Heart and Soul Communities Ii
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.
2245 Sol Street · San Leandro, 94578
2245 Sol Street, San Leandro — view in Maps
Quick facts
Quality snapshot
Updated April 25, 2026Compared to 122 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
Severity1thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency60thDeficiencies per inspection
Trajectory93thImproving or worsening vs. prior year
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
Improving or worsening vs. prior year
Tick mark at 50% = peer median · higher percentile = better facility
Heart and Soul Communities Ii scores B−. Better than 64% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 1%. Repeats: top 0%. Frequency: 60th percentile. Trajectory: improving.
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 (122 facilities).
Citation severity over time
↓ improvingWeighted severity score per month · 24 months
Weighted score (24mo)
207
Last citation
Aug 25
Finding distribution
34 total · 36 monthsScope × Severity (CMS A–L)
StarlynnCare receives no payment from any facility listed on this site.
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 Oct 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.
What must this facility report to the state — and how fast?Cited Aug 202522 CCR §87211 / WIC §15630
- ImmediateElopement, fire, epidemic outbreak, or poisoningImmediately
- 2 hoursAbuse with serious bodily injury2-hour phone report + 2-hour written report — to the California Department of Social Services (CDSS), Adult Protective Services, and law enforcement
- 24 hrsAbuse without serious bodily injuryWithin 24 hours
- Next dayDeath of a residentPhone by next working day; written within 7 days
- Next dayInjury requiring medical treatment beyond first aidPhone by next working day; written within 7 days
- WrittenBankruptcy, foreclosure, eviction, or utility shutoff noticeWritten notice to CDSS and residents — $100/day penalty (max $2,000) for failure
Your enforcement lever:Incidents that aren't reported on time are themselves a separate violation. If you believe a reportable event wasn't filed, you can submit a complaint directly to the California Department of Social Services (CDSS).
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.
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
- 019200476
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Ericka Tillis
Inspections & citations
41
reports on file
36
total deficiencies
17
Type A (actual harm)
3
dementia-care citations
Other visitOctober 29, 2025No deficiencies
Plain-language summary
On October 29, 2025, inspectors conducted a final closure visit at the facility and found no violations. The facility's license was surrendered, and two residents still living there were told they must move to a licensed care facility; the families indicated they plan to take them into their own care. The facility is now unlicensed, and any care provided there is considered unlicensed care.
View full inspector notes
On 10/29/2025 at around 9:30 AM, Licensing Program Analysts (LPAs) Y. Brown and A. Gomez arrived to conduct a Case Management Closure visit and met with Licensee Ericka Tillis and explained the purpose of the visit. During the visit, LPAs inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining area, living area and storage areas. LPAs observed that there are still two (2) residents that require assistance residing at the facility. LPAs informed the Licensee that the two remaining residents that are still residing at the facility need to be relocated to licensed care. Licensee states that the residents families plan on taking them into their care. LPAs retrieved the facility License from the Licensee during the visit. LPAs explained to Licensee that the facility is now considered unlicensed and that any care being provided is now considered unlicensed. No Deficiencies cited during today's visit. Exit interview conducted and a copy of this report provided to Licensee.
Other visitOctober 20, 2025No deficiencies
Plain-language summary
On October 17, 2025, state licensing conducted a case management and health checks visit at the facility. The inspector observed residents in their rooms, confirmed staffing coverage during an upcoming vacation period, and reviewed the facility's current census. No violations were found.
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On 10/17/2025 at 11:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced for this Case Management - Health Checks visit. Upon entry into the facility, the LPA explained the purpose of the visit. During the visit, the LPA observed the residents R1 and R2 in their bedrooms. The LPA was updated on the correct time and coverage for when the Licensee will go on vacation. The LPA obtained the total facility census. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Other visitOctober 17, 2025No deficiencies
Plain-language summary
On October 17, 2025, a state licensing analyst conducted a case management visit to discuss resident relocation and verify the facility's current census. The licensee reported working with residents' families on moving arrangements, and no violations were found during the visit.
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On 10/17/2025 at 12:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted a case management-legal non-compliance visit and met with Licensee Ericka Tillis and LPA explained the purpose of the visit. During the visit, LPA and Licensee discussed the update on the relocation of the residents, and LPA obtained the total census at the facility. Licensee stated that they have been working with the residents responsible parties and discussing their movement. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Other visitOctober 10, 2025No deficiencies
Plain-language summary
A licensing analyst visited the facility on October 10, 2025 to check on legal compliance matters and discussed the relocation of residents with the owner. The owner reported they were working with families and the Public Guardian to move residents to other placements. No violations were found during the visit.
View full inspector notes
On 10/10/2025 at 10:00 AM, Licensing Program Analyst (LPA) Y. Brown conducted a case management-legal non-compliance visit and met with Licensee Ericka Tillis and LPA explained the purpose of the visit. During the visit, LPA and Licensee discussed the update on the relocation of the residents, and LPA obtained the total census at the facility. Licensee stated that they have been working with the residents responsible parties and discussing their movement. Licensee discussed that they have contacted the Public Guardian to relocate the residents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Other visitOctober 2, 2025No deficiencies
Plain-language summary
On October 2, 2025, a state licensing analyst conducted a case management and legal compliance visit to the facility. The analyst met with the licensee to discuss the relocation of residents and current census, with no violations found. The facility is working with residents' families and the Public Guardian's office on the relocations.
View full inspector notes
On 10/2/2025 at 10:55 AM, Licensing Program Analyst (LPA) Y. Brown conducted a case management-legal non-compliance visit and met with Licensee Ericka Tillis and LPA explained the purpose of the visit. During the visit, LPA and Licensee discussed the update on the relocation of the residents, the residents ambulatory status and the total census at the facility. Licensee stated that they have been working with the residents responsible parties and Public Guardian to relocate the residents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Other visitSeptember 19, 2025No deficiencies
Plain-language summary
On September 19, 2025, state licensing staff visited the facility to review case management and legal compliance matters. Staff observed three residents on-site and noted that a fourth resident was hospitalized at the time of the visit, and discussed the facility's plan to relocate residents with the owner. No violations were identified during this visit.
View full inspector notes
On 9/19/2025 at 11:00 AM, Licensing Program Analyst (LPAs) Y. Brown and J. Sampair conducted a case management-legal non-compliance visit and met with Licensee Ericka Tillis. Upon entry, the LPAs explained the purpose of the visit. During the visit, LPAs and Licensee discussed the update on the relocation of the residents. The LPAs observed three (3) residents at the facility and a fourth (R1) is in the hospital. Exit interview conducted and a copy of this report provided.
Other visitSeptember 5, 2025No deficiencies
Plain-language summary
On September 5, 2025, state licensing staff conducted a legal compliance review and met with the facility owner to discuss the relocation of residents, their mobility status, and current census. The visit covered the facility's work with families and the Public Guardian's office on resident relocations. No violations were found.
View full inspector notes
On 9/5/2025 at 8:00 AM, Licensing Program Analyst (LPAs) Y. Brown and J. Sampair conducted a case management-legal non-compliance visit and met with Licensee Ericka Tillis and LPAs explained the purpose of the visit. During the visit, LPAs and Licensee discussed the update on the relocation of the residents, the residents ambulatory status and the total census at the facility. Licensee stated that they have been working with the residents responsible parties and Public Guardian to relocate the residents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Other visitAugust 28, 2025No deficiencies
Plain-language summary
On August 28, 2025, inspectors made an unannounced visit to verify that the facility had corrected three previous violations. The facility had addressed all three issues: submitting required written documentation, removing expired food and restocking supplies, and providing self-certification paperwork. All deficiencies were cleared during the visit.
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On 8/28/2025 at 9:25AM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown arrived unannounced to conduct a POC (proof of correction) inspection. LPAs met with Licensee, Ericka Tillis informed her the reason for the visit. The following deficiencies was cleared by visit : - 87465(h)(6): LPAs received a written plan via email. - 87555(b)(8): Licensee threw away the expired food and purchased additional non-perishable food supplies. - 87211(a)(1): LPAs received self-certification during visit. LPA cleared deficiencies during visit and provided POC letters to Licensee. Exit interview conducted. A copy of this report provided.
InspectionAugust 22, 2025No deficiencies
Plain-language summary
On August 22, 2025, state inspectors made an unannounced visit to deliver a compliance letter to the facility owner. No violations were found during this visit.
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On 8/22/2025, at 10:00 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced for this Case Management Legal/Non-compliance visit to deliver the letter dated 8/21/2025 to the Licensee Ericka Tillis. Upon entry, Licensee Ericka Tillis was notified of the purpose of the visit. During this visit, the LPAs delivered the letter to Licensee Ericka Tillis. No citations issued during this visit. Exit interview conducted with Licensee and a copy of this report provided.
Other visitAugust 7, 2025Type B1 deficiency
Plain-language summary
On August 7, 2025, inspectors visited the facility as part of a complaint investigation and found that the facility was not keeping centralized medication records for residents. Staff confirmed during interviews that medication records were not being maintained at the facility. The facility was cited for this violation and told that failure to correct it could result in civil penalties.
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On 8/7/2025 at 4:00PM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown arrived unannounced to conduct a case management visit. LPAs met with Licensee/Administrator, Ericka Tillis and explained the purpose of the visit. While LPAs were at the facility for a complaint investigation (#15-AS-20250528121744), the following deficiency was observed. LPAs observed facility does not have centrally stored medication records available. Interview with staff indicated that facility did not keep medication records for residents. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.
Regulation
Incidental Medical and Dental Care. The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained... This requirement is not met as evidence by:
Inspector finding
Based on record review, licensee did not comply with the section cited above by not having centrally stored records for residents available which poses a potential health and safety risk to the persons in care.
ComplaintAugust 7, 2025· MixedType B2 deficiencies
Inspector: Grace Luk
Plain-language summary
A complaint investigation found that the facility failed to report incidents to appropriate authorities when a resident went to the hospital and another resident had injuries — this violation was substantiated. The investigation also looked into allegations of physical abuse, failure to obtain medical care, failure to manage medications, and poor sanitation, but found insufficient evidence to substantiate those claims. Staff stated that one resident's facial bruising came from a closet door accident rather than abuse, and interviews with other residents and staff did not corroborate the abuse allegation.
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Licensee does not report incidents to appropriate parties LPA G. Luk reviewed facility file and observed no incident reports were submitted when R1 went the hospital or when R2 had injuries. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED . California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Licensee physically abuses resident Police report stated R2 had bruising on the left side of the face; however, R2 consistently stated R2 was not assaulted and could not stay on topic due to dementia diagnosis. Deputies were informed by S1 that the closet door fell on R2’s head when R2 rummaged through the closet and the closet door broke. Interview with residents revealed they have not witnessed staff physically abuse residents. Interview with staff indicated they have not heard or witnessed physical abuse towards residents. Licensee does not assist resident's with obtaining medical care Interview with staff indicated that R2's bump or bruise was observed. However, S1 stated that medical attention was not needed for R2's injury at that time and R2 did not complain of pain. S1 also stated that R2 was evaluated after injury was observed and injury site was flat. Licensee did not assist resident with obtaining prescribed medication Interview with staff revealed that S1 handle’s residents’ medications including ordering and picking up prescription medications. Facility did not keep medication records; therefore, LPA was unable to determine if resident’s prescription medications were obtained and administered. Licensee does not maintain facility sanitary Interview with residents revealed that staff clean the facility daily. Interview with staff indicated that staff cleans every morning. LPAs observed facility has cleaning supplies available. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted. A copy of this report provided.
Regulation
Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence... This requirement is not met as evidence by:
Inspector finding
Based on observation, licensee did not comply with the section cited above by not submitting incident reports which poses a potential health and safety risk to the persons in care.
Regulation
General Food Service Requirements. All food shall be of good quality... This requirement is not met as evidence by:
Inspector finding
Based on observation, licensee did not comply with the section cited above by having expired non-perishable foods which poses a potential health and safety risk to the persons in care.
Other visitAugust 4, 2025No deficiencies
Plain-language summary
On August 4, 2025, inspectors made an unannounced visit to check whether the facility had corrected a deficiency found during a previous case management visit on July 18, 2025. The deficiency was corrected and no new violations were found.
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On 8/04/2025, at 12:45 PM, Licensing Program Analyst (LPAs) James Sampair and Yasamin Brown arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPAs stated the purpose of the visit to Licensee Ericka Tillis. On 7/18/2025, LPAs Brown and Luk conducted a Case Management visit during which 1 deficiency was cited. The 1 deficiency was cleared during this visit. No citations were issued Exit interview conducted and a copy of this report provided.
Other visitAugust 4, 2025Type A2 deficiencies
Plain-language summary
This was the facility's required annual inspection on August 4, 2025, and inspectors found the building well-maintained with adequate lighting, safety equipment like grab bars, locked medications, and sufficient food supplies. There were no deficiencies identified with staff training — all four staff members present had current CPR and First Aid certifications. The facility's license is valid through August 2027.
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On 8/4/2025 at 12:45 pm, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator/ Licensee Ericka Tillis and explained the purpose of the visit. The administrator currently holds a certificate (#6042836740) that expires on 8/29/2027. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. All outdoor and indoor passageways are kept free of obstruction. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Fire extinguisher was last serviced on 9/19/2024. The following deficiencies were observed: At 2:30 pm, LPAs observed missing CPR training from 0/4 staff members. At 2:35 pm, LPAs observed missing First Aid training from 0/4 staff members. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.
Regulation
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staf…
Inspector finding
Based on record review, the licensee did not comply with the section cited above in that out of the 4 staff members, none of the staff members on duty had proof of CPR training in which poses an immediate health and safety risk to persons in care. POC Due Date: 08/05/2025 Plan of Correction 1 2 3 4 The Administrator agrees to schedule at least one staff member to receive CPR training and submit documentation of scheduled training to CCLD by POC date. Administrator agreed to also send the comp…
Regulation
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
Inspector finding
Based on record review, the licensee did not comply with the section cited above in that 0 out of 4 staff members did not have first aid certification on file which poses an immediate health and safety risk to persons in care. POC Due Date: 08/05/2025 Plan of Correction 1 2 3 4 The Administrator agrees to schedule all staff members to receive first aid training and submit documentation of scheduled training to CCLD by POC date. Administrator agreed to also send the completion of the training o…
Other visitAugust 4, 2025No deficiencies
Plain-language summary
State inspectors visited the facility on August 4, 2025, to verify that previous corrections had been made (this was a follow-up inspection). The inspectors toured the bedrooms, bathrooms, common areas, kitchen, and outdoor spaces, and found adequate food supplies on hand. No violations were found.
View full inspector notes
On 8/04/2025, at 12:45 PM, Licensing Program Analyst (LPAs) James Sampair and Yasamin Brown arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPAs stated the purpose of the visit to Licensee Ericka Tillis. LPAs toured the facility, including the residents' bedrooms, bathrooms, common area, kitchen, and outdoor areas. 7 days of non-perishable and 2 days of perishable food supplies were present. No citations were issued Exit interview conducted and a copy of this report provided.
Other visitJuly 18, 2025Type B1 deficiency
Plain-language summary
Inspectors made an unannounced health and safety visit on July 18, 2025 and found that a shared bathroom door and handle downstairs were in disrepair. Hot water temperature and food supplies were acceptable. The facility must submit proof that this damage has been corrected by the deadline set by the state or face penalties.
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On 7/18/2025 at 3:00 pm, Licensing Program Analysts (LPAs) Y. Brown and G. Luk arrived unannounced to conduct a health and safety check. LPAs met with Licensee/Administrator, Ericka Tillis and informed her the reason for visit. LPAs toured the facility including but not limited to resident's bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 106.2 degrees F in a resident's bathroom sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. The following deficiency was observed: At 3:47 pm, LPAs observed downstairs residents shared restroom door and door handle were in disrepair . Deficiency are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. During the visit, LPAs also hand delivered a copy of the civil penalty invoice to the licensee due to mail was undeliverable. LPAs were informed by licensee that the facility address has been changed recently and licensee provided current facility address to LPAs. Exit interview conducted with Licensee/Administrator and a copy of the appeal rights and this report provided.
Regulation
87307 Personal Accommodations and Services (c) Individual privacy shall be provided in all toilet, bath and shower areas.
Inspector finding
This requirement was not met as evidence by: Based on observation, the Licensee did not comply with the section cited above by having the resident's bathroom door and door handle in disrepair which poses a potential health and safety risk to persons in care.
Other visitJune 18, 2025Type A2 deficiencies
Plain-language summary
This was a health and safety inspection conducted in June 2025 following a complaint filed the previous month. Inspectors found that the refrigerator was not cold enough (49.3 degrees instead of the required temperature) and the freezer was also warmer than it should be (9 degrees), which can allow bacteria to grow in stored food; they also found a staff member on-site who did not have the proper clearance to work at the facility. The facility was assessed civil penalties of $250 and $500 and must submit proof that these problems have been corrected.
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On 6/18/2025 at 11:00 am, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced to conduct a health and safety check as a result of the accusation issued on 5/27/2025. LPAs met with Licensee/Administrator, Ericka Tillis and explained the purpose for the visit. LPAs toured facility including but not limited to resident's bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 101.5 degrees F in the facilities kitchen sink. LPAs observed 7-days of non-perishable and 2-days of perishable food supplies were sufficient. LPAs observed the following deficiencies: At 2:00 PM, LPAs measured that the temperature of the freezer was 9 degrees Fahrenheit and the refrigerator was 49.3 degrees Fahrenheit. At 5:00 PM, LPAs observed S1 has fingerprint clearance but is not associated with the facility. Continued on LIC809C... 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 Continued from LIC809. Immediate civil penalties of $250 and $500 were assessed. The deficiencies were cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties Exit interview conduct. A copy of this report, appeal rights, LIC421BG, and LIC421FC provided.
Regulation
87555 General Food Service Requirements: (b)(21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C). This requirement was not met as evidenced by:
Inspector finding
The temperature of one of the freezers was 9 degrees and one of the refrigerators was 49.3 degrees Fahrenheit. All of the refrigerators and freezers were observed to be unclean.
Regulation
(e) All individuals subject to a criminal record review... shall prior to working.. in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement was not met as evidence by:
Inspector finding
Based on record review the Licensee did not comply with the section cited above in having S1 associated to the facility, which poses an immediate health and safety risk to person in care.
Other visitJune 18, 2025No deficiencies
Plain-language summary
On June 18, 2025, regulators conducted a follow-up visit to check whether the facility had corrected violations from a prior accusation of non-compliance. The facility had failed to post a notice about the accusation in a visible location and had not notified residents' families or the local ombudsman, but during this visit inspectors confirmed the notice was now properly posted. Two violations were cited.
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On 6/18/2025, at 11:00 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced for this Case Management Legal/Non-compliance visit, concerning the California Department of Social Services (CDSS) Accusation #7525116301 dated 5/27/2025. Upon entry into the facility, the LPAs stated the purpose of the visit to Licensee Ericka Tillis. On 6/9/2025, LPAs Yasamin Brown and Laura Hall observed that the CDSS Accusation was not posted in a conspicuous place. Additionally, the Licensee had not provided notice to the responsible party for any of the residents nor for the local long-term care ombudsman. During this visit, the LPAs verified that the CDSS Accusation received by Licensee Ericka Tillis on 5/29/2025 was posted in a conspicuous place. 2 A-Type citations were issued during this visit (for additional details refer to 809-D). Exit interview conducted with Licensee and a copy of this report provided.
Other visitJune 9, 2025No deficiencies
Plain-language summary
Inspectors conducted an unannounced health and safety check on June 9, 2025 following a priority complaint and found no violations during their tour of the facility. The administrator was unaware that a copy of the complaint accusation needed to be posted at the facility and had notified five of eight residents' families about the complaint; she agreed to notify the remaining three families' representatives.
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On 6/9/2025 at 10:35am, Licensing Program Analysts (LPAs) L. Hall and Y. Brown arrived unannounced to conduct a health and safety check as a result of a priority 1 complaint. LPAs met with Licensee/Administrator, Ericka Tillis and informed her the reason for visit. LPAs toured facility including but not limited to resident's bedrooms, bathrooms, common area, kitchen, and outdoor area. LPAs observed one (1) resident upstairs bedroom and the other seven (7) residents downstairs in the common area. S1 stated she did receive the accusation via mail, but was not aware it had to be posted. S1 stated five (5) of the eight (8) residents have been notified. S1 also stated she will notify the other three (3) residents' responsible parties regarding the accusation. No deficiencies cited during visit. Exit interview conduct with Licensee/Administrator and a copy of this report provided.
Other visitMay 29, 2025Type A2 deficiencies
Plain-language summary
On May 29, 2025, state inspectors made an unannounced visit to the facility following a priority complaint and found that a staff member had not completed required fingerprint clearance, medications were left unlocked in the kitchen and refrigerator, and hot water temperature in a bathroom exceeded safe levels. The facility was issued a $500 civil penalty and must correct these violations or face additional penalties. The facility's food supplies, fire safety equipment, and smoke and carbon monoxide detectors were adequate.
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On 5/29/2025 at 2:00PM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown arrived unannounced to conduct a health and safety check as a result of a priority 1 complaint. LPAs met with Licensee/Administrator, Ericka Tillis and informed her the reason for visit. LPAs toured facility including but not limited to resident's bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 106.2 degrees F in a resident's bathroom sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Smoke and Carbon monoxide detectors observe. Fire extinguisher was observed to be full and last serviced on 3/7/2025. At 1:52PM, LPAs observed S1 is not fingerprint cleared after reviewing Guardian system. Civil penalty of $500 is being assessed. At 3:15PM, LPAs observed unlocked medication in the refrigerator and on the counter in the kitchen. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Ericka Tillis. A copy of this report, civil penalty, and appeal rights provided.
Regulation
Criminal Record Clearance. Obtain a California clearance or a criminal record exemption as required by the Department or...This requirement is not met as evidence by:
Inspector finding
Based on record review, licensee did not comply with the section cited above by not having S1 fingerprint cleared which poses an immediate health and safety risk to the persons in care.
Regulation
Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible ...This requirement is not met as evidence by:
Inspector finding
Based on record review, licensee did not comply with the section cited above by having unlocked medications which poses an immediate health and safety risk to the persons in care.
Other visitApril 14, 2025No deficiencies
Plain-language summary
On April 14, 2025, inspectors returned to the facility to verify that four deficiencies found during a previous case management visit on April 4 had been corrected. All four issues were confirmed to have been fixed during this follow-up visit. No new citations were issued.
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On 4/14/2025 at 1:30 PM, Licensing Program Analyst (LPAs) James Sampair and Yasamin Brown arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPAs stated the purpose of the visit to Licensee Ericka Tillis. On 4/4/2025, LPAs Sampair and Brown conducted a Case Management visit during which 4 deficiencies were cited. all 4 of the deficiencies were cleared during the visit. No citations were issued Exit interview conducted and a copy provided.
Other visitApril 4, 2025Type A4 deficiencies
Plain-language summary
During an unannounced inspection on April 4, 2025, inspectors found the facility operating beyond its licensed capacity and caring for residents who require mobility assistance in a facility licensed only for independent walkers; the facility also lacked a certified administrator and had unpaid fees. Inspectors also cited four additional violations during the visit and imposed a $500 penalty, with daily penalties continuing until the facility corrects these deficiencies. Basic safety equipment including fire extinguishers and smoke/carbon monoxide detectors were in proper working order.
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On 04/04/2025, at 2:30 PM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced to conduct a Case Management - Health Check inspection . Upon entering the facility, the LPAs explained the purpose of visit to Licensee Ericka Tillis. The LPAs toured the facility with the Licensee. The LPAs inspected both floors of the facility, including both of the kitchens, dining areas, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. Temperature in the upstairs kitchen was measured at 73.8 degrees Fahrenheit. Fire extinguisher was fully charged and last replaced on 02/11/2025. The combination carbon monoxide and smoke detector was fully operational. The facility remains over capacity, care of persons classified as non-ambulatory in a facility licensed to care for ambulatory only persons, unpaid annual and late fees, and absence of a certified administrator. In addition to the existing deficiencies listed above, 2 new Type-A and 2 new Type-B deficiencies, and a $500 Civil Penalty were issued during the visit (for details refer to LIC 809-D and LIC 421BG). The exit interview was conducted and a copy of this report provided. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to Community Care Licensing (CCL).
Regulation
87555 General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by:
Inspector finding
Based on observation, the Licensee did not have a one week supply of nonperishable and 2 days of perishable foods maintained on the premises, which poses a potential health risk to persons in care.
Regulation
87555 General Food Service Requirements (b)(21) Freezers of adequate size shall be maintained at a temperature of 0-degree F (-17.7 degree C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degree F. (4 degree C). They shall be kept clean, and food stored to enable adequate air circulation to maintain the above temper…
Inspector finding
The temperature of one of the freezers was 13.8 degrees and one of the refrigerators was 43.2 degrees Fahrenheit. All of the refrigerators and freezers were observed to be unclean.
Regulation
(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in a…
Inspector finding
Family member S1 living at the facility is 18 years old and did not have fingerprint clearance, which poses an immediate safety risk to persons in care.
Regulation
Incidental Medical and Dental Care (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. This requirement is not met as evi…
Inspector finding
With medications stored unlocked in the refrigerators, the licensee did not comply with the section above, which poses an immediate safety risk to persons in care.
Other visitFebruary 12, 2025No deficiencies
Inspector: James Sampair
Plain-language summary
On February 12, 2025, regulators conducted a follow-up visit to verify that the facility had corrected six deficiencies found during an earlier inspection on January 29, 2025—including operating over capacity, lacking a certified administrator, caring for non-ambulatory and dementia residents in a facility designed only for ambulatory residents, and failing to pay annual licensing fees from 2019 through 2024. The facility had not corrected these deficiencies by the required deadline, resulting in civil penalties of $7,800, with additional daily penalties continuing until the facility provides proof of correction. The facility remains subject to these ongoing penalties until it demonstrates that all violations have been resolved.
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On February 12, 2025 at 3:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPA stated the purpose of the visit to Licensee Ericka Tillis. On January 29, 2025, LPAs Clancy-Czuleger and Sampair conducted a Case Management visit during which 7 deficiencies were cited. 1 deficiency was cleared during the visit. 6 of the deficiencies were not cleared during the visit. Civil Penalties for deficiencies not cleared during visit: · Due 1/31/25 for CCR 87204(a): 14 days at $100 per day totals $1,400 – Over Capacity · Due 1/31/25 for CCR 87355(d): 12 days at $100 per day totals $1,200 – No Certified Administrator Present · Due 1/31/25 for CCR 87204(b): 14 days at $100 per day totals $1,400 – Care of Persons Classified as Non-Ambulatory in Ambulatory Only Facility · Due 1/31/25 for CCR 87705(c)(1): 14 days at $100 per day totals $1,400 – Care of Persons with Dementia in Ambulatory Only Facility · Due 1/31/25 for HSC 1569.185(a)(1): 12 days at $100 per day totals $1,200 – Payment of Annual Fees 2019-2024 · Due 1/31/25 for HSC 1569.185(b)(1)(F): 12 days at $100 per day totals $1,200 – Payment of Late Fees 2019-2024 Civil Penalties totaling $7,800 have been assessed today for failure to meet POC due dates for the deficiencies above. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to Community Care Licensing (CCL). Continued on LIC 809-C… 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 ...Continued from LIC 809 Deficiencies are cited from Title 22 California Code of Regulations (see 809D's). Failure to submit proof of correction along with the LIC9098 Proof of Correction by due date may result in additional civil penalty. Exit interview conducted. A copy of this report, appeal rights, and LIC 421FCs provided.
Other visitJanuary 29, 2025No deficiencies
Inspector: James Sampair
Plain-language summary
On January 29, 2025, state inspectors conducted a follow-up visit to verify that the facility had corrected three deficiencies found during a prior inspection on January 13, 2025: missing resident records, no emergency drill on file, and hot water temperature that was too hot at 133.7 degrees Fahrenheit. The facility had not corrected these problems by the required deadline, so the state assessed $3,400 in civil penalties and will continue charging daily penalties until the facility provides proof of correction. The facility was given information about its appeal rights.
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On 1/29/2025 at 10:30 AM, Licensing Program Analysts (LPAs) James Sampair and Jill Clancy-Czuleger arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPAs stated the purpose of the visit to Licensee Ericka Tillis. On 01/13/2025, LPA Sampair conducted a Case Management visit during which 4 deficiencies were cited. 1 deficiency was cleared during the visit. 3 of the deficiencies were not cleared during the visit: resident records missing, no emergency/disaster drill conducted, and the hot water temperature was measured at 133.7 degrees Fahrenheit. Civil Penalties for deficiencies not cleared during visit: Due 1/14/202 5 for 87303(e)(2) 16 x $100 per day = $1,600 Due 1/14/2025 for 87506(a) 16 x $100 per day = $1,600 Due 1/27/2025 for 1569.695(c) 2 x $100 per day = $200 Civil Penalties in the total amount of $3,400 have been assessed today for failure to meet POC due dates for the deficiencies above. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to CCL. Exit interview conducted. A copy of this report, appeal rights, and LIC 421FCs provided.
Other visitJanuary 29, 2025Type A1 deficiency
Inspector: Jill Clancy-Czuleger
Plain-language summary
On January 29, 2025, state licensing staff conducted an unannounced inspection as a follow-up to issues identified in November 2024, and found multiple violations: the facility has not paid annual licensing fees or late fees from 2019 through 2024, one staff member lacks a required administrator certificate, one staff member has not completed fingerprint clearance, and the facility is caring for residents with dementia and non-ambulatory residents despite being licensed only for ambulatory residents. The state issued civil penalties totaling $1,250 and required the facility to submit corrections by a specified deadline.
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On this day, January 29, 2025 at 10:40 am, Licensing Program Analysts (LPAs) J. Clancy-Czuleger and J. Sampair arrived unannounced to conduct case management inspection as part of monitoring plan from Non-compliance Conference held on November 07, 2024. LPA met with Licensee Erika Tillis, and informed the reason for visit. LPA toured the facility inside out. LPA inspected the living room, dining area, kitchen, bathrooms, residents rooms. LPA inspected the food supples and observed good for 2 days of perishables and 7 days of non-perishables. During the health and safety check, LPA observed a total of 3 staff members and 9 residents at the facility. The following deficiencies are observed: Annuals fees are outstanding for 2019, 2020, 2021, 2022, 2023 and 2024. Late fees have been assessed and are outstanding for 2019, 2021, 2022, 2023 and 2024. S1 does not have a valid Administrator Certificate S3 is not fingerprint cleared and associated to the facility Facility is caring for residents who are non-ambulatory Facility is caring for residents beyond the conditions and limitations specified on the license Facility is licensed for only ambulatory residents, but is caring for residents who are diagnosed with dementia Continued on 809-C... 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 ...Continued from 809 Deficiencies are cited from Title 22 California Code of Regulations (see 809D's). A $500.00 civil penalty is assessed for deficiency #87355(d). A $750 immediate civil penalty assessed for repeat citations 87204(b), 87705(c)(1) and 87204(a). Failure to submit proof of correction along with the LIC9098 Proof of Correction by due date may result in additional civil penalty. Exit interview conducted. Appeal Rights and a copy of this report provided.
Regulation
All individuals subject to criminal record review shall be fingerprinted... Criminal Record Statement... (3) The licensee shall submit these fingerprints... for the purpose of searching the records... prior to the individual's employment, residence, or initial presence in the facility.
Inspector finding
Based on record review the Licensee did not comply with the section cited above in having S3 fingerprinted before working at facility which poses a potential immediate health and safety risk to persons in care.
Other visitJanuary 13, 2025Type A2 deficiencies
Inspector: James Sampair
Plain-language summary
This was a monitoring inspection on January 13, 2025 following a previous non-compliance conference. Inspectors found that hot water in the upstairs kitchen measured 137.3 degrees Fahrenheit (which exceeds the safe limit) and that the fire extinguisher had not been serviced since October 2023; the facility also received civil penalties for repeat violations. Food supplies and dining room temperature were adequate.
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On 1/13/2025 at 8:15 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Case Management inspection as part of the monitoring plan from Non-compliance Conference held on November 07, 2024 with Licensee Ericka Tillis. Upon arrival, the LPA informed the Licensee of the reason for visit. The LPA inspected the interior and exterior of the facility, including the kitchens upstairs and downstairs, the dining room areas, community living spaces, restrooms, resident rooms, storage areas, the garage, and the grounds of the facility. There was more than the required minimum of 2 days of perishable and 7 days of nonperishable food at the facility. The hot water temperature was measured in the upstairs kitchen at 137.3 degrees Fahrenheit (Type-A Citation). The upstairs dining room temperature was measured at 70.0 degrees Fahrenheit. The fire extinguisher was last serviced on 10/30/2023 (Type-B Citation). LPA observed a total of 3 staff members and 9 residents at the facility. Continued on LIC 809-C 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 . . . Continued from LIC 809 1 Type-A and 3 Type-B deficiencies cited and 2 Civil Penalties for Repeat Violations for $250 each were issued during the visit. Deficiencies and plan and proof of corrections were discussed with the Licensee. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809-D. Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights, LIC 9098 Proof of Correction form, and copy of this report were provided.
Regulation
87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) … Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to … not less than 105 degree F … and not more than 120 degree F. This requirement is not met as evidenced by:
Inspector finding
Based on observation, the licensee did not comply with the section cited above. The hot water temperature was measured at 137.3 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.
Regulation
87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by:
Inspector finding
Based on observation, the licensee did not comply with the section cited above. The last time the fire extinguisher was serviced was 10/30/2023, beyond the annual inspection time limit, which poses a potential health, safety or personal rights risk to persons in care.
ComplaintJanuary 13, 2025· UnsubstantiatedNo deficiencies
Inspector: James Sampair
Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.
Plain-language summary
This was a complaint investigation into allegations that staff yelled at or spoke inappropriately to residents. Investigators interviewed five residents, family members, the administrator, and staff; three residents and both family members interviewed denied witnessing any yelling or inappropriate speech, and the administrator and staff denied the allegations. Based on the evidence gathered, the complaint was unsubstantiated and no violation was found.
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. . . Continued from LIC 809 Based on interviews conducted, 3 out of 5 residents denied observing staff yelling at residents. The Administrator and two staff interviewed denied yelling or speaking to residents inappropriately. The Licesee states that she takes care of a family member who has illness and needed to be picked up by an ambulance a few days before LPA visit. On 10/14/2024, LPA interviewed responsible persons for R5 and R6, residents with a dementia diagnosis. Both RPs denied witnessing or hearing staff yelling and/or speaking inappropriately to the residents. Based on interviews and record reviews conducted, the above allegations are unsubstantiated . Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. There was no deficiency associated with this complaint. A copy of this report was provided to the Licesee.
Other visitDecember 30, 2024No deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
An unannounced case management inspection was conducted on December 30, 2024, as part of follow-up monitoring from a November conference. The facility was toured throughout, food supplies were adequate, and staff and resident counts were verified; no violations were found.
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On this day, December 30, 2024 at 2:40 am, Licensing Program Analyst (LPA) Clancy-Czuleger arrived unannounced to conduct case management inspection as part of monitoring plan from Non-compliance Conference held on November 07, 2024. LPA met with Licensee Ericka Tillis, and informed the reason for visit. LPA toured the facility inside out. LPA inspected the living room, dining area, kitchen, bathrooms, residents rooms, front, side and backyard. LPA inspected the food supples and observed good for 2 days of perishables and 7 days of non-perishables. During the health and safety check, LPA observed a total of 2 staff members and 9 residents at the facility. LPA confirmed that residents were served notices. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
Other visitNovember 18, 2024No deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
An unannounced monitoring visit took place on November 18, 2024, following up on issues identified at a non-compliance conference earlier that month; the inspector toured the entire facility, checked food supplies, and observed 2 staff members and 9 residents present. No violations were found during the health and safety inspection.
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On this day, November 18, 2024 at 1:25 am, Licensing Program Analyst (LPA) Clancy-Czuleger arrived unannounced to conduct case management inspection as part of monitoring plan from Non-compliance Conference held on November 07, 2024. LPA met with Licensee Ericka Tillis, and informed the reason for visit. LPA toured the facility inside out. LPA inspected the living room, dining area, kitchen, bathrooms, residents rooms, front, side and backyard. LPA inspected the food supples and observed good for 2 days of perishables and 7 days of non-perishables. During the health and safety check, LPA observed a total of 2 staff members and 9 residents at the facility. LPA confirmed that residents were served notices. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
Other visitOctober 21, 2024Type B1 deficiency
Inspector: James Sampair
Plain-language summary
This was a follow-up inspection on October 21, 2024 to verify that the facility had corrected a previous violation about medication safety signage. The facility failed to provide documentation that corrections had been made, and inspectors found that required warning signs were still missing from the first and second floors where medications are stored, even though the medications themselves were properly locked up. The facility was assessed a $1,100 civil penalty for repeating this violation.
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On 10/21/2024 at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Ardalan Gharachorloo conducted a Plan of Correction (POC) inspection. Upon entry into facility, LPAs explained the purpose of the visit to Licensee Ericka Tillis. The Licensee failed to send documentation of POC clearance from the citation issued 10/10/2024 to LPA Sampair. During the inspection of the facility, the medications were in locked storage, however, the signage on the first and second floors was not posted. Per Title 22 California Code of Regulations, a $1,100.00 Civil Penalty was assessed for the repeat of a prior violation of Section 87309(b) first issued on 9/24/2024 that was due on 10/11/2024. For additional details, refer to the LIC 421FC form. Failure to submit proof of corrections may result in additional civil penalties. Exit interview conducted, a copy of this report, and the appeal rights were provided.
Regulation
87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by:
Inspector finding
Based on observation, the licensee did not comply with the section cited above. A toilet seat had a large crack, which poses a potential health, safety or personal rights risk to persons in care.
Other visitOctober 21, 2024Type B1 deficiency
Inspector: James Sampair
Plain-language summary
During a case management visit on October 21, 2024, inspectors found that five residents living at this facility were actually registered residents of a different facility (Heart & Soul Communities). The facility received one citation for this deficiency and was instructed to submit a correction plan.
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On 10/21/2024 at 8:30 AM, Licensing Program Analysts (LPAs) James Sampair and Ardalan Gharachorloo conducted a Case Management visit of the facility. The LPAs observed that residents R7 through R11 were living at this facility, though they are residents of Heart & Soul Communities #015601242. 1 Type-B citation issued during the inspection. Deficiencies are cited per Title 22 California Code of Regulations as listed on the LIC 809-Ds. Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties. Exit interview conducted, 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. This requirement is not met as evidenced by:
Inspector finding
During the record review, the Licensee had no records available for the LPAs to review for residents R7 through R11, which poses a potential health, safety or personal rights risk to persons in care.
Other visitOctober 10, 2024Type A3 deficiencies
Inspector: James Sampair
Plain-language summary
On October 10, 2024, state inspectors conducted an unannounced inspection and found one serious violation and two other violations related to case management at the facility. The facility was assessed a $250 penalty for repeating a prior violation and a $500 penalty for a serious violation involving resident care planning or documentation. The facility must submit proof of correcting these violations or face additional penalties.
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On 10/10/2024 at 8:30 AM, Licensing Program Analysts (LPAs) James Sampair and Jill Clancy-Czuleger arrived unannounced to conduct a Case Management – Deficiencies inspection of the facility. Upon entry the LPAs informed Licensee Ericka Tillis of the reason for the visit. 1 Type-A and 2 Type-B citations issued during the inspection. Deficiencies are cited per Title 22 California Code of Regulations as listed on the LIC 809-Ds. $250.00 Civil Penalty assessed for repeat violation of Section 87309(b). $500.00 Immediate Civil Penalty assessed for serious violation of Section 87204(b). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties. Exit interview conducted, a copy of this report, and the appeal rights were provided.
Regulation
(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. This requirement is not met as evidenced by:
Inspector finding
On 10/7/2024, LPAs Sampair and Doidge observed medications in an open and not locking container on cabinet in 2nd floor dining room, which posed an immediate health, safety or personal rights risk to persons in care.
Regulation
Limitations - Capacity and Ambulatory Status (b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement is not met as evidenced by:
Inspector finding
On 9/24/2024, a review of the records revealed that the facility licensed for all ambulatory residents, but 5 of 6 residents currently living in the facility are nonambulatory, which poses a potential health, safety or personal rights risk to persons in care.
Regulation
Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (1) The facility has a nonambulatory fire clearance for each room that will be used to accommodate a resident with dementia who is unable to or unlikely to respond either physically or mentally to oral instructi…
Inspector finding
On 9/24/2024, a review of the records revealed that 4 of 6 residents are diagnosed with dementia, but the facility is licensed for only ambulatory residents, which poses a potential health, safety or personal rights risk to persons in care.
Other visitOctober 10, 2024Type A2 deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
This was a case management inspection conducted on October 10, 2024. Inspectors found that cleaning chemicals and other toxic substances were stored under kitchen and bathroom sinks in unlocked cabinets where residents could access them, and cited the facility for this violation and a repeat violation of the same issue. The facility was assessed a $250 civil penalty for each violation.
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On 10/10/2024 at 08:30 AM Licensing Program Analysts (LPA) J. Clancy-Czuleger and J. Sampair arrived unannounced to conduct a Case Management. LPA met with Ericka Tillis, Administrator. While at the facility on 10/07/2024 LPA J. Sampair observed that there were 11 residents in the care facility. S1 stated that only 6 were residents of this home and the other 5 were residents for the other home Heart and Sol Communities (15601242) that's located at 3770 Sutter st. Oakland. When arriving at the facility on 10/10/2024 LPA's were informed by staff that they had 7 residents. It was also observed that there were chemicals left under the upstairs kitchen sink and bathroom sink unlocked and accessible to residents. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809D's. A $250.00 civil penalty is assessed for each of the repeat violation of deficiency section #'s 87204(a) and 87309(a) . Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties. Exit interview conducted. Appeal Rights, LIC421FC, and copy of this report provided.
Regulation
A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time... This requirement is not met as evidenced by…
Inspector finding
On 10/07/2024 LPA's observed 6 residents, and 5 visiting residents at the care facility being cared for. On 10/10/2024 LPA's were informed that there are 7 residents.
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. This requirement is not met as evidenced by…
Inspector finding
On 10/07/2025 LPAs's observed chemicals left unlocked and accessible under the upstairs kitchen sink and bathroom sink.
InspectionOctober 7, 2024No deficiencies
Inspector: James Sampair
Plain-language summary
During a follow-up inspection on October 7, 2024, the facility failed to provide documentation showing it had corrected three of five violations found during a previous inspection in September. The facility was issued three civil penalties for not submitting proof of correction to the licensing agency as required.
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On 10/7/2024 at 1:30 PM, Licensing Program Analysts (LPAs) James Sampair and David Doidge conducted a Plan of Correction (POC) inspection. Upon entry into facility, LPAs explained the purpose of the visit to Caregiver Keiyata Pettway. The Licensee failed to provide documentation to LPA Sampair on 3 of the 5 citations issued during the 9/24/2024 visit. Failure to send proof of correction to the LPA resulted in the issue of 3 civil penalties (for details, refer to the LIC 421FC forms). Exit interview conducted and appeal rights provided.
Other visitSeptember 24, 2024Type A5 deficiencies
Inspector: David Doidge
Plain-language summary
A required annual inspection was conducted on September 24, 2024, and found that the facility met standards for safety features including working smoke and carbon monoxide detectors, properly installed grab bars, adequate lighting, and secure medication storage. The inspection identified 3 Type A violations and 2 Type B violations, and the administrator was required to provide documentation including emergency disaster plans and insurance certificates by October 1, 2024. The facility's physical conditions, food supplies, and staffing levels met regulatory requirements.
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On 9/24/2024 at 10:00 AM, Licensing Program Analysts (LPAs) David Doidge and James Sampair arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs stated the purpose of the visit to Ericka Tillis, Administrator/Licensee.. LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, activity rooms, kitchen, common areas, and outdoor areas. Centrally stored medications were locked in medication room. Smoke detectors and carbon monoxide detectors were observed and in working condition. Fire extinguishers were observed to be full and last serviced on 10/30/2024. Temperature in the facility was measured at 82. degrees Fahrenheit at 4:00 PM. Water temperature is 148 degrees Fahrenheit at 11:11 AM. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. Grab bars for each toilet and shower were installed. Non-skid mats were observed. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. Indoor and outdoor passages were free of obstruction. One week of nonperishable and 2 days of perishable food supplies were available. 3 A- and 2 B-type citations issued. Continued on LIC 809-C 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 Continued from LIC 809 Administrator will provide the following documents by 10/1/2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Exit interview conducted and a copy of this report provided.
Regulation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 degre…
Inspector finding
Based on observation the licensee did not comply with the section cited above as water temperature was 147.3 degrees, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 09/25/2024 Plan of Correction 1 2 3 4 Reduce tempurature and send proof to LPA Sampair that water tempurature has been reduced to 105 to 120 range.
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, the licensee did not comply with the section cited above as Raid and other cleaning solutions were found in unlocked pantry kitchen and bathroom, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 09/25/2024 Plan of Correction 1 2 3 4 Cleared during visit
Regulation
(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above.
Inspector finding
Based on observation, the licensee did not comply with the section cited above as medications found in unlocked storage in kitchen which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 09/25/2024 Plan of Correction 1 2 3 4 Cleared during inspectionn
Regulation
(f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof.
Inspector finding
Based on observation, the licensee did not comply with the section cited above as there were no lids found on trashbins which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/01/2024 Plan of Correction 1 2 3 4 replace trash bins those that have lids and send proof to LPA Sampair.
Regulation
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (…
Inspector finding
Based on observation, the licensee did not comply with the section cited above as Complaint Poster, Personal Rights posters, and the Theft and Loss Policy were not posted. which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/01/2024 Plan of Correction 1 2 3 4 Post required posters and send proof to LPA Sampair
ComplaintSeptember 10, 2024· MixedType A3 deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
A complaint investigation found that a resident fell and died in 2018, but the facility no longer had records from that time and there was insufficient evidence to substantiate or disprove the allegation. However, inspectors did find a substantiated violation: a potato eaten by a rodent was observed in the kitchen, indicating a pest control problem in the food service area.
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...Continued from 9099A On the allegation Resident fell sustaining injuries resulting in death due to staff neglect. The incident happened in 2018, and the facility no longer has the documentation for this resident. S1 stated that they are only required to keep resident records for three years after a resident passed, so they no longer have R2 documents. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided. 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 ...Continued from 9099 On the allegation Staff are not providing adequate food service to residents. It was observed that there was a potato that had been eaten by a rodent in the kitchen. Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22 has been cited. Exit interview conducted. A copy appeal rights, and this report provided
Regulation
The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by
Inspector finding
R1 AWOLing from the facility on 5/14/24 and no devices were in place at tht time.
Regulation
(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.This requirement is not met as evidenced by
Inspector finding
It was observed that there was a potato that had been eaten by a rodent in the kitchen.
Regulation
A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time... This requirement is not met as evidenced by…
Inspector finding
LPA observed 6 residents, and 3 visiting residents at the care facility being cared for.
Other visitSeptember 10, 2024Type B2 deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
During a complaint investigation in September 2024, inspectors found chemical cleaner left accessible in a bathroom and a rope tied to a door in the residents' living room. These conditions posed potential safety risks and were cited as violations of California regulations. The facility was notified of the findings and given the opportunity to correct them or appeal.
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While LPA J. Clancy-Czuleger conducted a complaint investigation (15-AS-20240514153218) on 09/10/2024, LPA observed the following: Chemical cleaner left out in the bathroom A rope that was tied a door closed in the residents living room The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.
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.This requirement is not met as evidenced by…
Inspector finding
405 chemical cleaner left out in upstairs bathroom.
Regulation
the licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement was not met as evidenced by
Inspector finding
a rope tying the door in the residents living room.
InspectionMay 16, 2024No deficiencies
Inspector: Jill Clancy-Czuleger
Plain-language summary
An inspector made an unannounced visit on May 16, 2024, in response to a priority complaint and found no violations. The facility appeared clean and safe, with residents comfortable and engaged in daily activities like eating breakfast and relaxing in common areas.
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On 05/16/24 at 9:30AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Health and Safety check due to the department receiving a priority 1 complaint. During the health and safety check, LPA observed a total of 4 staff members and 6 residents at the facility and 3 visitors. LPA toured facility with Licensee, including but not limited to bedrooms, kitchen, dining rooms, bathroom, and common areas. LPA observed residents comfortable in their surroundings, eating their breakfast meals and relaxing in common area. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
InspectionOctober 31, 2023No deficiencies
Inspector: Gregory Clark
Plain-language summary
An unannounced annual inspection was conducted on October 31, 2023, and found no violations. The inspector verified that the facility properly maintained safe conditions, including adequate lighting and temperature, working fire and smoke detectors, secure medication storage, and appropriate food supplies, and confirmed that all resident and staff records were complete.
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On 10/31/23 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Ericka Tillis and explained the purpose of the visit. The facility’s fire clearance was approved for 6 ambulatory clients. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms of which 3 bedrooms are occupied by the residents and 3 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the kitchen sink was measured at 106 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 10/30/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 5/15/23. LPA reviewed 5 residents records and 5 staff records and all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
ComplaintAugust 30, 2023· UnsubstantiatedNo deficiencies
Inspector: Gregory Clark
Unsubstantiated — the California Department of Social Services (CDSS) investigated and did not find a violation.
Plain-language summary
A complaint alleged that the facility improperly admitted a resident with a colostomy without approval, failed to provide documents to her family, did not follow her care plan regarding diet, and delayed seeking medical care. The investigation found no evidence to support these allegations; medical records showed the facility brought the resident to the emergency department promptly when she developed decreased appetite and vomiting in October 2020, leading to diagnosis of a urinary tract infection and later a bowel obstruction, after which she was transferred to a hospital and then a skilled nursing facility where she died. All complaints were found unsubstantiated.
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Facility accepted a resident with restricted health condition without department approval. R1 had a colostomy upon admission. Physician’s Report dated 2/19/2020 stated that R1 is capable of caring for her colostomy and only needed help ordering supplies. Per Title 22, Division 6 Chapter 8 Article 11. Health-Related Services and Conditions 87621 this is NOT considered a restricted health condition. Facility did not provide documents to responsible party. During R1’s time at the facility her guardianship was with Alameda County. The guardianship was terminated 1 year after R1’s death. The facility is awaiting instructions from the county as to what, if any, documents the facility can share with the RP. Facility staff did not seek medical attention in a timely manner for resident in care. Documents received from the RP and the facility show that R1 received routine medical attention in a timely manner. On 10/05/2020 R1 was taken to the emergency department of Sutter Health by facility staff due to concerns that R1’s appetite had decreased and there were several instances of vomiting. R1 was diagnosed with a UTI and discharged back to the facility. Facility staff noticed no improvement in R1’s condition after the round of antibiotics for the UTI was completed. Facility staff brought R1 back to the emergency department on 10/10/2020. R1 was then diagnosed with a bowel obstruction. R1 was admitted to the hospital and later discharged to a SNF on 11/11/2020 where she passed away on 11/18/2020. This agency has investigated the complaints alleging: facility did not follow care plan- Special diet was not given, facility accepted a resident with restricted health condition without department approval, facility did not provide documents to responsible party and facility staff did not seek medical attention in a timely manner for resident in care. We have found that the complaints are UNSUBSTANTIATED . Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted, a copy of this reported provided.
ComplaintDecember 1, 2021· MixedNo deficiencies
Inspector: Laura Hall
Mixed — CDSS found some allegations substantiated and others unsubstantiated during this investigation.
Plain-language summary
An investigator looked into a complaint at this facility but found insufficient evidence to determine whether the alleged problem actually occurred. The complaint remains unsubstantiated, meaning it could not be proven or disproven based on the evidence gathered.
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Continued from LIC9099. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided.
ComplaintSeptember 22, 2021Type A2 deficiencies
Inspector: Lizette Francisco
Plain-language summary
This was an unannounced infection control inspection on September 22, 2021. Inspectors found the facility had adequate food supplies, appropriate hand washing and social distancing materials, staff wearing proper protective equipment, and a sufficient supply of protective equipment on hand. Deficiencies were noted related to resident care documentation and a civil penalty of $1,000 was assessed.
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On 09/22/2021 at 12:30pm, Licensing Program Analysts (LPAs) L. Francisco and L. Hall arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs met with Care Staff, Gwen Green. Administrator/Licensee, Ericka Tillis later arrived at 1:00pm. During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and outdoor area. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. The following deficiencies were observed: -At 12:55pm, LPAs observed 9 residents at the facility. -At 2:00pm during record review of R1's physician's report, LPAs observed R1 is non-ambulatory The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate $1,000 civil penalty is being assessed. Exit interview conducted. Appeal Rights and a copy of this report provided.
Regulation
(a) A license shall be issued for a specific capacity which shall be the maximum number of residents which can be provided care at any given time. The capacity shall be exclusive of any members of the licensee's own family who reside at the facility. However, the licensing agency shall consider the presence of other family members or other person…
Inspector finding
Based on observation and interview, the licensee did not comply with the section cited above. LPAs observed 9 residents at facility. S1 stated 3 residents are from S1's other licensed facility and stays at this facility during the day which poses an immediate health, safety to persons in care. POC Due Date: 09/23/2021 Plan of Correction 1 2 3 4 By POC date, Administrator agrees to review regulation and send self-certification letter to CCL. An immediate $500 Civil Penalty is being assessed.
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 …
Inspector finding
Based on record review of R1's physician's report, the licensee did not comply with the section cited above. LPA observed R1 is non-ambulatory which poses an immediate health, safety risk to persons in care. POC Due Date: 09/23/2021 Plan of Correction 1 2 3 4 By POC date, Administrator agrees to submit a LIC 200 and floor plan to CCL. An immediate $500 civil penalty is being assessed.
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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