AEGIS LIVING SAN RAFAEL

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303:(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations made, Licensee did not comply with the section cited above. 12 of 12 sinks were found to be out of compliance measuring at temperatures between 120.5F and 124.5F. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2026 Plan of Correction Licensee to submit a self certification stating that a water temperature log will be done and submitted. Self Certification due by POC due date of 08/05/2026. Log to be started on 08/05/2026 and end on 05/14/2026. Log to include date, location of sink, water temperature, and time of temperature check. Log to be submitted to CCL by POC due date of 08/17/2026.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance: (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 observations made and record review, Licensee did not comply with the section cited above. Licensee did not ensure that 6 out of 25 staff members had been associated to the facility prior working on-site and prior to LPA's visit. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2026 Plan of Correction Licensee to submit a written plan outlining how the facility will maintain compliance with regulation and ensure that facility staff members are associated to the facility once they have been background cleared. Plan to be submitted to CCL for review by POC due date of 08/05/2026.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities:(a) In addition to the rights listed in Section 87468.1... residents...shall have all of the following...: (4) To care, supervision, and services that meet their individual needs and are delivered by staff...this requirement was not met as evidenced by: based on records, interviews & observations made, Licensee did not comply with the section cited above and did not ensure that R2 received supervision to met their individual needs.This poses a potential health/safety/personal rights risk to residents in care.

Official plan of correction

Licensee to conduct a reassessment of R1 and R2, update their care plans to meet their current care needs and inform their responsible parties. Proof of updated assessments and care plan, and additional supporting documents to be submitted to CCL for review and approval by POC due due date of 04/27/2026.

Deadline recorded: Apr 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(e)(7)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (e) Licensees that use delayed egress devices... shall meet the following...requirements: (7) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents...this requirement was not met as evidenced by: based on record review, Licensee did not comply with the section cited above. Resident 1 (R1) eloped from the facility. R1's physician report & care plan showed R1 is unable to leave unassisted. This poses an potential health/safety/personal rights risk to residents in care.

Official plan of correction

Licensee provided proof of elopement training dated 12/24/2025. Deficiency cleared during visit.

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

Official classification

Type B

Official code

87616(a)

Regulation authority

CCR

What the official deficiency says

87616 Exceptions for Health Conditions (a) ...the licensee may submit a written exception request if he/she agrees that the resident has a prohibited... health condition but believes that the intent of the law can be met through alternative means. This requirement was not met as evidenced by: based on record review and interviews, Licensee did not submit the proper paperwork to Community Care Licensing once it was believed that R1 had an unstageable wound. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee to conduct in-service training for all direct staff reviewing the following regulations: 87616 Exceptions for Health Conditions and 87615 Prohibited Health Conditions. Training to include the following: Date, Topic, Job Role, Staff Names, and Signatures. In-Service and supporting documents to be submitted to CCL for review and approval by POC due date of 04/06/2026.

Deadline recorded: Apr 6, 2026. 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 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted...within seven days of the occurrence of any of the events specified...below. This requirement was not met as evidenced by: Licensee did not comply with section cited above. Per record review, Licensee did not submit incident reports timely. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to conduct inservice-training on Reporting Requirements. Training to include the following: Date, Topic, Name/Job Role, and Signatures. In-Service and supporting documents to be submitted to CCL for review and approval by POC due date of 04/06/2026.

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