AEGIS ASSISTED LIVING OF FREMONT

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) Storage Space and Access ...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: Based on observations and record review, the licensee did not comply with the section cited above by having Lysol wipes and Lysol spray in R3’s room and Clorox wipes in R4’s room which poses an immediate safety risk to persons in care.

Official plan of correction

By POC date, staff agree to lock the items and send proof to CCLD.

Deadline recorded: Jul 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. 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 the emergency food in the same closet as the antibacterial liquid soap and water supply inside the laundry room which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/15/2025 Plan of Correction The General Manager agrees to place the emergency food and water supply separate from the cleaning supplies. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a)(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions,...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: Based on observation, the licensee did not comply with the section cited above by having a tide pod and sanitzation wipes unlocked and accessible to residents which poses an immediate safety risks to person in care.

Official plan of correction

The General Manager agrees to lock the items and send proof to CCLD by POC date.

Deadline recorded: Aug 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2) Incidental Medical and Dental Care (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: The licensee did not comply with the section cited above by giving R1 a discontinued PRN medication that posed a potential health and safety risk to person in care.

Official plan of correction

Staff conducted a Medication Administration In-Service Training on 07/22/2025. Deficiency cleared during the visit.

Deadline recorded: Aug 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by having a missed medication for R1's insulin which poses a potential health and safety risk to persons in care.

Official plan of correction

The facility conducted an Insulin Training on 06/18/2025 after the incident occured with all the Wellness Nurses. Deficiency cleared during the visit.

Deadline recorded: Jul 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by staff failing to provide adequate supervision resulting in resident sustaining multiple fractures while in care which posed an immediate risk to resident in care.

Official plan of correction

Deficiency corrected during visit. In-service staff retraining on proper care and supervision conducted on 04/12/24. Immediate civil penalty of $500 assessed during visit for staff failing to provide adequate care and supervision to resident resulting in resident sustaining multiple fractures while in care.

Deadline recorded: Feb 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. Based on interviews the licensee did not comply with the section cited above by having a staff person lock residents' in their rooms using a laundry cart which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to conduct Personal Rights training and send proof to LPA by POC date.

Deadline recorded: Sep 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

(a)Each licensee shall furnish to the licensing agency such reports... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on reports the licensee did not comply with the section cited above by not submitting an incident report involving an injury resident sustained from accidental fall.

Official plan of correction

Licensee will submit a written certification indicating the understanding of reporting requirements. Civil penalty assessed of $250 for repeat violation.

Deadline recorded: Aug 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, ... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and records review, the facility did not observe R1 close enough to know that he had a fall resulting in injury.

Official plan of correction

Licensee will submit a written certification indicating the understanding of the regulation. Civil penalty assessed of $250 for repeat violation.

Deadline recorded: Aug 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and records review, the facility did not seek medical attention for a resident who had two falls.

Official plan of correction

The administrator agreed to have an in-staff training to review regulation 87465(g). The facility will submit a copy of the training topic with attendees’ signatures and will be abided by going forward to CCLD by POC date.

Deadline recorded: Jul 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department ... A written report shall be submitted to the licensing agency ... This report shall include... Any serious injury as determined by the attending physician... This requirement was not met and evidenced by: Based on interviews and records review, the facility did not report to the department that the resident had bruising and two unwitnessed falls.

Official plan of correction

The administrator agreed to have an in-staff training to review regulation 87211. The facility will submit a copy of the training topic with attendees’ signatures and will be abided by going forward to CCLD by POC date.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, ... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and records review, the facility did not for a resident who had two falls.

Official plan of correction

The administrator agreed to have an in-staff training to review regulation 87466. The facility will submit a copy of the training topic with attendees’ signatures and will be abided by going forward to CCLD by POC date.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures: (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified... This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not giving R1 a proper eviction notice to be removed from the community which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agree to review section 87224- Eviction Procedures and to submit a self-certification with a signature of all community directors acknowledging the above section and to submit a copy to CCL by POC due date.

Deadline recorded: Sep 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(6)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job... (6) Knowledge of community services and resources. This requirement is not met as evidenced by: Based on the observation and interview, the licensee failed to ensure that the facility staff was properly trained which poses to the health and safety and/or personal rights of clients in care.

Official plan of correction

Facility will conduct a staff training for all staff in related to regulation cited, documentation of training need to be submitted on the POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.