St. Therese Care Home Ii
What is an RCFE with 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.
2640 Mallard Court · Union City, 94587
Record last updated April 20, 2026.
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Quick facts
Memory care context
St. Therese Care Home II is a California-licensed Residential Care Facility for the Elderly (RCFE) designated for memory care, licensed for 6 residents. California Title 22 requires facilities serving dementia residents to meet specific standards under §87705 and §87706, covering individualized care plans, staff training in dementia care, and appropriate resident supervision. CDSS records show this facility has been cited four times under these dementia-care regulations. The inspection history includes 7 inspection reports with 21 total deficiencies: 7 Type A citations (indicating actual harm occurred) and 14 Type B citations (potential for harm). One complaint is also on file. The most recent inspection occurred on September 10, 2025.
Questions to ask on your tour
Based on St. Therese Care Home Ii's state inspection record.
The facility has received 7 Type A deficiencies indicating actual harm to residents — what were the specific circumstances of these citations, and what corrective actions were implemented?
CDSS records show 4 citations under §87705 or §87706 related to dementia care requirements — which specific provisions were violated, and how has the facility changed its dementia care practices in response?
With 21 total deficiencies across 7 inspections, what systemic changes has St. Therese Hope Corp implemented to reduce recurring compliance issues?
One complaint is on file with CDSS — was this complaint substantiated, and what was the subject matter?
In a 6-bed facility, how many staff members are on duty during overnight hours, and what is the protocol if a caregiver is unable to report for a shift?
State records
California CDSS · Community Care Licensing Division- License number
- 015601391
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- St. Therese Hope Corp Dba St. Therese Care Home Ii
Inspections & citations
7
reports on file
21
total deficiencies
7
Type A (actual harm)
4
dementia-care citations
Other visitSeptember 10, 2025No deficiencies
Inspector: Jill Clancy-Czuleger
Inspector notes
While LPA J. Clancy-Czuleger conducted a complaint investigation (15-AS-20230228093307) on 08/04/2023 LPA observed the following deficiencies Based on interviews and observations staff is sleeping in common area including the living room and the kitchen. During interviews with staff, they stated that three staff sleeps in the kitchen and/or living room on fold up cot mattresses that are stored in the staff room where the fourth staff member sleeps. While doing a walk through of the facility LPA observed that all five beds in the home have some form of bed rail. R1 and R2 are on hospice and are permitted to have bed rails. R3 is not on hospice and does not have doctors’ orders for bed rails but has full bed rails. R4 does not have doctor’s order for a bed rail and has it written in on an unsigned physician’s report. The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided. Exit interview conducted.
InspectionMarch 20, 2025No deficiencies
Inspector notes
On 09/10/25 at 10:35AM, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced Case Management, met with caregiver, Alvin Galang and spoke with Administrator (ADM) Faith Oribello via phone explained the purpose of the visit. ADM was not available during LPA visit. ADM gave permission to Alvin to sign the report. LPA discuss with ADM regarding the outstanding Annual Fee. ADM stated ADM will send confirmation of paid Annual Fee by 9/12/25. No deficiency issue on today date. Exit interview is conducted and a copy of this report is provided.
InspectionMarch 28, 2024Type A3 deficiencies
Inspector: Patricia Manalo
Inspector notes
On 03/20/2025 at 2:55 PM, Licensing Program Analysts (LPAs) P. Manalo and K.Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Care Staff, Alvin Galang, and explained the purpose of the visit. Administrator, Rachel White, gave authorization on the phone for Care Staff to sign the report. Administrator certificate is current. The facility’s fire clearance was approved for six (6) all may be non-ambulatory and three (3) hospice waiver. LPAs toured facility with staff inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 01/22/2025. Emergency Disaster Plan was last posted on 03/28/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/20/2025. At 3:03 PM, LPA reviewed 5 residents records. At 03:28 PM, LPAs reviewed 4 staff records and all are associated to the facility. At 5:00 PM, LPA reviewed a sample of resident’s medications. Continue to LIC809-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 Continue from LIC809... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 4:00 PM, LPAs observed wound care saline, prescribed thick-it, Halls, Isopropyl Alcohol, etc. accessible to residents in care. At 5:15pm LPAs observed residents PRN are not documented on the Medication Administration Record (MAR). At 5:20PM LPAs observed resident medication are not listed on MAR. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Staff. Appeal Rights and a copy of this report provided.
(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.
Based on observation the licensee did not comply with the section cited above in having unlocked wound care saline, prescribed thick-it, Halls, Isopropyl Alcohol, etc. accessible to residents in care which poses an immediate health and safety risk to persons in care. POC Due Date: 03/21/2025 Plan of Correction 1 2 3 4 The Administrator agrees to lock the items, have a Medication In-Service Training, and send proof to CCLD by POC date.
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
Based on record review, the licensee did not comply with the section cited above in having residents' PRN that are not documented on the Medication Administration Record (MAR) which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 Administrator agrees to submit proof of the PRN medications documented on the MAR by POC date.
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are…
Based on record review, the licensee did not comply with the section cited above in having residents' medication that are not listed on MAR which poses a potential health and safety risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 Administrator agrees to look through all the MAR, ensure all the medications are correctly documented, and send proof to CCLD by POC date.
ComplaintAugust 4, 2023Type A2 deficiencies
Inspector: Laura Hall
Inspector notes
On 4/28/2022 at 10:00AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Alvin Galang, Caregiver and explained the purpose of the visit. House Manager arrived at 10:40AM. Upon entry, LPA's temperature was checked. LPA observed screening station that contained hand sanitizer, masks and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. LPA observed cough etiquette, physical distancing signs posted, and hand sanitizer dispensers in the common areas. All hand washing stations were equipped with soap and paper towel. Hot water temperature in the shared clients’ bathroom was measured at 106.7 degree Fahrenheit. Fire extinguisher was last serviced on 11/21/2021. During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food, and paper supplies are sufficient. The following forms are to be updated and submitted to CCLD by 5/05/2022 : -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility Continued on LIC9099C 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 LIC9099. -LIC610E Emergency Disaster Plan -An updated copy of Administrator certificate The following deficiencies were observed: -At 10:10AM, LPA observed Staff 2 (S2) and Staff 3 (S3) not associated to the facility. -At 10:20AM, LPA observed unlocked garage door with detergent and fabuloso sitting on counter. An immediate civil penalty of $600 was assessed. The following deficiencies were observed (see LIC809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.
87411 Personnel Requirements- General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or
Based on record review, the licensee did not comply with the section cited above in having S2 and S3 associated to the facility which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/29/2022 Plan of Correction 1 2 3 4 House Manager agreed to submit an LIC9182 and Identification for both S2 and S3 to associate staff to CCLD by POC date. House manager submitted LIC9182 and Identficiation for both S2 and S3 to LPA during visit. Deficiency cleared.
87705 Care of persons with dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
This requirement was not met as evidence by: Deficient Practice Statement 1 2 3 4 Based on observation, the licensee did not comply with the section cited above in having detergent and fabuloso accessible which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/01/2022 Plan of Correction 1 2 3 4 House Manager agreed to lock detergent and fabuloso in locked cabinet in garage and take photo to submit to CCLD by POC date. House manager locked detergent…
Other visitAugust 4, 2023Type A8 deficiencies
Inspector notes
On 03/11/2026 at 9:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 1-Year Annual Required inspection. LPA met with Care Staff, Josielyn Ranosa, and explained the purpose of the visit. Administrator Rachel White was not available, however CO- Administrator Faith Oribello gave authorization on the phone for Care Staff to sign the report. Administrator certificate is current (7022033740 exp: 04/16/26). The facility’s fire clearance was approved for six (6), all may be non-ambulatory, and three (3) hospice waiver. LPA toured the facility with staff inside and out, including but not limited to bedrooms, bathrooms, kitchen, common area, and backyard. The facility consists of 5 total bedrooms, of which 4 bedrooms are occupied by the residents, and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed that lighting in all rooms is adequate for the comfort and safety of the residents. The temperature of the hot water in the residents’ shared bathroom was measured at 115.9°F. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week's supply of nonperishable and 2 days' supply of perishable foods. Report Continued on LIC 809c… 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 Report Continued… Carbon monoxide detectors were in operation during the visit. The fire extinguisher was last serviced on 09/8/2025. Emergency Disaster Plan was last posted on 1/14/2026. The first aid kit was observed to be complete. The emergency disaster drill was last conducted on 01/15/2026. Liability insurance dated: 3/8/25 to 3/8/26 LPA reviewed 1 resident's records. LPA reviewed 4 staff records, and all are associated with the facility. LPA reviewed a sample of residents’ medications. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING THE VISIT: · At 10:15 am, LPA conducted a file review of resident PRNs that were not documented on the Medication Administration Record (MAR). · At 10:17 am, LPA conducted a file review of the resident's file, and the resident had no record of PRN. · At 10:20 am, LPA conducted a file review of the resident's medication, which is not listed on MAR. Report continue on LIC 809... 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 Report continued... · At 10:30 am, LPA observed a cockroach crawling on the wall, floor, and a dead cockroach inside/ outside the refrigerator · At 10:35 am, LPA observed expired food and moldy food inside the refrigerator · At 11:25 am, LPA observed liquid detergent underneath the sink · At 11:35 am, LPA observed that three sliding door net screen ripped - A repeat of 87465(a)(6) and 87465(c)(2) is issue on today date in the amount of $250 + $250 = $500. The Facility was cited from the California Code of Regulations, Title 22, and/or Health and Safety Code. Failure to correct deficiencies by the POC date may result in additional Civil Penalties. An exit interview was conducted with the staff. Appeal Rights and a copy of this report are provided along with LIC421FC.
(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. (1) Disinfectants, cleaning solutio…
Based on observation, the licensee did not comply with the section cited above in having unlock liquid detergent underneath the sink, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/12/2026 Plan of Correction 1 2 3 4 Administrator immediately removed the unlocked liquid detergent and secured it in a locked cabinet inaccessible to residents. Administrator will ensure all cleaning supplies and hazardous items are kept locked at all times. Admi…
(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.
Based on observation, the licensee did not comply with the section cited above in LPA observed a cockroach crawling on the wall and a dead cockroach inside the refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator immediately cleaned and sanitized the affected areas and removed the dead cockroach from the refrigerator. Licensee will contact a licensed pest control service and imple…
(c) All window screens shall be clean and maintained in good repair.
Based on observation the licensee did not comply with the section cited above in LPA observed that three sliding door net screen ripped which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator will repair or replace the three ripped sliding door screens to ensure they are in good repair. Administrator will conduct routine facility checks to ensure all screens remain in good condition. Proof of co…
(23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.
Based on observation, the licensee did not comply with the section cited above by having moldy food inside the refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator immediately discarded the moldy food and cleaned and sanitized the refrigerator. Administrator will ensure staff routinely check and remove expired or spoiled food to maintain sanitary food storage. Proof of correctio…
(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
Based on observation, the licensee did not comply with the section cited above by LPA observed a cockroach crawling on the wall, floor, and a dead cockroach inside/ outside the refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator immediately cleaned and sanitized the affected areas and removed the dead cockroach. Licensee will arrange pest control service and implement routine cl…
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
Based on record review, the licensee did not comply with the section cited above in LPA file review that resident PRNs are not documented on the Medication Administration Record (MAR), which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator will ensure all PRN medications are documented on the Medication Administration Record (MAR). Administrator will review resident medication records and train …
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are…
Based on record review, the licensee did not comply with the section cited above in onducted a file review of the resident's medication, which is not listed on MAR, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator will review resident medication records and ensure all medications are accurately listed on the Medication Administration Record (MAR). Administrator will train staff on proper M…
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and …
Based on record review, the licensee did not comply with the section cited above in LPA conducted a file review of the resident's file, and the resident had no record of PRN. which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/18/2026 Plan of Correction 1 2 3 4 Administrator will review resident records and ensure all PRN medications and orders are properly documented in the resident’s file. Administrator will train staff on proper document…
InspectionJanuary 28, 2023Type A2 deficiencies
Inspector: Alona Gomez
Inspector notes
On 03/28/2024 at 10:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Alvin Galang and explained the purpose of the visit. LPA spoke with Administrator, Faith Oribello over the phone who approved Caregiver, Alvin Galang to lead the visit. The facility’s fire clearance was approved for 6. Administrator Faith Oribello arrived at 11:42AM LPA toured facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the residents and 1 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 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 116.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. 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 9/20/2023. Emergency Disaster Plan was last posted on 3/28/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 2/28/2024. At 10:45AM, LPA reviewed 4 of 4 residents records. LPA spoke with administrator about ensuring dementia residents get a physicians assessment done annually. At 10:55AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. Report continues 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 THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:57AM during staff file review LPA observed that S3's file is missing a health screen, and TB result At 11:07AM during facility tour LPA observed multiple unsecured medications unlocked in kitchen for residents and caretakers. LPA observed Caretaker Alvin remove and secure all medications. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.
(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
Based on observation, the licensee did not comply with the section cited above inhaving unlocked perscription medications which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/29/2024 Plan of Correction 1 2 3 4 LPA observed caregiver remove and secure medications.
(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…
Based on record review, the licensee did not comply with the section cited above in having S3 working for over 2 months without a health screen and TB result which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2024 Plan of Correction 1 2 3 4 By POC date Administrator agrees to ensure that S3 gets the necessary screens and self certify to CCLD
InspectionApril 28, 2022Type A6 deficiencies
Inspector: Laura Hall
Inspector notes
On 1/28/2023 at 12:40PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Bennet Flores Caregiver and explained the purpose of the visit. LPA spoke with Administrator Maria Bantay, via telephone at 1:20PM and was given approval for caregiver to sign documents. Upon entry, LPA's temperature was not checked. LPA observed screening station and COVID-19 signs were posted on the front door. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, back yard, kitchen, and garage. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. Hot water temperature in the shared clients’ bathroom was measured at 116.5 degrees Fahrenheit. Fire extinguisher last serviced on 10/06/21. During record review, LPA observed visitors sign-in log. LPA observed facility has a copy of the mitigation plan on file. LPA observed paper supplies are sufficient. 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. LPA requested the following documents to be submitted to CCLD by 2/6/2023. Personnel Record (LIC500). Updated emergency disaster plan (LIC610E). Facility roster LPA observed the following deficiencies: -At 12:45PM, LPA observed steak knife, and two pair of scissors drying in hospital pitcher on kitchen counter. -At 12:55PM, LPA observed unlocked kitchen drawer with key containing knives. -At 12:58PM, LPA observed Day Quil and other medication in unlocked kitchen pantry with key, Day Quil and congestion medication in refrigerator, and Miralex and Meta Mucil sitting on kitchen counter. -At 1:00PM, LPA observed fire extinguisher was last services 10/6/2021. -At 1:05PM, LPA observed facility did not have a supply of 7-day non-perishables (canned goods and meat) and 2-day perishable (observed 6 bananas, 1 apple, and 5 oranges) -At 1:10PM, LPA observed cough medication sitting on chest of drawers in bedroom #1. -At 1:15PM, LPA observed bed in bedroom #2 was blocking exit (patio door). 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 LIC809C. -At 1:20PM, LPA observed cardboard, 3 chair patio chair cushions, and toilet seat on left side of house. -At 1:30PM, LPA observed R3 did not have a doctor's order for the hospital bed. An immediate civil penalty of $500.00 will to assessed on today's date. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. A $500.00 civil penalty is assessed for deficiency # 87203. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report, LIC421IM, and appeal rights provided.
87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).
Based on observation, the licensee did not comply with the section cited above in having knives and scissors locked away and inaccessible which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/29/2023 Plan of Correction 1 2 3 4 Caregiver placed knives and scissors in kitchen drawer and locked kitchen drawer during inspection. Deficiency cleared during visit.
f) The following shall be stored inaccessible to residents with dementia: (1) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
Based on observation, the licensee did not comply with the section cited above in having medication locked away and inaccessible which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/29/2023 Plan of Correction 1 2 3 4 Caregiver locked medication in closet, making medication inaccessible to residents during inspection. Deficiency cleared during visit.
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.
Based on observation and record review, the licensee did not comply with the section cited above in not having the fire extinguisher serviced or purchasing a new fire extinguisher, and blocking an exit door with a resident's bed which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 01/29/2023 Plan of Correction 1 2 3 4 Administrator agreed to have fire extinguisher serviced or replace it with a new one and submit photo to CCLD by 2/6/2023. And rearra…
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.
Based on observation, the licensee did not comply with the section cited above in having 7-day of non-perishables and 2-day perishable foods for residents which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 02/06/2023 Plan of Correction 1 2 3 4 Administrator agreed to purchase food and submit photos of food and receipts to CCLD by POC date.
87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.
Based on observation, the licensee did not comply with the section cited above in having passageway on left side of house free of obstruction which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 02/06/2023 Plan of Correction 1 2 3 4 Administrator agreed to remove cardboard, toilet, cushions, and any other debris from side of house and submit a photo to CCLD by POC date.
87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A writt…
Based on observation and record review) the licensee did not comply with the section cited above in having a doctor's order for R3's bed which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 02/06/2023 Plan of Correction 1 2 3 4 Administrator agreed to obtain a doctor's order for R3's bed and submit a photo copy to CCLD by POC date.
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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