's visit, LPA discussed the plan of correction with the administrator and observed the following deficiencies were cleared: - 87405(c) Administrator - Qualification and Duties - 87309(a) Storage Space and Access - 1569.625(b)(2) Other Provisions - 1569.69(b) Other Provisions - 1569.695(b) Other Provisions - 1569.695(d) Other Provisions The following deficiencies are not corrected: - 87412(a) Personnel Records, the administrator was not able to provide proof that S1's health screen as completed or scheduled. - 87463(a) Reappraisals, the administrator was not able to provide proof that the reappraisals were completed for R2, R3, and R4 - 1569.695(c) Other Provisions, the administrator was not able to provide proof that emergency drill was completed on 1/30/2026 as indicated on the plan of correction. 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 Due to the above observation and deficiency not being corrected, a civil penalty is being assessed in the amount of $100 a day from 1/21/2026 through 2/3/2026 for 87412(a) and will continue to accrue until corrected. Due to the above observation and deficiency not being corrected, a civil penalty is being assessed in the amount of $100 a day from 1/29/2026 through 2/3/2026 for 87463(a) and 1569.695(c) and will continue to accrue until corrected. A total civil penalty of $2500 is being accessed today ( $1300 for 87412(a) and $1200 for 87463(a) and 1569.695(c)). This report is reviewed and discussed with the administrator. A copy of this report is provided.
Other visitJanuary 20, 2026Type A9 deficiencies
Plain-language summary
An unannounced annual inspection on January 20, 2025 found the facility's physical environment and supplies adequate, but identified three repeat violations from previous inspections: resident assessments were not updated, staff annual training was incomplete, and emergency drills were not conducted properly. The facility was also cited for leaving sharps, medications, and chemicals unlocked and accessible to residents. The facility has until January 28, 2026 to submit liability insurance documentation and correct these deficiencies, or may face civil penalties.
View full inspector notes
On January 20, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers, Rodolfo Castalone and Fernando "Don" Gonzalez and LPA explained the purpose of today's visit. Caregiver called and informed the administrator, Roxanne Eduarte of LPA's inspection. LPA toured the facility's building and grounds. This is a two level home. Upper level is for facility care staff and 1st floor is for residents. There are 4 bedrooms (2 shared and 2 private) for the residents and 2 full bathrooms. All rooms for residents are non-ambulatory. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 108-110 degrees F. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. LPA observed sharps, medication, toxins and chemical were unlocked and accessible to residents. Facility is equipped with smoke detectors and carbon monoxide detectors. . A review of (4) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. 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 The following documents were requested submitted to CCL by :1/28/2026: - Liability Insurance - LIC500 During today's visit, LPA observed repeat citations that were made from the previous annual inspections in January 2024, December 2024 and today. The citations were resident's reappraisals were not updated, staff annual training was not complete and emergency drills were not conducted accordingly. 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 caregivers. A copy of this report and the appeal rights were provided.
Regulation
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed knife and chemicals were unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and the plan shall include staff re-education. The completion date of the re-education shall be no later …
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 S1 did not have a health screen in the personnel file which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure S1 completes a health screen and the completion date shall be no later than 1/28/2026. The plan shall also include what is t…
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 LPA observed S1 and S2 did not complete their annual training which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance. The plan shall include the completion date of the annual training for S1 and S2 and the date shall be no later than 1…
Regulation
(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance. The plan shall include the completion date of the self-medication administration training for S2 and other staff w…
Regulation
(b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster.
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 complete their annual training which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/21/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance. The plan shall include the completion date of the annual training for S1 and S2 and the date shall be no later than 1…
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 LPA observed R2, R3 and R4 did not have an updated reappraisals which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/28/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance. The administrator/licensee shall provide a copy of an updated reappraisal for R2, R3, and R4 and a copy of the…
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 LPA observed emergency drills were not completed accordingly, they were completed in Jan 2025, May 2025 and Dec 2025 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/28/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and the plan of correction shall indicate what is the plan…
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 in as the facility was not able to provide proof that the emergency disaster plan was reviewed annually which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/28/2026 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and will provide proof that the emergency and disaster plan was reviewed. …
Inspector finding
87405 Administrator - Qualifications and Duties (c) Failure to comply with all licensing requirements pertaining to certified administrators may constitute cause for revocation of the license of the facility. Based on observation, and record reviews, the facility has recieved several same citations during the annual inspections on 1/2024, 12/2024 and 1/2026 Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cit…
InspectionJuly 10, 2025No deficiencies
Plain-language summary
On July 10, 2025, state licensing staff conducted an unannounced inspection and delivered an immediate exclusion letter to prevent a staff member from working at the facility. According to the facility, that staff member no longer works there. The facility was advised that this person is not permitted on the premises.
View full inspector notes
On 7/10/2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit. LPA met with caregivers, Fernando "Don" Gonzales and Meriam Castalone. LPA explained the purpose of today's visit. LPA delivered an immediate exclusion letter to exclude staff (S1) and according to facility staff members, S1 no longer works at the facility. Staff was advised that S1 is not allowed in the facility. LPA reviewed the immediate exclusion letter. This report is reviewed and discussed with caregiver, and a copy is provided.
InspectionDecember 23, 2024Type A3 deficiencies
Inspector: Murial Han
Plain-language summary
On December 23, 2024, state licensing staff conducted a routine unannounced inspection of this four-bedroom home for non-ambulatory residents and found the facility clean, comfortable, and well-stocked with supplies, with proper safety equipment and locked storage for medications and hazardous materials. The inspector identified at least one deficiency related to state regulations and requested the administrator's certificate and liability insurance documentation. Staff were informed of findings and given notice of appeal rights.
View full inspector notes
On 12/23/2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Rodolfo Castalone and explained the purpose of today's visit. Caregiver called and informed the Licensee, Fe Bret and the administrator, Roxanne Eduarte of LPA's inspection. LPA toured the facility's building and grounds. This is a two level home. Upper level is for facility care staff and 1st floor is for residents. There are 4 bedrooms (2 shared and 2 private) for the residents and 2 full bathrooms. All rooms for residents are non-ambulatory. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 109-110 degrees F. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. LPA observed sharps, central stored medication, toxins and chemical were locked and inaccessible to residents. Facility is equipped with smoke detectors and carbon monoxide detectors. . A review of (6) resident files was conducted and noted on the LIC 858. A review of (4) staff files was conducted and noted on the LIC 859. The following documents were requested submitted to CCL by :12/24/2024: - Administrator Certificate 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. This report is reviewed and discussed with the caregiver in person and administrator over the phone. A copy of this report and the appeal rights were provided.
Regulation
87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
Inspector finding
based on observation, record review and interview, the administrator acknowledged that 2 out of 6 resident's file did not have a copy of the reapprasials Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in based on observation, record review and interview, the administrator acknowledged that 2 out of 6 resident's files did not have a copy of the reappraisals which poses/posed a potential health, s…
Regulation
87412 Pesonnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation.
Inspector finding
based on records review, observation and interview, training records are missing from personnel records for 4 out of 4 staff members and the administrator acknowledged this observation and stated that training will be provided to LPA/CCL by the end of the day. Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above based on records review, observation and interview, training records are missing from per…
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 based on record review, observation and interview, 5 out of 6 residents have 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: 12/24/2024 Plan of Correction 1 2 3 4 The administrator will provide a plan in writing to ensure a physician's order is obtained, date it will be obtain…
Other visitJanuary 17, 2024Type A6 deficiencies
Inspector: Murial Han
Plain-language summary
During an unannounced annual inspection on January 17, 2024, inspectors found that kitchen knives and other sharp objects were unlocked and accessible to residents, and resident records were missing required documents including admission agreements and personal belongings safeguards. The facility also lacked proper documentation that the administrator was officially assigned to work there. The inspector requested these issues be corrected by January 19, 2024, and noted that failure to do so could result in civil penalties.
View full inspector notes
On 1/17/2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with administrator, Roxanne Eduarte and explained the purpose of today's visit. LPA toured the facility's building and grounds. This is a two level home. Upper level is for facility care staff and ground floor is where the residents live. There are 4 bedrooms (2 shared and 2 private) for the residents and 2 full bathrooms. All rooms for residents are non-ambulatory. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 105-108 degrees F. LPA inspected the kitchen and dining room area. Dining room area is observed as clean and in order. Both fresh food and frozen food supplies are inspected and observed as in place in the kitchen. Dry goods/emergency food supplies are in place also being stored in the garage. LPA observed central stored medication, toxins and chemical were locked and inaccessible to residents. LPA observed sharps in the kitchen were unlocked and accessible to residents in care. Facility is equipped with smoke detectors and carbon monoxide detectors. . 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 LPA reviewed 4 resident records and all of them contained physician's report (LIC 602); however missing admission agreement, appraisal service needs and plan, pre-admission appraisal and safeguards for resident's personal belongings and valuables. LPA reviewed 3 staff files (one of them is the administrator) and all of them contained personnel records, health screening, First Aide/CPR, fingerprint cleared, however, none the staff members are associated to the facility. LPA requested documents to update administrator- A written letter from the Licensee appointing the current administrator for the facility, administrator certification, LIC 500, LIC 501 and LIC 308 to be submitted to CCL by 1/19/2024. 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 the administrator. A copy of this report and the appeal rights were provided.
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 facility was not able to provide any documentation to proof that drills were conducted per the regulation which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/18/2024 Plan of Correction 1 2 3 4 The administrator/licensee will conduct a drill immediately and provide staff training sign-in sheet to CCL along with a plan to ensure dr…
Regulation
(f) The following shall be stored inaccessible to residents with dementia:
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as sharps in the kitchen were not locked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/18/2024 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and in-service staff.
Regulation
(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal.
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 1 out of 4 residents did not have an admission agreement and 4 out of 4 residents did not have a pre-placement appraisal which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/24/2024 Plan of Correction 1 2 3 4 The administrator/licensee will ensure all the admission agreement and pre-admission appraisals are completed and provide …
Regulation
(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Parti…
Inspector finding
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 4 out of 4 residents did not have documents to proof that this process has been completed which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/24/2024 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 1/24/2024.
Inspector finding
S1, S2 and new administrator are not associated with the facility. Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as S1, S2 and new administrator are not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/18/2024 Plan of Correction 1 2 3 4 The administrator will provide a plan by 1/18/2024 to ensure all staff are as…
Inspector finding
Safeguards for Personal Property and Valuables Deficient Practice Statement 1 2 3 4 Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 4 out of 4 residents did not have proof that facility has documented their personal property and valuables which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 01/24/2024 Plan of Correction 1 2 3 4 The administrator/licensee will develop a plan to e…
Other visitJanuary 20, 2023No deficiencies
Inspector: Jaime Vado
Plain-language summary
This was a pre-licensing inspection of a newly owned two-level home where the ground floor houses non-ambulatory residents and the upper level serves as staff quarters. The inspector found the facility clean and well-maintained, with proper emergency exits, working utilities, secure medication storage, locked knives, a current first aid kit, and all required resident furniture and supplies in place. The facility meets state regulations, and the inspector recommended that the license be issued.
View full inspector notes
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an announced pre-licensing inspection visit. LPA met with licensee Faye Pobre who is the new owner of the facility who will be leasing the property from the land owner. LPA toured the facility's building and grounds. This is a two level home. Upper level is care staff quarters and ground floor are where the residents live. All rooms for residents are non-ambulatory . All utilities are connected and functioning through out both buildings when inspected. Egress routes are clear and easily definable, labeled with exit signs, and egress route maps within the physical plant. Egress and emergency exit routes are free and clear of obstructions. COVID postings are in place on the ground floor of the facility. Hand washing signs are posted in resident bathrooms. Water temperature is tested at 106F in common bathroom on ground floor. LPA observed all resident rooms and they contain the required furniture outlined in regulations. Beddings and extra linens are observed in a storage cabinet in the garage. LPA observed a fire extinguisher as inspected as of 11/03/2023 and within operating range located near the dining table. LPA inspected the kitchen and dining room area. Dining room area is observed as clean and in order. Both fresh food and frozen food supplies are inspected and observed as in place in the kitchen. Dry goods/emergency food supplies are in place also being stored in the garage. LPA observed medications as being locked and stored in an upper cabinet in the kitchen. Knives are locked in a drawer adjacent to the stove. First aid kit is observed as in place in the kitchen locked in the same cabinet as the medications. Resident medications are current and medications administration records as well. Resident temperatures are checked daily as well as staff. Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued. LPA is recommending the license of the facility to be issued. Component III is conducted and report is reviewed with licensee Faye Pobre.
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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