Administrator qualifications
Cited in 2 reports, with 2 deficiencies in total.
5836 ETTERSBERG DRIVE, San Jose CA 95123
6 bedsLatest official report Mar 10, 2026Licensed
The available records show 7 Type A deficiencies for this facility.
5 later reports, from Sep 30, 2024 through Mar 10, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
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.
Counts cover the five-year public record. Typical figures are the median for the 185 Santa Clara County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 11 reports for this facility: 7 inspections, 4 complaint investigations, and 0 licensing or administrative records.
Those records contain 7 Type A and 0 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
More than the typical 5
1 in the last 12 months
More than the typical 3
0 in the last 12 months
Well above the typical 1
0 in the last 12 months
Fewer than the typical 2
0 in the last 12 months
Most this size have none
0 in the last 12 months
Last 36 months
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.
Cited in 2 reports, with 2 deficiencies in total.
All preserved reports from the most recent to the oldest, sortable by report type.
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportAllegations1 substantiated · 8 unsubstantiated · 0 unfounded · 2 cited · investigated over 2 visits
No deficiencies recorded in this reportPart of the complaint whose outcome is recorded on Sep 30, 2024 · Control 26-AS-20240430100728
87211 Reporting Requirement (a) Each licensee shall furnish to the licensing agency ... reports (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified in (A) Death of any resident. This requirement was not met as evidenced by: Based on document review and as stated by LIC/ADM he/she did not submit a death report because the resident passed away in the hospital and not in the facility.
LIC/ADM gave a written statement to LPA during today's visit that he/she will comply with Title 22 reporting requirement. con't LIC/ADM stated he/she is not aware that any death should be reported regardless of where it occurred.
Deadline recorded: May 30, 2024. A deadline is not proof that correction was completed.
Administrator Qualification (d) administrator shall have the qualifications (2) knowledge of and ability to conform to the applicable laws and regulations. This requirement was not met as evidenced by: Based on record review and interview. LIC/ADM did not conform to the applicable laws and regulations. LIC/ADM stated he/she was not aware of the reporting requirements for unusual incidents and death of a resident.
LIC/ADM stated that he/whe will submit a statement of understanding for reporting requirements and will conform to the applicable laws and regulations for Title 22
Deadline recorded: May 30, 2024. A deadline is not proof that correction was completed.
87355 All individuals...pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by Based on interview Licensee/ADM stated that he hired a staff that does not have a fingerprint or criminal background clearance prior to working at the facility, which pose/poses an immediate health, safety and personal rights risk to residents in care.
Licensee/ADM stated that all staff prior to working at the facility have criminal background and fingerprint clearance prior to working at the facility. Licensee will have staff fingerprinted and ensure that residents are protected from any harm. Licensee/ADM will provide a written plan of action by POC due date. LIC/ADM agreed and understood.
Deadline recorded: Apr 29, 2024. A deadline is not proof that correction was completed.
87468.2 Additional Personal Rights of Residents in privately owned facilities (a)(4)To care, supervision...that meet their..needs and are delivered by staff that are sufficient in qualifications...This requirement is not met as evidenced by: Based on interview and observation, Licensee/ADM did not provide care & supervision to residents by leaving the resident unattended and with a person who is a minor, which pose/poses an immediate health, safety and personal rights risk to persons in care.
Licensee/ADM stated that staff will have sufficient qualification to provide care & supervision that meets the needs of the persons in care, by providing training and guidance to staff. Licensee/ADM will provide a written plan of action by POC due date. LIC/ADM agreed and understood.
Deadline recorded: Apr 29, 2024. A deadline is not proof that correction was completed.
87705 Care of Person with dementia. (f) The following shall be stored inaccessible to residents with dementia: (1) Knives...(2)Over-the counter medication... supplements... toxics... such as... cleaning supplies...This requirement was not met as evidenced by: Based on observation, Licensee/ADM did not ensure that toxics, medications & knives located in the kitchen and three bathroom sink cabinets are inaccessible to persons with dementia, which pose/poses an immediate health, safety and personal right risk to persons in care.
Licensee/ADM stated to ensure that cleaning supplies and knives are locked at all times to ensure the safety of persons in care. Licensee/ADM will submit a written plan of action by the POC due date. Licensee/ADM agreed and understood.
Deadline recorded: Apr 29, 2024. A deadline is not proof that correction was completed.
87465 Incidental Medical and Dental Care Services (h)(2) Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication. This requirement is not met as evidenced by: Based on observation Licensee/ADM did not lock the upper kitchen cabinet and resident's prescription medication were accessible, which pose/poses an immediate health, safety and personal risks to persons in care.
Licensee/ADM stated that prescription and over-the counter medications is not accessible to persons in care. Licensee/ADM will submit a written plan of action by the POC due date. Licensee/ADM agreed and understood.
Deadline recorded: Apr 29, 2024. A deadline is not proof that correction was completed.
87405 Administrator - Qualifications and Duties (d)The administrator shall have the qualifications specified in Sections 87405(d) (1) through (7) If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement is not met as evidenced by: Based on observation, interview & record review, Licensee/ADM did not provide, care and supervision, did not ensure knives,toxics and medication are inaccessible to residents with dementia, and did not ensure staff has obtained a California criminal record clearance before providing direct care
LIcensee/ADM stated that a letter of understanding regarding Title 22 regulation by POC due date. Licensee/ADM agreed and undestood. (con't) to residents, which pose/poses an immediate health, safety and personal risks to persons in care. *87405(d)(1-7)
Deadline recorded: Apr 29, 2024. A deadline is not proof that correction was completed.
Allegations0 substantiated · 0 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportCalifornia 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.
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