Petani Haven
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.
1840 Evergreen Street · 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
Severity15thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency5thDeficiencies 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
Petani Haven scores C−. Better than 40% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 15%. Repeats: top 0%. Frequency: bottom 5%.
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)
55
Last citation
Jan 26
Finding distribution
9 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
- 410508482
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Haupeakui, Ane
Inspections & citations
2
reports on file
9
total deficiencies
4
Type A (actual harm)
InspectionJanuary 20, 2026Type A6 deficiencies
Plain-language summary
This was a routine inspection of the facility's physical space, safety equipment, and records. Inspectors found the building properly maintained with working safety equipment, appropriate medication storage, and required disaster planning in place, though some licensing paperwork and staff records were not available for review at the time of inspection. The facility administrator's certificate expires in August 2026, and the facility was asked to submit several required documents by early February 2026.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, including detached storage building. There are client bedrooms--two are occupied as private rooms--a staff room, 2 full bathrooms, living/dining room, TV room, and kitchen. Washer and dryer are located in 1-car garage. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Hot water temperature is tested at 113 degrees in rear client bathroom. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Client files are reviewed, including Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, however, staff records are not available for review. Ane Haupeakui and Esther Hunkin oversee facility operations; Esther Hunkin's RCFE administrator certificate expires 8/27. The following licensing forms are requested to be completed and submitted to CCLD BY 2/3/26: - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - page 9 of revised Emergency Disaster Plan (signed and dated) - Facility Sketch (LIC999), including dimensions - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages.
Regulation
POSTURAL SUPPORTS Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met, as hospice
Inspector finding
client #2 has full bed rails, but this is not included in hospice care plan. Licensee failed to ensure that full bed rails are included in hospice care plan, which poses a potential health, safety or personal rights risk to clients in care.
Regulation
INCIDENTAL MEDICAL CARE 87465 A record of centrally stored prescription 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
Inspector finding
& expiration, prescription number and instructions. This requirement is not met, as medications for 3 residents are not recorded on Centrally Stored Medications Records. Licensee failed to ensure that medications for clients are logged on CSMR, which poses a potential health or safety risk.
Regulation
ALTERATIONS TO BUILDINGS/GROUNDS Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met, as rear family room has been extended almost 8 feet, but there is no approved building permit. Licensee failed to maintain approved
Inspector finding
building permit, which poses a potential health, safety or personal rights risk to clients in care.
Regulation
MEDICAL ASSESSMENT 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
This requirement is not met, as there are no MD reports for clients #3 and #4. Licensee failed to ensrue that MD reports are maintained prior to admission and maintained, which poses a potential health, safety or personal rights risk to clients in care.
Regulation
PERSONNEL RECORDS All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met, as there are no staff records available for review. Licensee failed to ensure that staff records are maintained
Inspector finding
at facility, which poses an immediate health, safety, or personal rights risk to clients in care.
Regulation
PREADMISSION APPRAISAL Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs. This requirement is not met, as there are no appraisals on file for all residents. Licensee failed to ensure
Inspector finding
that appraisals are maintained for all clients, with poses a potential health, safety or personal rights risk to clients in care. No preadmission appraisals for clients #3 and #4 and no appraisals for clients #1 and #2
InspectionFebruary 18, 2025Type A3 deficiencies
Inspector: Audrey Jeung
Plain-language summary
This was a routine inspection of the facility's physical environment, safety equipment, medication storage, and staffing qualifications. The facility met standards for layout, water temperature, first aid supplies, and background clearances, though the administrator's certificate expires in February 2025. The facility was found not to have a required written Infection Control Plan that designates who is responsible for infection control training and practices at the facility.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, including detached storage building. There are 3 shared client bedrooms--only 2 are occupied as private rooms--a staff room, 2 full bathrooms, living/dining room, TV room, and kitchen. Washer and dryer are located in 1-car garage. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Hot water temperature is tested at 116 degrees in rear client bathroom. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Client files are reviewed, including Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff training records. Ane Haupeakui and Tomasi Haupeakui oversee facility operations; Tomasi's RCFE administrator certificate expires 2/25. As per legislation, effective 1/1/2015, the following information is posted: 1) text of Health and Safety Code 1569.269 AND CCR Title 22 Section 87468 (Personal Rights form LIC613C), per AB2171; 2) CCLD Hotline information, per SB895. The following licensing forms are requested to be completed and submitted to CCLD BY 2/25/25: - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (revised 9 page LIC610-E signed and dated on page 9) - Facility Sketch (LIC999), including dimensions - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Technical Advisory Note. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Facility is not in compliance with Section 87470 Infection Control Plan: An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (A) Identification of a staff position to perform the duties of an Infection Control Lead for the facility. 1. Contact information for the designated Infection Control Lead shall be made available to the department upon request. 2. A description shall be included of how the Infection Control Lead shall be trained by a medical professional, local health official, health department, or other research-based medical authority that provides infection control training that will include enforcement of the Infection Control Plan. (B) A description of how the licensee shall meet the specific infection control practice requirements of subsections (a), (b) and (d). (C) An Infection Control Training Plan. 1. Initial training requirements for new facility staff shall be addressed in the plan, with training to be provided by the Infection Control Lead before staff works independently with residents. 2. Ongoing training requirements for all facility staff shall be addressed by the plan, with training to be provided by the Infection Control Lead. 3. The description of initial and ongoing training shall address the requirements of subsections (a), (b) and (d). (D) The licensee shall review the use of infection control procedures in the facility at least annually, if local government public health determines an epidemic outbreak has occurred, or if the review is requested by the local licensing agency. (E) The licensee shall ensure that staff encourage residents to follow infection control practices as necessary.
Regulation
PRE-ADMISSION APPRAISAL Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455.
Inspector finding
This requirement is not met, as there are no appraisals maintained for both hospice clients. Client #1 admitted 7/2023 & client #2 admitted 9/2024. This was cited in 2024. Licensee failed to ensure appraisals are completed for clients, which poses a potential health, safety or personal rights risk
Regulation
PERSONNEL REQUIREMENTS-GENL Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met, as there is no documentation maintained that all staff have current first aid training. Licensee failed to
Inspector finding
maintain evidence that caregivers have required first aid training, which poses a potential health, safety or personal rigjts risk to clients in care. This was cited in 2024 and subsequently corrected.
Regulation
CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to HSC Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: obtain a CA clearance or a criminal record exemption as required by the Department
Inspector finding
This requirement is not met as staff #1 is present at facility, but has not yet obtained criminal record clearance. Licensee failed to ensure that all staff have criminal record clearance prior to working with clients. This poses an immediate health, safety or personal rights risk to clients in care.
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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