Inspection
No deficiencies recorded in this report
BLUEFIELD MANOR
4620 ROYAL GROVE CT., San Jose CA 95136
6 bedsLatest official report Apr 21, 2026Licensed
Additional info
- Telephone
- (408) 281-2213
- Licensee
- VALIN, ROSA BELLA I.
- Administrator
- VALIN, CHRISTIAN I.
- Contact
- VALIN, CHRISTIAN I.
- License first date
- Apr 29, 2020
- License effective date
- Apr 29, 2020
- District office
- SAN JOSE RO · (408) 324-2112
- Regional office
- 26
- Clients served
- 935 - ELDERLY
Summary
The available records show 5 Type B deficiencies for this facility.
- Most recent inspection
- Apr 21, 2026
- Most recent deficiency
- Apr 11, 2025
1 later report, on Apr 21, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
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 185 Santa Clara County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 4 reports for this facility: 4 inspections, 0 complaint investigations, and 0 licensing or administrative records.
Those records contain 0 Type A and 5 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 4
- Recorded deficiencies
- 5
- Type A deficiencies
- 0
- Type B deficiencies
- 5
- Substantiated complaints
- 0
- Repeated topics
- 0
Fewer than the typical 5
1 in the last 12 months
More than the typical 3
0 in the last 12 months
Fewer than the typical 1
0 in the last 12 months
More than the typical 2
0 in the last 12 months
Most this size also have none
0 in the last 12 months
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
Background checksType B
- 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 observation and record review, the licensee did not comply with the section cited above in that staff S1 was observed in the facility without association with the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/18/2025 Plan of Correction Administrator agreed to read Title 22 and to send plan of correction by the POC due date to ensure the facility always associated staff with the facility prior to working in the facility.
Plan of correction recorded
Correction not verified in available records
Inspection
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(c)(3)
- Regulation authority
- HSC
What the official deficiency says
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that a staff did not have valid first aid certificate which poses/posed a potential health, safety risk to persons in care.
Official plan of correction
POC Due Date: 04/10/2024 Plan of Correction Administrator stated to submit a plan of correction by the POC due date to have the staff complete the first aid training and to obtain the first aid certificate.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- 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 record review, the licensee did not comply with the section cited above in that a staff did not have health screen form completed which poses/posed a potential health risk to persons in care.
Official plan of correction
POC Due Date: 04/10/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to have the staff complete the health screen form.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(b)(1)(A)
- Regulation authority
- CCR
What the official deficiency says
(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that 1 out 3 resident did not have personal rights from signed in the resident file which poses/posed a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/10/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to have the resident to sign the personal right form and to keep it in the resident file.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType B
- Official classification
- Type B
- Official code
- 87465(c)(3)
- Regulation authority
- CCR
What the official deficiency says
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that 1 out of 3 resident's central stored medication form was not matched with the resident's medications which poses/posed a potential health, safety risk to persons in care.
Official plan of correction
POC Due Date: 04/10/2024 Plan of Correction ADM stated to submit the plan of correction by the POC due date to maintain residents' central stored medication forms accurate and up to date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this 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