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295 SPARROW DR, Hercules CA 94547

Facility 079200822 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Jul 10, 2024Licensed

Additional info
Licensee
DASTGHEIB, ALI SINA
Administrator
DASTGHEIB, ALI SINA
Contact
DASTGHEIB, ALI SINA
License first date
Aug 19, 2019
License effective date
Aug 19, 2019
District office
OAKLAND ASC · (510) 286-4201
Regional office
15
Clients served
935 - ELDERLY

Summary

The available records show 3 Type A and 8 Type B deficiencies for this facility.

Most recent inspection
Jul 10, 2024
Most recent deficiency
Jul 10, 2024

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 391 Contra Costa County facilities licensed for 6 or fewer beds.

In the available public five-year record, CCLD published 4 reports for this facility: 4 inspections, 0 complaint investigations, and 0 licensing or administrative records.

Those records contain 3 Type A and 8 Type B deficiencies.

3 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections
4

Fewer than the typical 5

0 in the last 12 months

Recorded deficiencies
11

Well above the typical 3

0 in the last 12 months

Type A deficiencies
3

More than the typical 1

0 in the last 12 months

Type B deficiencies
8

Well above the typical 2

0 in the last 12 months

Substantiated complaints
0

Most this size also have none

0 in the last 12 months

Repeated topics
0

Last 36 months

No inspection in the last 12 months, so a zero above means no record rather than a clean visit.

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.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Inspection
Not classified in the sourceType B
Official classification
Type B
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, the licensee did not comply with the section cited above in not having carbon monoxide detector/smoke detector working which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Administrator agreed to check carbon monoxide detector/smoke detector every 6 months to insure detector is in operating condition at all times. DEFICIENCY CLEARED DURING VISIT.

Official record says corrected or clearedRecorded in report dated Jul 10, 2024
Plan of correction recorded
View official report
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 observation and record review, the licensee did not comply with the section cited above by not having the Administrator file located at the facility and having incomplete staff files which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction Administrator agreed to create a file for the Administrator and complete files for S1 and S2, read the regulation and self certify that he will comply with the regulation and submit self certification to the department by the POC date.

Plan of correction recorded
Correction not verified in available records
View official report
Admission, assessment, and evictionType B
Official classification
Type B
Official code
87463(c)
Regulation authority
CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 updated Physicians reports for all 4 clients which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Administrator agreed to get all 4 residents updated Physicians reports updated, and submit copies to the department by the POC date.

Plan of correction recorded
Correction not verified in available records
View official report
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 record review, the licensee did not comply with the section cited above by not conducting emergency disaster drills which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction Administrator agreed to conduct an emergency disaster drill and submit log to the department by the POC date.

Plan of correction recorded
Correction not verified in available records
View official report
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
87203
Regulation authority
CCR

What the official deficiency says

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. 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 having the fire extinguisher serviced by the expiration date which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Administrator agreed to have fire extinguisher serviced and submit a copy of the fire extinguisher tag to the department by the POC date.

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Dementia careType B
Official classification
Type B
Official code
87705(f)(1)
Regulation authority
CCR

What the official deficiency says

87705(f)(1) Knives, tools, firearms (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 LPA observation licensee did not comply with the section cited above by having a weed eater, round up week killer, rake, slug & snail killer, bleach, air freshener, lysol, gardening soil and comet which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 10/06/2022 Plan of Correction Administrator agreed to flip the top lock on the door leading to the garage to make garage inaccessible to residents in care. Deficiency cleared during visit.

Official record says corrected or clearedRecorded in report dated Sep 29, 2022
Plan of correction recorded
View official report
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
87202(a)
Regulation authority
CCR

What the official deficiency says

87202 (a) Fire Clearance 87202 Fire Clearance (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: Deficient Practice Statement Based on observation and records review, Licensee failed to have storage shed in back yard cleared as a living space which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 10/13/2022 Plan of Correction Administrator agreed to vacate the storage shed and submit a LIC 200 along with an updated facility sketch to request for a new fire clearance to CCLD no later then the POC date.

Plan of correction recorded
Correction not verified in available records
View official 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 record review, the licensee did not comply with the section cited above by locking side gate which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2021 Plan of Correction Staff removed lock during inspection. Deficiency cleared. Civil penalty of $500 is being assessed.

Official record says corrected or clearedOn or before Sep 2, 2021
Plan of correction recorded
View official report
Staffing, personnel, and trainingType A
Official classification
Type A
Official code
87412(a)(13)
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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: 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 that is not finger print cleared working at the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2021 Plan of Correction Administrator will obtain finger print clearance for staff and provide documentation to CCLD by POC date. Civil penalty of $500 is being assessed.

Plan of correction recorded
Correction not verified in available records
View official report
Health conditions and treatmentsType A
Official classification
Type A
Official code
87608(a)(5)(B)
Regulation authority
CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 full bed rail for resident who's not on hospice care which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2021 Plan of Correction Administrator has agreed to remove full bed rail and provide picture to CCLD by POC date.

Plan of correction recorded
Correction not verified in available records
View official report
Food serviceType B
Official classification
Type B
Official code
87555(b)(26)
Regulation authority
CCR

What the official deficiency says

(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. 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 having one week of non perishable food which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2021 Plan of Correction Administrator has agreed to purchase additional non perishable food supply and submit receipt to CCLD by POC date.

Plan of correction recorded
Correction not verified in available records
View official 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