SERRA HIGHLANDS SENIOR LIVING

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... This requirement is not met as evidenced by Based on observations, R1's room smelled like urine and LPA observed stains on R1's carpet which poses a potentional health and safety risk to residents in care.

Official plan of correction

Based on observations made during complaint visit on 4/28/26, the carpet was replaced with hardwood floors and the room was aired out and no longer smelled like urine. Deficiency cleared and corrected. A civil penalty of $250.00 is being issued during the visit for a repeat citation within 12 months. Deficiency was cited on 2/18/26.

Deadline recorded: May 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, 1/5 staff members was fingerprint cleared to work at a facility, however was not associated which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2026 Plan of Correction Licensee/administrator shall associated S1 to the facility and provide LPA proof of association.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on resident records reviewed, 5/5 resident records reviewed did not have a complete and current record of file as it was missing the admissions agreement, personal rights form, and safeguarding of property valuables form which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2026 Plan of Correction Licensee/administrator shall submit a written plan in writing how to ensure all resident files have all required documents per regulation 87506 readily available for review.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by: Deficient Practice Statement Based on resident records reviewed, 5/5 resident records reviewed did not have documentation in their files to show that annual routine visits were being done once every twelve months which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2026 Plan of Correction Licensee/administrator shall submit a plan in writing on how to ensure all resident records have annual routine visit documentation maintained in their files, including when the RSD is not at the facility and not available.

Official classification

Type A

Official code

1569.69(a)(1)

Regulation authority

HSC

What the official deficiency says

§1569.69 Employees assisting residents with self-administration of medication; training requirements: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 16 hours of initial training... This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medication which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on training records reviewed, S1 and S2 did not have their initial 16 hours of training documented prior to administering medication to residents in care which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/administrator shall submit a plan in writing on how to ensure all med-techs complete their initial 16 hours of training. Plan shall include, documented how many hours it took to complete the training.

Deadline recorded: Mar 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(c)(3)(D)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General: (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (3) The training shall include, but not be limited to, the following:(D) Policies and procedures regarding medications, including the knowledge in Section 87411(d)(4). This requirement is not met as evidenced by: The facility was unable to provide LPA documentation to show med-techs have been receiving their annual on-the-job training. LPA did not observe any annual trainings in med-techs files during file review.

Official plan of correction

Licensee/administrator shall submit a plan in writing on how to ensure all staff receive their annual on-the-job training. Plan shall include; who will be conducting the training, when it will be conducted, keeping track of staff that require their annual training, maintaining documentation of the training, etc.

Deadline recorded: Mar 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records: (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on 7 personnel records reviewed, LPA did not observe any staff training records in the files. In addition, facility was unable to provide it to LPA during the complaint visit on 3/5/26 which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/administrator shall submit a plan in writing on how to ensure personnel files are maintained at the facility and each personnel file contain the documents/information as listed on CCR 87412.

Deadline recorded: Mar 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(f)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures: (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement is not met as evidenced by: Based on record review, the facility was unable to provide LPA documentation to show that a copy of the 30-day eviction for R1 was submitted to CCLD. In addition, based on CCLD's record, a copy of the eviction notice was not observed which poses a potential health and safety risk to residents in care.

Official plan of correction

Facility shall develop a plan of correction to ensure compliance with Sec.87224(f). Licensee shall provide proper notice to CCLD if/when a resident is being issued an eviction notice.

Deadline recorded: Mar 12, 2026. 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... This requirement is not met as evidenced by: Based on LPA's observations, R1's room to have a urine odor which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/administrator shall submit a plan in writing on how to ensure resident rooms are clean and odor-free. Plan shall include, increasing housekeeping services.

Deadline recorded: Feb 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff... This requirement is not met as evidenced by: Based on interviews, R1 indicated that S1 says the F word or use other profanity towards him/her several times. According to staff interviewed, he/she witnessed S1 cursing at R1 while assisting S1 with providing care to R1 which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/administrator shall conduct an in-service training regarding personal rights of residents, including but not limited to treating residents with dignity and respect

Deadline recorded: Feb 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on R1’s file reviewed, R1 is unable to leave the facility unassisted, however, R1 left the facility unassisted on 1/8/26 at around 10:40am and did not return back to the community till 7pm when R1 was found by a good samaritan. Staff indicated they were not aware that R1 was not allowed to leave the facility unsupervised which poses an immediate health and safety risk to residents in care

Official plan of correction

Licensee/administrator shall conduct an in-service training with staff regarding elopement risk/wandering behavior. Regional sales indicated there is a book with the receptionist at the front desk to show which residents that are ABLE to leave unassisted and residents that are UNABLE to leave unassisted.

Deadline recorded: Jan 28, 2026. A deadline is not proof that correction was completed.

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... (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on R1's medication list, R1 was required to take one tablet of Pregabalin (75mg) medication daily every morning, and one 75mg tablet at bedtime, however the med-tech administered one 50mg capsule instead. The facility failed to provide R1's medication as prescribed by the physician.

Official plan of correction

Licensee/administrator shall conduct in-service training with med-techs to ensure residents are receiving their medication as prescribed.

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

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals: (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by: Based on records reviewed, R1 has not received an annual routine visit since 9/2021 which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/administrator shall ensure all residents are receiving annual visits and documentation is maintained in each resident's file. In addition, administrator/licensee shall ensure if residents refuse annual appointments or responsible parties fail to be responsive, it gets documented.

Deadline recorded: Jun 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on bservation, the licensee did not comply with the section cited above due to hot water being tested in random rooms and 7 out of 9 showed a temperature of between 99-103 deg F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee to submit a plan to address the water temperatures. Include in the plan a date on when the scheduled maintenance will be held and how the facility will monitor the temperature moving forward. Licensee to submit by POC due date.

Official classification

Type A

Official code

87355(e)(4)

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: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above due to four staff members does not have criminal record clearances which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee will develop a plan in writing to ensure compliance and the plan shall indicate the compliance date no later than 4/24/2025. Licensee to submit by POC due date.

Official classification

Type B

Official code

87468.1(a)(13)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (13)To have access to individual storage space for private use. This requirement is not met as evidenced by: LPA observed R1's room and observed R1's dresser against R1's bed and LPA was unable to fully open the dresser which poses a potential health and safety risk for residents in care.

Official plan of correction

Deficiency is cleared during the visit. LPA observed R1's room and observed R1 to have access to dresser.

Deadline recorded: Mar 14, 2025. 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 observations, the facility does not have working heating units in some parts of the facility. According to the administrator, there has been issues with some of the HVAC units and facility currently looking for repairs, however for the meantime, residents are being provided space heaters as an alternative option.

Official plan of correction

Licensee/Administrator shall submit a plan in writing indicating how to ensure a comfortable temperature is maintained at the facility. Plan shall include repairing heating units.

Deadline recorded: Mar 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on staff interviews, there was a resident (R1) who did leave the facility unassisted once and was found by a caregiver and redirected back to the facility. Based on R1's physician's report reviewed, it was noted R1 had a diagnosis of dementia and is unable to leave the facility unassisted which poses an immediate health and safety risk for residents in care.

Official plan of correction

Licensee/administrator to conduct in-service training regarding elopment risks and how to ensure there is adequate supervision. Immediate Civil Penalty of $500.00 is being assessed today 2/24/25 for absence of supervision.

Deadline recorded: Feb 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87206(a)

Regulation authority

CCR

What the official deficiency says

87206 Advertisment and License Number: (a) In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence. Violation of this regulation is not met as evidenced by: Based on LPA’s observation, the facility is observed to be advertising online as Serra Highlands Senior Living and has signage of the facility name as Serra Highlands Senior Living outside the facility building without a valid RCFE License. Licensee has failed to operate consistent with licensure as ATRIA AT DALY CITY, which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Plan of correction to cease operating as Pacific Senior Living Burlingame to be submitted to CCLD BY DUE DATE

Deadline recorded: Apr 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87109(b)

Regulation authority

CCR

What the official deficiency says

87109(b) Transferability of License: The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least 30 days prior to the transfer of the property or business...as specified in Health and Safety Code Section 1569.191. This requirement was not met, as evidenced by absence of proof that written notice was issued to residents or their responsible parties. Licensee failed to ensure that proper notices were issued prior to doing business as Pacfica Senior Living, which poses a potential health, safety or personal rights risk to clients in care.

Official plan of correction

Plan of correction to be developed and submitted to CCLD BY DUE DATE

Deadline recorded: Apr 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87206(a)

Regulation authority

CCR

What the official deficiency says

87206 Advertisment and License Number: (a) In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence. Violation of this regulation is not met as evidenced by: Based on LPA’s observation, the facility is observed to be advertising online as Serra Highlands Senior Living and has signage of the facility name as Serra Highlands Senior Living outside the facility building without a valid RCFE License. Licensee has failed to operate consistent with licensure as ATRIA AT DALY CITY, which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Plan of correction to cease operating as Pacific Senior Living Burlingame to be submitted to CCLD BY DUE DATE

Deadline recorded: Apr 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87109(b)

Regulation authority

CCR

What the official deficiency says

87109(b) Transferability of License: The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least 30 days prior to the transfer of the property or business...as specified in Health and Safety Code Section 1569.191. This requirement was not met, as evidenced by absence of proof that written notice was issued to residents or their responsible parties. Licensee failed to ensure that proper notices were issued prior to doing business as Pacfica Senior Living, which poses a potential health, safety or personal rights risk to clients in care.

Official plan of correction

Plan of correction to be developed and submitted to CCLD BY DUE DATE

Deadline recorded: Apr 15, 2022. A deadline is not proof that correction was completed.