SAN LEANDRO SENIOR LIVING

Official classification

Type A

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication... assist the resident with self-administration.. This requirement is not met as evidenced by: Based on Interview and record review, the licensee did not comply with the section cited above in administering the incorrect dosage of medication to R1 which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Executive Director(ED) conducted staff training on Wrong Doses and Adverse Reactions on 4/3/2026. ED updated R1's Needs and Services Plan, and created a separate system for when the facility receives physician orders regarding resident medication changes. DEFICIENCY CLEARED DURING VISIT.

Deadline recorded: Apr 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(1)(3)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored (1)Medications shall be centrally stored..(3) Each container shall carry all of the information.. (E) below plus expiration date and number of refills. This requirement is not met as evidenced by: Based on Interview and record review, the licensee did not comply with the section cited above in administering expired medication to R1 which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Executive Director(ED) conducted staff training on Medication Errors and Adverse Reactions on 3/30/2026. ED updated R1's Needs and Services Plan, and utilized a system online called ADL Advantage for Med Tech's to utilize when reviewing medications. DEFICIENCY CLEARED DURING VISIT.

Deadline recorded: Apr 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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 in that comet bleach powder and Endust Dust & Clean multi-surface spray was found unlocked in a residents room which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 01/29/2026 Plan of Correction Administrator removed the comet bleach powder and Endust Dust & Clean multi- surface spray and put it in a locked cabinet. Deficiency cleared during visit.

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 The licensee did not comply with the section cited above by having the residents shower with debris, resident’s room with a strong odor of feces, and the handicapped button in the front door in disrepair, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction By POC date, the administrator agrees to clean the resident's room and bathroom, and repair the door.

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 in that S1, S3, S4, and S5 files were incomplete which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/04/2026 Plan of Correction By POC date, the administrator agrees to complete S1, S3, S4, and S5's files and make sure documents are up top date and send self-certification to CCLD.

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...competency to meet their needs. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by staff not properly care for resident's pressure injury which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) agreed to a written plan to address wound care including staff training and submit a copy to CCLD by POC date.

Deadline recorded: Mar 14, 2025. A deadline is not proof that correction was completed.

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...m LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. Based on observation, interview, record review, the licensee did not comply with the section cited above in having current medical assessment for R1 which poses a potential health and safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to get a current medical assessment for R1 and submit documents to CCLD by POC date.

Deadline recorded: Jan 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(5)(A)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (5) Change of use of the facility. (A)The licensee may, upon no less than sixty (60) days written notice, evict a resident due to change of use of the facility. 1. In addition to written notice to quit requirements specified in Section 87224(d),...notice shall include all requirements specified in Section 1569.682(a)(2)(A) through (F) of the HSC. This requirement is not met as evidenced by the 60-day notice letter given to residents was not in compliance with regulation which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM to submit 60-day eviction letter that meets regulations to LPA, residents, and families by POC date.

Deadline recorded: Nov 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208

Regulation authority

CCR

What the official deficiency says

“…Any significant changes in the plan of operation…shall be submitted to the licensing agency for approval. " This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

By POC date, the facility will submit to CCLD for review a new, detailed plan of operation describing the changes that the Licensee wishes to implement. The facility also agree to not admit any more resident to the 55+ floor until they have received approval of their new plan of operations

Deadline recorded: Nov 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. Based on interviews conducted the licensee did not comply with the section cited above. Medications were found under R3's bed which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator to conduct a medication training adressing the issue of residents cheek-ing medication and provide proof to LPA by POC date.

Deadline recorded: Sep 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. All individuals subject to a criminal record review ...Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not associating S1 to the facility which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility associated S1 during inspection. Deficiency cleared.

Deadline recorded: May 30, 2024. 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

87309 (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: -Based on observation, the licensee did not comply with the section above for unlocked laundry room which posed an immediate health and safety risks to persons in care.

Official plan of correction

Staff locked the room. In addition, administrator to in-service the staff and submit proof by 3/21/24.

Deadline recorded: Mar 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(30)(F)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services: (a).....The following provisions shall apply: (3).....if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(F) Basic laundry service (washing, drying, and ironing of personal clothing). -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above for charging the residents for laundry of personal clothing which poses a potential personal rights risk to persons in care.

Official plan of correction

Administrator to do the following, and submit proof by 4/03/24: 1. Stop charging the residents for personal laundry. 2. Notify the residents regarding item # 1. 3. Revise the Admission Agreement pertaining to laundry service.

Deadline recorded: Apr 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 having a staff member not fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/02/2024 Plan of Correction The facility agrees to remove the staff until they are fingerprint cleared and associated to the facility. A civil penalty of $500.00 is assessed on this day. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency....(1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence of any of the events......(A) Death of any resident from any cause regardless of where death occured This requirement is not met evidenced by: Based on record review, the Administrator did not comply with the section above for not submitting the death report within 7 days which posed potential personal rights risk to person in care.

Official plan of correction

Administrator will go over reporting requirements and submit a self certification of understanding of reporting requirements. Administrator shall submit self-certification to CCLD by POC due date.

Deadline recorded: Jan 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements... centrally stored: (2) Centrally stored medicines... to persons... the... medication. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not securing medication when being delivered to resident’s apartment which poses and immediate health and safety risk to residents in care.

Official plan of correction

Administrator will review and understand regulation and send self-certification to CCLD no later than POC date. Administrator will conduct in-service training for all Medical Technicians on the importance of keeping medication in a safe and locked place inaccessible to residents in care.

Deadline recorded: May 16, 2023. 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

87303 Maintenance and Operation (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 interviews and inspection. the licensee did not comply with the section above. LPA observed water damage in the walls and ceiling of Apt 12 which poses potential safety risk to person in care.

Official plan of correction

Administrator to do the following: Have the necessary repairs completed in Apt. 12 by the POC date and submit proof to LPA.

Deadline recorded: Feb 23, 2023. 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

87303 Maintenance and Operation (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 interviews and inspection. the licensee did not comply with the section above. The shower head holder fixture in resident apartment broken and P-trap in the kitchen sink of another apartment clogged which pose potential personal rights risks to person in care.

Official plan of correction

Administrator to have shower head holder fixture installed and P-trap cleared of clogging, Proof to be submitted by 5/18/2022.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... -This requirement is not met as evidenced by: -Based on interview and review of record, the licensee did not comply with the section cited above by not reporting the positive case of COVID-19 to CCL and LPH.

Official plan of correction

Executive Director to submit proof by May 5, 2022 that the positive case is reported.

Deadline recorded: May 5, 2022. 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

87303 Maintenance and Operation (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 interviews and inspection. the licensee did not comply with the section above. LPA observed the following: (1) water leaking from the bathroom ceiling and sign of water leak in the bedroom ceiling in one of the residents' apartment; (2) sink faucet leaking in another resident apartment; (3) water damage in the ceiling on the third floor hallway which pose potential safety and personal rights risks to persons in care.

Official plan of correction

Administrator to do the following: Check all apartments for leak and have the repair needed done. Proof to be submitted by May 18, 2022.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) ...(4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. -This requirement is not met as evidenced by: -Based on inspection, the licensee did not comply with the section above. LPA observed one of the shower room of the resident's apartment without grab bar which poses potential safety risk to person in care.

Official plan of correction

Administrator to have grab bar installed and submit picture by 5/18/2022.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(b)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. -This requirement is not met as evidenced by: -Based on interviews and records review, the licensee did not comply with the section above. The temperature at the dining area was not at comfortable level and heaters in residents apartments not working. These pose potential health and personal right risks to persons in care.

Official plan of correction

Administrator to check all apartment and have the heater fixed/repaired. Proof to be submitted by 5/18/2022.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463(a) Reappraisals The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. This requirement is not met as evidenced by: Based on records obtained by the Department, R1 has fallen multiple times between 09/2019 and 02/2020. There is no documentation to show that the facility conducted a reassessment of the resident and updated the resident’s Needs and Services Plan for changes in condition following these falls which poses a potential risk to the health and safety of clients under care.

Official plan of correction

By POC date, Administrator will review and ensure that all Appraisal Needs and Services Plans (ANS) are current. Administrator will submit to CCL self-certification stating that all ANS have been reviewed, updated and signed by resident/responsible person.

Deadline recorded: Apr 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(5)(a)

Regulation authority

CCR

What the official deficiency says

87705(c) (5) (A) Care of Persons with Dementia (A) When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Based on investigation conducted by the Department, R1 had fallen multiple times between 9/2019 and 2/2020. There is no documentation to show that the facility conducted a reassessment of R1. On 2/26/2020, R1 fell in the bathroom which resulted in a fractured spine. Medical records show R1 diagnosed with Dementia on 02/07/2017.

Official plan of correction

1. By POC date, Administrator will send to CCL schedule of staff training on Observation of Residents. Proof of training will be submitted to CCL by POC date. 2. A Non- Compliance Conference (NCC) will be scheduled to discuss additional plans of correction. 3. A $500 civil penalty is assessed on this day for violation which resulted to the injury of R1. 4. Civil penalty determination related to serious bodily injury is pending. A $500 immediate civil penalty is assessed today.

Deadline recorded: Apr 19, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)(4)

Regulation authority

CCR

What the official deficiency says

87224 (a) (4) 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 in paragraph (5) (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement is not met as evidenced by: Based on interview and records review, facility failed to issue R1 a 30-day notice of eviction. Facility refused to take back R1 when R1 was ready for discharge back to the facility from the skilled nursing facility (SNF).

Official plan of correction

By POC date, Administrator will review regulation, and submit a self-certification of understanding to CCL.

Deadline recorded: Apr 25, 2022. A deadline is not proof that correction was completed.