Emerald Residential Care Home
RCFE
A Residential Care Facility for the Elderly (RCFE) is a non-medical residential care home licensed by California CDSS under Health & Safety Code §1560. Residents receive assistance with daily living activities such as bathing, dressing, meals, and medication management in a home-like setting. RCFEs are not hospitals or skilled nursing facilities — they do not provide round-the-clock medical care.
1749 Newbridge Avenue · San Mateo, 94401
Quick facts
Quality snapshot
Updated April 25, 2026Compared to 214 California RCFE facilities of similar size, over the last 36 months.
Source: California Department of Social Services, Community Care Licensing Division. View raw inspection records →
Quality grade· click to show how this was calculated
Severity2thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency16thDeficiencies 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
Emerald Residential Care Home scores D. Better than 39% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 2%. Repeats: top 0%. Frequency: bottom 16%.
Each metric is converted to a 0–100 percentile within the peer set (higher = better). The composite grade averages all four. Peer set: CA / rcfe_general / small beds (214 facilities).
Citation severity over time
↑ worseningWeighted severity score per month · 24 months
Weighted score (24mo)
159
Last citation
Feb 26
Finding distribution
27 total · 36 monthsScope × Severity (CMS A–L)
The rules that apply to this facility
California Title 22 requirements for this facility, with the specific regulation and a suggested question for each.
What training are all staff required to complete?22 CCR §87411
All direct-care staff must complete:
- 10 hours initial training within the first four weeks of employment.
- 4 hours annual in-service every year thereafter.
- Administrator certificate from a CDSS-approved program — 80 hours for first-time, 40 hours renewal every 2 years.
Ask on tour: Ask when the last staff training was completed and how it's tracked.
How many staff must be on duty overnight?22 CCR §87415
Based on 6 licensed beds:
One qualified staff member must be on call and physically on premises at all times overnight.
Violation pattern to watch for:A facility that documents a staff member as "on call" but with that person physically off-site — when the law requires on-premises presence — is in violation of this section.
Ask on tour: Ask the facility to walk you through their overnight staffing plan and confirm whether on-call staff are on premises or off-site.
What health conditions can this facility legally accept or refuse?22 CCR §87612–87615
Restricted — allowed with physician order + care plan
- Supplemental oxygen
- Insulin and injectable medications
- Indwelling or intermittent catheters
- Colostomy / ileostomy
- Stage 1 and Stage 2 pressure injuries
- Wound care (non-complex)
- Incontinence
- Contractures
Prohibited — facility must refuse or discharge
- Stage 3 or Stage 4 pressure injuries
- Feeding tubes (PEG, NG, or J-tube)
- Tracheostomies
- Active MRSA or communicable infections requiring isolation
- 24-hour skilled nursing needs
- Total ADL dependence with inability to communicate needs
A hospice waiver (HSC §1569.73) can allow continued care for residents on hospice who would otherwise fall into a prohibited category.
Ask on tour: Ask whether your loved one's specific care needs are restricted or prohibited, and what the facility's process is if needs change after admission.
What must this facility report to the state — and how fast?22 CCR §87211 / WIC §15630
- ImmediateElopement, fire, epidemic outbreak, or poisoningImmediately
- 2 hoursAbuse with serious bodily injury2-hour phone report + 2-hour written report — to the California Department of Social Services (CDSS), Adult Protective Services, and law enforcement
- 24 hrsAbuse without serious bodily injuryWithin 24 hours
- Next dayDeath of a residentPhone by next working day; written within 7 days
- Next dayInjury requiring medical treatment beyond first aidPhone by next working day; written within 7 days
- WrittenBankruptcy, foreclosure, eviction, or utility shutoff noticeWritten notice to CDSS and residents — $100/day penalty (max $2,000) for failure
Your enforcement lever:Incidents that aren't reported on time are themselves a separate violation. If you believe a reportable event wasn't filed, you can submit a complaint directly to the California Department of Social Services (CDSS).
How does CDSS enforce these rules?22 CCR §87755–87777 / HSC §1569.58
- 1Notice of DeficiencyWritten citation with a correction deadline. Facility must submit a Plan of Correction.
- 2Civil PenaltyStarts at $50/day for non-serious; $150/day for serious deficiencies — immediately, with no grace period. Repeats escalate to $150 first day + $50/day, then $1,000 first day + $100/day.
- 3Suspension of AdmissionsFacility cannot accept new residents until violations are corrected.
- 4Temporary Suspension or RevocationEmergency suspension for imminent danger; full revocation after administrative hearing.
- 5Exclusion OrderAdministrator and operator can be barred from all CDSS-licensed facilities — not just this one.
See how these rules have been applied to this specific facility:
View state inspection record and citationsState records
California Dept. of Social Services · Community Care Licensing- License number
- 415600823
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Emerald Residential Care Home, Inc.
Inspections & citations
9
reports on file
27
total deficiencies
14
Type A (actual harm)
Other visitFebruary 25, 2026Type A11 deficiencies
Plain-language summary
An inspector visited this six-bedroom facility to review its operations, staffing, and records. The facility met standards for physical safety, including grab bars in bathrooms, appropriate water temperature, and a secure outdoor area, and the inspector confirmed that staff criminal clearances and client files were in order. The facility must submit several updated forms to the state by March 11, 2026, and there are regulatory deficiencies noted in the detailed inspection report.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, consisting of 6 private client bedrooms--2 of which have exit doors to outside, and 3 of which have private full bathrooms. There is a common bathroom, living room, dining room, and kitchen. Backyard is level and fenced, and there is a detached storage shed. There are 3 staff and 4 clients present. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 115 degrees in common bathroom. Washer and dryer are located in detached 2-car garage. Food supply and first-aid kit are inspected. All client files are reviewed, including Centrally Stored Medications Records and clients' cash handling records. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as other staff records. Isabelle Gil is a certified RCFE administrator (x 6/26) that oversees facility operations, as well as assistant administrators Michelle Carino-Becerra (x 5/26) and Kristine Tan (x 12/27) The following forms/information are requested to be completed and returned to CCL by 3/11/26: • LIC 400 Affidavit regarding Client Cash Resources • LIC 308 Designation of Administrative Responsibility Updated Personnel Report (LIC500), proof of current liability insurance and surety bonding are given to LPA. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--3 pages.
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, the licensee did not comply with the section cited above, as Ajax cleanser is stored in common bathroom, Comet cleanser stored in bathroom of client #1, and Comet cleanser and liquid Fabuloso stored in bathroom of client #4, accessible to clients, who are present. This poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 02/25/2026 Plan of Correction 1 2 3 4 Cleansers were relocated to locked storage cabinet in LPA's presence. Def…
Regulation
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permi…
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above in 1 out of 5 staff files reviewed, which poses an immediate health, safety or personal rights risk to persons in care. - Criminal record clearance for Staff #3 is not associated to this facility, and needs to be transferred. POC Due Date: 02/26/2026 Plan of Correction 1 2 3 4 Criminal record clearance of staff #3 will be transferred to this facility and proof of correction to be sent to CCLD BY DUE DATE.
Regulation
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
Inspector finding
Based on observation during facility tour, the licensee did not comply with the section cited above, as Albuterol and Claritin are stored in dresser in room of client #1, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 02/25/2026 Plan of Correction 1 2 3 4 Claritin and Albuterol were removed from room of client #1 and stored in locked medications cabinet. Deficiency corrected and cleared.
Regulation
PERSONAL RIGHTS In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have ...personal rights...to have a reasonable level of personal privacy in accommodations,
Inspector finding
Based on observation, the licensee did not comply with the section cited above, as 2 staff are observed preparing to eat lunch in bedroom of client #2, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 02/26/2026 Plan of Correction 1 2 3 4 Bedrooms of clients shall not be used by staff for personal use. Plan of correction to be sent to CCLD BY DUE DATE.
Regulation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
Inspector finding
Based on observation, the licensee did not comply with the section cited above, as wooden hand rail outside of kitchen exit to driveway is broken, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 Wooden hand railing will be repaired or replaced, and proof of correction to be sent to CCLD BY DUE DATE
Regulation
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after e…
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above in 3 out of 5 staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care. - Health screenings are not maintained for staff #2, #3, #5, and TB test result is needed for staff #3, who was employed in 2020. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 Health screenings and/or TB test results for Staff #2, #3, #5 will be sent to CCLD BY DUE DATE.
Regulation
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, …
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above in 2 out of 5 records reviewed, which poses a potential health, safety or personal rights risk to persons in care. - There is no evidence of required training for staff #2 and #5, who started working in August 2025. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 Staff #2 and #5 will received required 40 hours of training, and proof of correction to be sent to CCLD BY DUE DATE.
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 staff record review, the licensee did not comply with the section cited above in 1 out of 5 staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care. - There is no evidence that Staff #3 has received annual training, including 8 hours of dementia training and 4 hours of training restricted health conditions, postural supports and hospice care. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 Proof that staff #3 received required annua…
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 staff record review, the licensee did not comply with the section cited above in 3 out of 3 medications staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care. - Medications staff #6, #7, #8 have not had annual medication training. Last training was in 2024. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4
Regulation
(a) A licensee of a facility that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for resident use.
Inspector finding
Based on observation, the licensee did not comply with the section cited above, as there is no internet capable device for client use only, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 An internet capable device for client use only will be maintained and available for clients. Proof of correction to be sent to CCLD BY DUE DATE
Regulation
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.
Inspector finding
Based on client records review, the licensee did not comply with the section cited above in 2 out of 5 client files reviewed, which poses a potential health, safety or personal rights risk to persons in care. Medical assessments for clients #3 and #5 are not signed and identified by a physician. POC Due Date: 03/11/2026 Plan of Correction 1 2 3 4 MD reports for clients #3 and #5 signed by physicians will be sent to CCLD by DUE DATE
Other visitMarch 26, 2025No deficiencies
Plain-language summary
This was a follow-up visit on March 10, 2025, to check that the facility had fixed problems found in earlier inspections. The facility corrected three issues: water temperature in bathrooms was brought to a safe level, records for residents' personal money were updated and made accurate, and emergency drill documentation was submitted to the state.
View full inspector notes
LPA Jeung met with administrator and staff to monitor corrections made as per citations and civil penalties issued on 2/25/25, 2/27/25, and 3/4/25. Proof of corrections was submitted to CCLD on 3/10/25. The following corrections have been made: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 117 degrees in client bathroom -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/5/25 - 3/9/25 at $100/day Section 87217(g)(1) Safeguards for Resident Cash - Records for clients' P & I monies has been modified and is current and accurate -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/4/25 - 3/9/25 Health and Safety Code 1569.695 - Copies of emergency disaster drills dated 1/2024, 7/2024, 10/24/ 1/2025 submitted to CCLD -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/4/25 - 3/9/25 *****Due to technical difficulties, this Facility Evaluation Report and associated 3 Civil Penalty Assessments cannot be printed. LPA to deliver reports at a later date or via email.****
Other visitMarch 4, 2025No deficiencies
Inspector: Audrey Jeung
Plain-language summary
During a follow-up inspection, staff found that three deficiencies from earlier citations in February 2025 still had not been corrected: the hot water in a client bathroom remained at 125 degrees (too hot), the facility had not submitted a plan to properly track and maintain clients' personal money, and the facility had not submitted a plan to conduct quarterly emergency drills. The facility is being assessed daily civil penalties until these issues are fixed and the state is notified of the corrections.
View full inspector notes
LPA Jeung monitored corrections of deficiencies cited on 2/27/25--for which plans/proof of corrections were due on 2/28/25--and 2/25/25--for which civil penalties were assessed. The following deficiency, which was cited on 2/25/25, still exists: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 125 degrees in client bathroom -- Civil penalty of $100/day continues to accrue daily until deficiency is corrected and CCLD is notified -- Civil penalty of $600 is assessed today for period 2/27/25 - 3/4/25 The following deficiencies, which were cited on 2/27/25, still exist: Section 87217(g)(1) Safeguards for Resident Cash - Plan of correction for plan to maintain clients' P & I monies current and accurate was not submitted -- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified -- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25 Health and Safety Code 1569.695 - Plan of correction for implementation of quarterly emergency disaster drills was not submitted -- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified -- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25
Other visitMarch 4, 2025Type A1 deficiency
Inspector: Audrey Jeung
Plain-language summary
This was a follow-up visit to verify corrections to a previously cited violation related to how the facility safeguards residents' money. The inspector confirmed that the facility's records were corrected to accurately reflect a resident's mobility status, and the facility was asked to provide a signed lease addendum from the landlord.
View full inspector notes
During plan of correction visit, LPA Jeung observed deficiency of the California Code of Regulations, Title 22. Citation appears on a following page. Information about safeguarding of clients' cash resources is provided to administrator. In addition, LIC200 is corrected in LPA's presence to accurately reflect requested change from non-ambulatory to one bedridden client. Licensee is also requested to submit lease addendum--signed and dated by landlord. Acknowledgement of a correction is issued--1 page. .
Regulation
PERSONAL RIGHTS Residents in all RCFEs shall have the right... to have access to individual storage space for private use. This requirement is not met, as personal belongings of staff--clothing, suitcases, purse, plastic bags--are stored in room of client #4, adjacent to dining room.
Inspector finding
Licensee failed to ensure that clients have their own personal storage space, which poses an immediate personal rights risk to clients in care.
Other visitFebruary 27, 2025No deficiencies
Inspector: Audrey Jeung
Plain-language summary
During a follow-up inspection on February 26, 2025, the facility was found to still have two problems from an earlier annual inspection: hot water temperature was measured at 102 degrees (below safe levels) and video baby monitors were being used in residents' rooms. The facility removed the video monitors during the inspection, but the hot water issue remained uncorrected; the facility was assessed $100 penalties for each violation and will face additional daily penalties until both are fixed.
View full inspector notes
LPA Jeung reviewed corrections of deficiencies cited on 2/25/25 during annual inspection. Acknowledgement of corrections made on 2/26/25 are given to Ms. Gil--2 pages. The following Type A deficiencies still exist, as corrections were not made by 2/26/25: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 102 degrees -- Civil penalty of $100 is assessed today for failure to correct deficiency by 2/26/25 --- Civil penalty of $100/day to be assessed until deficiency is corrected and CCLD is notified Section 87468.1(a)(1) Personal Rights - Video baby monitors are still in use upon LPA's arrival today - Video cameras and baby monitors are removed in LPA's presence -- Civil penalty of $100 is assessed today for failure to correct deficiency by 2/26/25
InspectionFebruary 27, 2025Type A7 deficiencies
Inspector: Audrey Jeung
Plain-language summary
This was a routine annual inspection conducted on February 25, 2025, where an inspector reviewed medication records and money handling practices for three residents. Deficiencies were found in how the facility manages medications and resident funds according to California regulations.
View full inspector notes
To complete annual inspection of 2/25/25, LPA Jeung reviewed clients' Centrally Stored Medication Records and personal and incidental money handling for 3 clients. Deficiencies of the California Code of Regulations, Title 22 are cited on a following page.
Regulation
GENERAL FOOD SERVICE 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 there are no canned fruits maintained and minimal fresh
Inspector finding
vegetables for 2 day supply. Licensee failed to maintain 7-day supply of canned food and 2-day supply of fresh vegetables, which poses a potential health and safety risk to clients in care. Minimal amount of broccoli crowns and lettuce and frozen mixed vegetables observed.
Regulation
MEDICAL ASSESSMENT Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a MD assessment, signed by a licensed medical professional... and made within the last year, to be kept in the resident's record.
Inspector finding
This requirement is not met, as there are no MD reports and/or TB test results on file for 3 out of 5 clients. Licensee failed to ensure that MD reports and/or TB test results are maintained for all clients, which poses a potential health, safety or personal rights risk. No MD report/TB test results for C1, C3,C5.
Regulation
RESIDENT RECORDS 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 was not met, as 1 out of 5
Inspector finding
client file is not available for review. Licensee failed to ensure that all client records are made available for licensing agency review, which poses a potential health, safety or personal rights risk to clients in care. File for client #5 is not available.
Regulation
REAPPRAISALS The pre-admission appraisal, as specified in Section 87457... 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.
Inspector finding
This requirement is not met, as there is no current appraisal or IPP for client #4, who was admitted 8/2022. Licensee failed to ensure that updated appraisals are maintained for cll clients, which poses a potential health, safety or personal rights risk to client in care
Regulation
PERSONNEL RECORDS The licensee shall ensure that personnel records are maintained on...each employee.... contain the following info: Employee's full name, Social Security #, date of employment, written verification that the employee is at least 18 years of age...home address and phone number,
Inspector finding
educational background, past experience, including types of employment and former employers, type of position for which employed. This requirment was not met, as job applications are not maintained for 2 out of 7 staff, which poses a potential health or safety risk. No job applications for S4 & S7.
Regulation
INCIDENTAL MEDICAL CARE A record of centrally stored Rx medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration,
Inspector finding
prescription number and instructions. This requirement was not met, as meds for client #3 and Senna 12/14/24 for client #2 are not recorded on Centrally Stored Medication Record, which poses a potential health, safety or personal rights risk.
Regulation
SAFEGUARDS FOR RESIDENT CASH Each licensee shall maintain adequate safeguards and accurate records of cash resources & valuables entrusted to his care, including....records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns
Inspector finding
for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement is not met, as P & I records & cash for C2 and C5 are not accurate& staff were unable to describe cash handling procedure & recordkeeping.
InspectionFebruary 25, 2025Type A6 deficiencies
Inspector: Audrey Jeung
Plain-language summary
During a routine inspection on an unspecified date, the inspector toured the 6-bedroom facility and found the building, grounds, bathrooms, and safety equipment in acceptable condition; staff criminal clearances were verified and files were reviewed. The facility was asked to submit several required administrative forms and documentation by March 11, 2025, and to pay the annual license renewal fee of $1,237. The inspector noted that deficiencies were observed and will be cited in a separate section of the report.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, consisting of 6 private client bedrooms--2 of which have exit doors to outside, and 3 of which have private full bathrooms. There is a common bathroom, living room, dining room, and kitchen. Backyard is level and fenced, and there is a detached storage shed. There are 3 staff present. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested. Food supply and first-aid kit are inspected. All client files are reviewed. Centrally Stored Medications Records and clients' cash handling records will be reviewed at a later date. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as other staff records. Isabelle Gil is a certified RCFE administrator (x 6/26) that oversees facility operations. Due to time constraints, this report is incomplete. Deficiencies observed will be cited at a later date. The following forms/information are requested to be completed and returned to CCL by 3/11/25: • LIC 309 Administrative Organization • LIC 400 Affidavit regarding Client Cash Resources • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • LIC 610D Emergency Disaster Plan (signed and dated) • LIC 9282 Infection Control Plan - Proof of control of property (signed and dated lease) - Proof of current liability insurance - Annual license renewal fee of $1237 is due and payable. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on page THREE.
Regulation
MAINTENANCE AND OPERATION Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F and not more than 120 degree F . This requirement is not met, as hot water
Inspector finding
temperature tested at 132 degrees in common bathroom, which poses an immediate health and safety risk to clients in care.
Regulation
PERSONAL RIGHTS Residents in all RCFEs shall have ...the right...to be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met, as there are video baby monitors in 3 clients' rooms, so
Inspector finding
staff can monitor clients from the kitchen. This poses an immediate personal rights risk to clients in care. Cameras are placed in rooms of clients #1, #3, #4, and provide video and audio surveillance.
Regulation
CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to H & S Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility, request a transfer of a criminal record clearance as specified in Section 87355(c).
Inspector finding
This requirement is not met, as 5 staff out of 7 staff files reviewed DO NOT have criminal record clearance associated to this facility. This poses an immediate health, safety or personal rights risk to clients, and civil penalty is assessed at $100/each. Three staff have been employed for over 7 months.
Regulation
STORAGE SPACE 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
Inspector finding
storage. This requirement was not met, as Comet cleanser stored in bathroom cabinet in private bathroom of client #1, which posed an immediate health, safety or personal rights risk to clients in care.
Regulation
FIRE CLEARANCE All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services.... Prior to accepting or retaining ...bedridden persons, the licensee shall notify the licensing agency &
Inspector finding
obtain an appropriate fire clearance approved by the city, county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met, as client #4 is bedridden, but there is no approved fire clearance for bedridden, which poses an immediate health and safety risk.
Regulation
INCIDENTAL MEDICAL CARE A complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least... specific items. This requirement was not met, as first aid kit only
Inspector finding
contains Medihoney, several bandaids, a flex fabric, cold pack, and tweezers. Licensee failed to ensure that first aid kit is complete, which poses a potential health, safety or personal rights risk to clients in care.
Other visitFebruary 21, 2024Type A2 deficiencies
Inspector: Jaime Vado
Plain-language summary
During an unannounced annual inspection on February 21, 2024, the facility was found to be generally well-maintained with functioning safety equipment, adequate supplies, secure medications, and clean living areas. However, one staff member was working at the facility without required fingerprint clearance from the state, resulting in a $200 civil penalty. The facility was asked to submit several updated documents to the state by the end of February.
View full inspector notes
On 02/21/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with caregiver Elnora Panilag and explained the purpose of today's visit. LPA toured the facility inside and outside. Emergency exit routes are free and clear of obstructions. The facility's ambient temperature is comfortable and warm. Water is tested in two communal bathrooms as being 120F. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed. One fire extinguisher is observed in the kitchen. Upon observation of the charge on the dial display it is within the green zone indicating it is charged and ready for use. The inspection tag indicates it was last inspected on 09/25/2022. Facility is equipped with fire sprinklers. Carbon monoxide detectors and smoke detectors are present through out the facility. Two resident bathrooms were observed to be in good repair. Client bathrooms are observed to be in working order with clean shower curtains and non-skid surfacing and strips are in place. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Kitchen is observed as operable and clean. Appliances are in good working order. LPA observed that the knives for cooking is locked in a small cabinet next to the stove. Medications are also observed as locked in a stand up cabinet in the kitchen. Medications are inaccessible to residents. Medication administration record is observed as current. First aid kit is observed with the medications as complete. 2 resident files are reviewed as being current. Continue on next page... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 - LIC809C On site laundry is available and functioning per observations made in the garage. Cleaning supplies are observed as locked in garage and in storage cabinets in the garage. An additional refrigerator is located in the garage that contains additional resident food as well as staff's personal food items. 2 client records are checked and both are complete and updated. At time of inspection, there is only one resident who has money being stored for safekeeping by staff. This is inspected and is observed as current. 3 Staff files are reviewed as current. At time of inspection. There is one staff (S1) not associated to the facility and no fingerprint clearance on record with the Department. The following updated items are requested to be sent to the Department by 02/28/2024 : • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Proof of control of property • Surety bond with expiration date Citations issued on following LIC809D. Civil penalty assessed for staff person with no finger print clearance on file with the Department and not being associated to the facility. S1 x (2 violations) at $100 = $200 Report is reviewed with caregiver Elnora Panilag.
Regulation
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by:
Inspector finding
Based on records review, licensee failed to request a transfer of criminal record clearance for S1 and S2 which poses an immediate health and safety risk to clients in care. It is confirmed that S1 and S2 are not associated to the facility on this day 7/1/2022.
Regulation
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
Inspector finding
Based on records review, licensee failed to obtain a criminal record clearance for S1 which poses an immediate health and safety risk to clients in care. It is confirmed that S1 does not have a criminal record clearance on this day.
InspectionJune 29, 2023No deficiencies
Inspector: Jaime Vado
Plain-language summary
A licensing inspector made an unannounced annual visit and found the facility clean and well-maintained, with working smoke detectors, carbon monoxide detectors, and fire safety equipment in place. Staff background checks, administrator certification, insurance, and required documentation were all current. No violations were cited.
View full inspector notes
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual continuation inspection visit. LPA met with licensee Isabelle Gil and explained the purpose of today's visit. LPA inspected the facility inside and out including, living room, dining area, kitchen, bathroom, garage and backyard. Both inside and outside of the facility were free of obstruction. Facility is free of odor and was observed to be clean. LPA observed sufficient furniture and lighting throughout the facility. LPA inspected a seven day non-perishable and two day perishable food which are in place. LPA tested the hot water temperature in the kitchen measuring at 110F. Smoke detectors in compliance with fire safety and are functioning according to the licensee. LPA observed the presence of one carbon monoxide detector in dining room area adjacent to carbon monoxide. Passageways and hallways were observed free of obstruction. A review of staff records on 06/29/2023 indicate that all facility staff or individual who require caregiver background checks have received criminal record clearances. All staff are associated as required. Surety bond is on file expiring on 10/17/2023. Liability insurance is on file dated 05/03/2023. Lease agreement on file expiring 12/31/2023. Disaster plan is on file dated 2023. Fire extinguisher in kitchen is fully charged and last inspected on 09/26/2022. Administrator certificate is current expiring 06/29/2024. At 1:15PM, LPA reviewed a sample of client files including cash resources and medications. Staff files including required and continued training are reviewed as current. Medications are inspected as in place and accounted for. No deficiencies are cited. Report is reviewed with the licensee on this day.
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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