Health conditions and treatments
Cited in 2 reports, with 3 deficiencies in total.
MARY'S MANOR
3156 PUTTENHAM WAY, Fremont CA 94536
6 bedsLatest official report Sep 17, 2025Licensed
Additional info
- Telephone
- (510) 565-1479
- Licensee
- SUNDERRAJ, MARY
- Administrator
- SUNDERRAJ, MARY
- Contact
- SUNDERRAJ, MARY
- License first date
- Sep 2, 1999
- License effective date
- Sep 2, 1999
- District office
- OAKLAND ASC · (510) 286-4201
- Regional office
- 15
- Clients served
- 935 - ELDERLY
Summary
The available records show 11 Type A and 19 Type B deficiencies for this facility.
- Most recent inspection
- Sep 17, 2025
- Most recent deficiency
- Sep 17, 2025
No later report is available, so the records do not show what happened afterward.
What Type A and Type B mean
- Type A
- Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
- Type B
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 152 Alameda County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 7 reports for this facility: 7 inspections, 0 complaint investigations, and 0 licensing or administrative records.
Those records contain 11 Type A and 19 Type B deficiencies.
5 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 7
- Recorded deficiencies
- 30
- Type A deficiencies
- 11
- Type B deficiencies
- 19
- Substantiated complaints
- 0
- Repeated topics
- 3
More than the typical 4
1 in the last 12 months
Well above the typical 4
9 in the last 12 months
Well above the typical 1
3 in the last 12 months
Well above the typical 2
6 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Facility condition and maintenance
Cited in 2 reports, with 2 deficiencies in total.
Hazardous items and storage
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
Not classified in the sourceType A
- Official classification
- Type A
- Official code
- 1569.311
- Regulation authority
- HSC
What the official deficiency says
Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by not having carbon monoxide detector in the facility which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction The Administrator agrees to purchase a carbon monoxide detector and install it. Proof of correction will be sent to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having lysol wipes in the office, disinfectant spray in the hallway, and Tide Pods in resident's room which poses an immediate safety risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction The Administrator agrees to remove the items and self-certify the regulation. Proof of correction will be sent to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
(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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having both of the residents' bathroom uncleaned, R5's room with a strong urine ordor, broken patio furnitures in the backyard which poses a potential safety and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/25/2025 Plan of Correction The Administrator agrees to maintained the bathroom, R5's room, and have a bulk pick up for the patio furniture. Proof of correction will be sent to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(2)
- Regulation authority
- HSC
What the official deficiency says
(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 subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having staff training within the last year completed by S3 and S4 which poses a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 10/02/2025 Plan of Correction The Administrator agrees to have staff training and send proof to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(5)(A)
- Regulation authority
- CCR
What the official deficiency says
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and observation, the licensee did not comply with the section cited above by having a half bed rail for R1 without a doctor's order which poses a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 10/02/2025 Plan of Correction The Administrator agrees to obtain a doctor's order for R1's half bed rail and send proof to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Medical and dental careType B
- Official classification
- Type B
- Official code
- 87465(a)(8)
- Regulation authority
- CCR
What the official deficiency says
If a facility has no medical unit on the grounds, 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 the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by not having a first aid kit which posesd a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 09/19/2025 Plan of Correction The Administrator agrees to purchase a first aid kid and send proof to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medications such as eyedrops, Miralax, Gummies, Tums, Levothyroxine, Ointment, etc., in all the residents room which poses an immediate safety risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction The Administrator agrees to lock the medications and self certify the regulation. Proof of correction will be sent to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having S4's file for review which poses a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 10/02/2025 Plan of Correction The Administrator agrees to send proof of S4's file to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Incident reportingType B
- Official classification
- Type B
- Official code
- 87211(a)(1)
- Regulation authority
- CCR
What the official deficiency says
(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by not reporting to licensing of an incident that occured with R3 back in January 2025 which posed a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 10/02/2025 Plan of Correction The Administrator agrees to self certify the regulation and send proof to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
No deficiencies recorded in this report
Inspection
Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)
- Regulation authority
- CCR
What the official deficiency says
(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 fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in by having a lock latch on gated fence which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/20/2024 Plan of Correction Administrator removed lock during visit. Deficiency cleared.
Official record says corrected or clearedOn or before Sep 19, 2024
Plan of correction recorded
Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in by not having a fire clearance for Bedridden which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/20/2024 Plan of Correction Administrator will submit facility sketch for new fire inspection for bedriddn room.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(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: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by not having Tide Laundry Pods and Clorox wipes inaccessible which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/20/2024 Plan of Correction Administrator will self-certify that they read the regulation and will comply moving forward.
Plan of correction recorded
Correction not verified in available records
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by not having unlocked medications and vitamins inaccessible which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/20/2024 Plan of Correction Administrator will self-certify that they read the regulation and will comply moving forward.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by not having personal rights posters posted in the facility which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will send a photo of poster hung in facility to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87307(a)(2)(D)
- Regulation authority
- CCR
What the official deficiency says
87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (D) Not more than two residents shall sleep in a bedroom. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by having three (3) residents sharing 1 (one) bedroom which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will read the regulation and self-certify that they understand the regulations. Move one of the residents to another bedroom that is not over capacity. Send a photo to CCLD by POC date of room change.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(c)(2)(A)
- Regulation authority
- CCR
What the official deficiency says
(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: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by not having PUB 475 poster posted in facility entry way which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will send a photo to CCLD a poster posted by POC date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(b)(1)
- Regulation authority
- CCR
What the official deficiency says
(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in by not having an medical assessment for R6 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator to send a copy of medical assessment to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87507(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review the licensee did not comply with the section cited above in by not having an Admission Agreement on file for R6 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will send a copy of Admissions Agreement to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(c)
- Regulation authority
- HSC
What the official deficiency says
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review the licensee did not comply with the section cited above in by not having quarterly fire drills conducted by staff which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will send fire drill with participants name and self certify that they read and understand the regulation moving forward. Will send certifications to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87606(c)
- Regulation authority
- CCR
What the official deficiency says
(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review the licensee did not comply with the section cited above in by not having a fire clearance, supporting documents to care for Bedridden and LIC200 on file which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator agree to submit an LIC 200 with facility sketch to CCLD by POC date. Immediate Civil Penalty $500.00 assessed today. Resident moved out. Deficiency cleared.
Official record says corrected or clearedOn or before Sep 19, 2024
Plan of correction recorded
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(5)(A)
- Regulation authority
- CCR
What the official deficiency says
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in by not having doctor's orders for 1/2 bed rails/hospital beds postural/mobility support for R2-R6 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will send copies of doctor's orders for R2-R6 bed rails to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Not classified in the sourceType B
- Official classification
- Type B
- Official code
- 87632(d)(2)
- Regulation authority
- CCR
What the official deficiency says
(2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in by not sending notification of hospice R1 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will read and self certify the regulation and send Initiation of Hospice Care Services for R1 to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(5)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not comply with the section cited above in by not having updated medical assessments and Appraisal Needs and Services (ANS) for R2-R6 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/10/2024 Plan of Correction Administrator will submit updated Physician's Reports (LIC602A) and ANS to CCLD by POC date.
Plan of correction recorded
Correction not verified in available records
Inspection
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not locking up clearning chemicals like clorox bleach and spray located in the garage hallway which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/26/2023 Plan of Correction Licensee agreed to keep all cleaning chemicals locked at all times. Deficiency cleared
Official record says corrected or clearedOn or before Aug 25, 2023
Plan of correction recorded
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not locking up residents stored medication located in the garage cabinet which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/26/2023 Plan of Correction Licensee agreed to lock up all medication and to submit a photo of locked medications to CCL as proof by POC due date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87457(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(c) 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, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not keeping and maintaining R1, R2, and R3's needs and service plan on file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/01/2023 Plan of Correction Licensee agreed to maintain residents needs and service plans at all times in residents file and to submit a copy of residents needs and service plan to CCL by POC due date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not maintaining and updating R1, R2, and R3's medical assessment yearly which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/01/2023 Plan of Correction Licensee agreed to update residents medical assessment and to submit a copy to CCL by POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(1)
- Regulation authority
- CCR
What the official deficiency says
(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). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not locking up knifes which were stored in an unlocked cabinet which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 08/27/2022 Plan of Correction Deficiency Cleared Licensee locked up knifes in cabinet.
Official record says corrected or clearedOn or before Aug 26, 2022
Plan of correction recorded
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having medication cabinet unlocked and accessible to residents in care which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 08/27/2022 Plan of Correction Deficiency cleared Licensee locked up medication in cabinet.
Official record says corrected or clearedOn or before Aug 26, 2022
Plan of correction recorded
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(6)
- Regulation authority
- CCR
What the official deficiency says
87705 Care of Persons with Dementia: (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, the licensee did not comply with the section cited above by not having residents Appraisal needs/service plans updated in their file which poses a potential health and safety risk to persons in care.
Official plan of correction
POC Due Date: 09/09/2022 Plan of Correction Licensee agreed to complete Appraisal needs/service plan and to submit it to CCL by POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology