BURLINGAME SENIOR HOME 2

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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed scssiors and knifves were in the kitchen drawers unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction The administrator will develop a plan to ensure all sharps are locked at all times and provide a copy of the plan of correction to CCL by 2/26/2026.

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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R5 has bed rails at the head and foot of the bed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction The administrator stated that she will remove the bed rails by the head of the bed and provide proof/ photo(s) to CCL by 2/26/2026.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed the hot water faucet did not work in R3's room which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction The administrator will develop a plan to ensure the hot water faucet is fixed and will provide a copy of the plan to CCL by 3/11/2026.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S2's health screen was incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction The administrator will develop a plan of correction to ensure compliance and will provide a copy of S2's health screen to CCL by 3/11/2026.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R5's physician report was not signed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction The administrator will develop a plan of correction to ensure compliance and will provide a copy of R5's physician's report to CCL by 3/11/2026.

Official classification

Type A

Official code

87755(C)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: based on observation, upon entry, S1 was not able to provided required documents for LPA to inspect. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above based on observation, upon entry, S1 was not able to provided required documents for LPA to inspect which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction The administrator will develop a plan of correction indicating that she will develop binders with all the required documents for all the current residents and current caregivers and maintain them at the facility. On the plan of correction the administrator shall indicate the date that this project will be completed. The administrator will provide a copy of the plan of correction to CCL by 2/26/2026. A civil penalty of $250 is being assessed today for repeat violation.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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.... This requirement is not met as evidenced by based on observation and interview, LPA observed the medication cabinet was unlocked and there were medications stored outside of the medication cabinet which poses an immediate health and safety risks to residents in care.

Official plan of correction

During the visit, the administrator has locked all the medication in a locked closet. The administrator will submit a plan of correction to CCL by 9/6/2025 and the plan will indicate that the facility will purchase a new medication cabinet to ensure compliance. The plan will also indicate the estimated date of arrival for the new cabinet.

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 2 out of 2 staff did not have proof that required annual training was completed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction The administrator will provide a plan of correction to ensure staff training is completed and will provide a copy of the plan to CCL by 3/12/2025.

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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed medication cabinet and sharps were unlocked and 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: 03/12/2025 Plan of Correction The administrator will provide a plan of correction to ensure medication cabinet and sharps are locked and inaccessible to resident at all times and will provide a copy of the plan to CCL by 3/12/2025.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator was not able to provide proof that emergency drills were completed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction The administrator will provide a plan of correction to ensure emergency drills are completed and will provide a copy of the plan to CCL by 3/12/2025.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 3 residents have bedrails without a physician's order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction The administrator will provide a plan of correction to ensure physician orders are obtained for the residents with bedrails and will provide a copy of the plan to CCL by 3/12/2025.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 6 out of 6 residents did not have a reappraisal and/or an updated reappraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2025 Plan of Correction The administrator will provide a plan of correction to ensure all residents have a reappraisal and/or an updated reappraisal and will provide a copy of the plan to CCL and a copy of the appraisals/reappraisal to CCL by 3/18/2025.

Official classification

Type A

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

87755 Inspection Authority of the Licensing Agency This requirement is not met as evidenced by: S2 was not able to provide staff and residents files for reveiw as the administrator has the key(s) to the file cabinets and the administrator was not on-site upon LPA's entrance. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above S2 was not able to provide staff and residents files for review as the administrator has the key(s) to the file cabinets and the administrator was not on-site upon LPA's entrance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction The administrator will develop a plan to ensure compliance and will provide a copy of the plan of correction to CCL by 3/12/2025.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator was not able to provide documentation of the drills for 2023 to present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction The administrator will conduct a drill immediately and provide a copy of the staff in-service sign-in record of the drill to CCL by 2/23/2024. In addition, the administrator will provide a plan to CCL by 2/23/2024 to ensure drills are completed according to the regulation.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 2 out of 3 residents did not have documents to proof that preadmission appraisal were completed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/29/2024 Plan of Correction The administrator will develop a plan to ensure all pre-admission appraisal is completed and will provide a copy of the plan to CCL by 2/29/2024.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator was not able to provide proof that this plan was reviewed and updated accordingly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/29/2024 Plan of Correction The administrator will provide a copy of the updated emergency disaster plan to CCL by 2/29/2024 and will submit a plan to CCL by 2/29/2024 to ensure compliance in the future.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as chemicals stored underneath the kitchen sink were unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction The administrator will develop a plan to ensure all the toxins and chemicals are locked at all times. The administrator will provide a copy of the plan of correction and photos to proof that chemicals and toxins are locked to CCL 2/14/2024.

Official classification

Type A

Official code

80065(i)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Staff Association Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as S1 who was hired in March 2023 is not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction The administrator will associate S1 immediately and provide proof of S1's association to CCL by 2/14/2024.

Official classification

Type B

Official code

87113

Regulation authority

CCR

What the official deficiency says

The license shall be posted in a prominent location in the licensed facility accessible to public view. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observed it was posted during tour which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2024 Plan of Correction The administrator will ensure the license is posted and provide a photo to CCL by 2/20/2024.

Official classification

Type B

Official code

87468(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observed it was posted during the tour and according to the administrator, it fell and was not reposted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2024 Plan of Correction The administrator will ensure the license is posted and provide a photo to CCL by 2/20/2024.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observed it was posted during the tour and according to the administrator, it fell and was not re-posted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2024 Plan of Correction The administrator will post the required posters and will provide a photo to CCL of the above poster by 2/20/2024.

Official classification

Type B

Official code

87468(d)

Regulation authority

CCR

What the official deficiency says

(d) Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observed it was posted during the tour and according to the administrator, it fell and was not reposted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2024 Plan of Correction The administrator will post the required posters and will provide a photo to CCL of the above poster by 2/20/2024.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: centrally stored medication observed to be not locked and accessible to residents in care. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as centrally stored medication observed to be not locked and 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: 02/14/2024 Plan of Correction The administrator shall develop a plan to ensure centrally stored medication is locked at all times. The administrator will submit a copy of the plan and phots to proof compliance to CCL by 2/14/2024.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:Personal Rights of Residents in All Facilities Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed 2 of resident #1's medications were expired which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction The administrator will review all resident's medication to ensure all medications are not expired and will provide a statement to CCL by 2/14/2024 stating this process has been completed . In addition, the administrator will provide a plan to CCL by 2/14/2024 to ensure compliance.

Official classification

Type A

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:Inspection Authority of the Licensing Agency Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as resident and staff records/files were locked and inaccessible for LPA to review which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction The administrator shall develop a plan to ensure records are available to inspect according to the regulation. The administrator shall submit a copy of the plan to CCL by 2/14/2024.