ELDERLY INN IV, THE

4908 ILLINOIS AVE, Fair Oaks CA 95628

Facility 342700416 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Nov 4, 2025Licensed

Additional info
Licensee
TOPLEAN, SAM
Administrator
TOPLEAN, SAM
Contact
TOPLEAN, SAM
License first date
Nov 14, 2018
License effective date
Nov 14, 2018
District office
SACRAMENTO NORTH ASC · (916) 263-4700
Regional office
59
Clients served
935 - ELDERLY

Summary

The available records show 2 Type A and 2 Type B deficiencies for this facility.

Most recent inspection
Nov 4, 2025
Most recent deficiency
Nov 4, 2025

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 598 Sacramento County facilities licensed for 6 or fewer beds.

In the available public five-year record, CCLD published 8 reports for this facility: 7 inspections, 1 complaint investigation, and 0 licensing or administrative records.

Those records contain 2 Type A and 2 Type B deficiencies.

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

Official inspections
7

More than the typical 5

1 in the last 12 months

Recorded deficiencies
4

More than the typical 1

1 in the last 12 months

Type A deficiencies
2

Most this size have none

1 in the last 12 months

Type B deficiencies
2

Most this size have none

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

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
Medication handling and storageType A
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 LPA's observations, the facility did not ensure that all centrally stored medications were stored in a safe and locked place that is not accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2025 Plan of Correction Facility will ensure that all centrally stored medications are kept in a safe and locked place that is not accessible to the residents in care at all times. Facility secured accessible medications during inspection. LPA cleared deficiency at the conclusion of this visit.

Official record says corrected or clearedRecorded in report dated Nov 4, 2025
Plan of correction recorded
View official report
Inspection
Facility condition and maintenanceType B
Official classification
Type B
Official code
87303(e)(2)
Regulation authority
CCR

What the official deficiency says

(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 observation, the facility did not ensure that hot water was maintained not less than 105 degrees F and not more than 120 degrees F, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2023 Plan of Correction Facility will ensure that water temperatures are controlled not less than 105 degrees F and not more than 120 degrees F. LPA will conduct a future visit to check the temperature of the hot water.

Plan of correction recorded
Correction not verified in available records
View official report
Food serviceType B
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 facility did not ensure that there were no expired food items on the premises, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2023 Plan of Correction Facility will ensure that they have no expired food items on the premises. Licensee will complete a statement of understanding regarding regulation 87555 and submit statement to LPA by POC due date.

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Medical and dental careType A
Official classification
Type A
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. The plan shall (...) provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication count and observations, the facility did not ensure that medications were properly administered by tracking R2 and R3's medications on Centrally Stored Medication form, which poses an immediate health, safety or personal rights risk to the residents in care.

Official plan of correction

Licensee will complete a statement of understanding regarding regulation 87465. Licensee will submit statement of understanding to LPA by POC due date.

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

Plan of correction recorded
Correction deadline recordedDeadline Jul 14, 2023
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