CARLTON PLAZA OF FREMONT

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(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: Based on observation, the licensee did not comply with the section cited above by having a leak in the main lobby by the receptionist area which poses a potential safety risk to persons in care.

Official plan of correction

The Executive Director agrees with the facility to come up with a plan regarding the leak and the reassurance of residents’ safety. Additionally, the facility will send proof of correction of the leak fixed.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632(a) Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department... This requirement is not met as evienced by Based on observation and interview, the licensee did not comply with the section cited above by having a total of 13 residents on hospice while the facility is only approved for 6 which poses a potential safety risk to persons in care.

Official plan of correction

By POC date, Executive Director will submit to CCLD a request for additional hospice waivers.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

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...locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section above by having two scissors unlocked in R1's room with a dementia diagnosis which poses an immediate safety risk to persons in care.

Official plan of correction

By POC date, the Executive Director agrees to remove the scissors, lock it, and send proof to CCLD. Moving forward, the Executive Director agrees to review the physician reports of all the residents to ensure that the specific items are not in the residents' rooms.

Deadline recorded: Jan 31, 2026. A deadline is not proof that correction was completed.

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: The licensee did not comply with the section cited above when the licensee had items such as hoyer lifts, bed frame, bed mattress, portraits, and vacuum which poses a potential safety risk to persons in care.

Official plan of correction

The Executive Director agrees to remove the items, ensuring, and addressing to staff that no items should be left in the hallways. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Feb 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

87615(a)(1) (a) Persons who require health services for or have a health condition including...shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above when facility retained a resident with a stage III pressure wound which posed a potential health risk to persons in care.

Official plan of correction

The Executive Director agrees to have an in-service regarding prohibited conditions and send proof to CCLD by POC date.

Deadline recorded: Feb 13, 2026. A deadline is not proof that correction was completed.

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... This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by having a over capacity of 130 residents which poses an immediate health and safety risk to persons in care.

Official plan of correction

1) Executive Director will also notify fire department within 24 hours of the over capacity census and send proof to CCLD. 2)Executive Director has agreed to create a plan to address the over capacity issue and submit the written plan to CCLD by 01/23/2026.

Deadline recorded: Jan 15, 2026. 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

(2) Once ordered by the physician the medication is given according to the physician's directions. 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 not having 4 PRN medications in the facility for R1 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2026 Plan of Correction The Executive Director agrees to obtain the medications and self-certify the regulation. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87458(b)

Regulation authority

CCR

What the official deficiency says

The licensee shall obtain an updated medical assessment when required by the Department. 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 R3, R5, R6 and R7’s physician report (LIC602A) updated which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction The Executive Director agrees to obtain an updated LIC602A for the residents and send proof to CCLD by POC date.

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 a hammer, wrench, Antacids Tablets, Nystatin Powder, and Cortizone in R3’s room and unlocked Method All-Purpose Cleaning Wipes, Clorox Spray, and Airborne in the activities closet which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2026 Plan of Correction The Executive Director agrees to lock the items and self certify the regulation with staff. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87309(a)(1)

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. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. 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 supplies in the same storage as paint, lighter fluid, and other debris which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2026 Plan of Correction The Executive Director agrees to separate place the food supplies in a different storage area and send proof to CCLD by POC date.

Official classification

Type B

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: 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 associated with the facility on Guardian which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2026 Plan of Correction The Executive Director agrees to have S4 associated before returning to work and send proof to CCLD by POC date.

Official classification

Type B

Official code

87412(b)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: 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 having staff files incomplete which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2026 Plan of Correction The Executive Director agrees to have the staff files completed and send proof to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 multiple food items such as Greek Nonfat yogurt with a best buy date of 10/08/2025, sauce with best buy date 09/30/2025, Chipotle Southwest with a best buy date of 04/22/2022, smoked guada best buy date of 08/29/2025, etc., which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/28/2026 Plan of Correction The Executive Director agrees to have an in-service training with all kitchen staff regarding food safety and discard the items. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements 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... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not sending R1's incident report to the department within the seven day timeframe which posed a safety risk to persons in care.

Official plan of correction

The Executive Director agrees to review and self-certify the regulation with staff. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Nov 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements (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 requirement is not met as evidenced by: The licensee did not comply with the section cited above by not reporting to the licensing department of any falls that R1 had at the facility which posed a potential health and safety risk to persons in care.

Official plan of correction

The Executive Director agrees to conduct an in-service regarding reporting requirements with all staff and self-certification of the regulation. Plan of correction will be sent 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

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. 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 evidence by: Based on investigation, licensee did not comply with section cited above by escorting R1 to the incorrect room and unaware R1's whereabouts which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director has agreed to conduct training for staff regarding escorting residents and submit staff sign in sheet with training materials to CCLD by POC date.

Deadline recorded: Feb 7, 2025. A deadline is not proof that correction was completed.

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 in having a knife in R2's room, Lysol spray and dish soap in R3's room, and cleaning supplies such as Lysol spray and the Pink Stuff in R1's room which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction The Executive Director agrees to remove the following items and send proof to CCLD by POC date.

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 in having prescribed medication of solution in R1's bathroom which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction Executive Director agrees remove the medication from the resident's room, and send proof to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(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. 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 not having a PRN medication for R2 in the Med Tech room and in R2's medication bin, there was medication found not listed in doctor's order which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/22/2025 Plan of Correction Executive Director agrees to obtain a discontinued order for both medications and send proof to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

(8) 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 the licensee did not comply with the section cited above in having an incomplete first aid kid in the second floor, third floor, and in the kitchen which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/22/2025 Plan of Correction Executive Director agrees to obtain a complete first aid kit in each level of the facility and send proof to CCLD by POC date.

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 lysol sprays stored in the same area as food supplies which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Staff removed the lysol sprays and stored them separate from food supplies during inspection. Deficiency cleared.