Inspection Reports for
Acacia Creek – Union City
34400 MISSION BLVD., UNION CITY, CA, 94587
Back to Facility ProfileDeficiencies (last 6 years)
Deficiencies (over 6 years)
2.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
30% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Occupancy
Latest occupancy rate
47% occupied
Based on a May 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Complaint Investigation
Census: 175
Capacity: 376
Deficiencies: 0
Date: May 22, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff were keeping a resident against their will.
Complaint Details
The complaint alleging that staff were keeping a resident against their will was investigated and found to be unfounded.
Findings
The allegation was found to be unfounded after review of resident rosters and interviews showed the individual involved never resided at the facility. No deficiencies were observed or cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Viarmina Paje-Forsythe | Wellness Manager | Met with Licensing Program Analyst during the investigation. |
| Chuck Major | Administrator | Named as facility administrator. |
Inspection Report
Annual Inspection
Census: 171
Capacity: 376
Deficiencies: 0
Date: Apr 16, 2025
Visit Reason
The inspection was an unannounced required annual inspection to evaluate compliance with licensing requirements.
Findings
No deficiencies or citations were observed or issued during the inspection. The facility was clean, odor free, and had appropriate safety measures in place.
Report Facts
Fire extinguisher last serviced date: Jan 10, 2025
Fire alarm inspection date: Feb 19, 2025
Fire drill date: Feb 19, 2025
Staff files reviewed: 6
Resident files reviewed: 10
Inspection Report
Complaint Investigation
Census: 171
Capacity: 376
Deficiencies: 0
Date: Apr 16, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff did not refund the entrance fee as required by the continuing care contract.
Complaint Details
The complaint alleged that staff did not refund the entrance fee as required by the continuing care contract. The allegation was found to be unfounded after review of agreements, financial documents, and interviews.
Findings
The investigation found that the allegation was unfounded because the resident entered a skilled nursing facility operated by Masonic Homes of California, which disqualified entitlement to a refund under the contract terms. The entrance fee refund was properly handled according to the approved Residence and Care Agreement.
Report Facts
Facility Capacity: 376
Resident Census: 171
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Evaluator | Conducted the complaint investigation |
| Sandra Simon | Executive Director | Met with evaluators during the investigation |
| Bennett Fong | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Census: 177
Capacity: 376
Deficiencies: 0
Date: Mar 19, 2025
Visit Reason
An unannounced Case Management Visit was conducted related to a previous complaint to review the facility's compliance with care plan documentation requirements.
Complaint Details
The visit was related to a previous complaint 15-AS-20241204123458. No deficiencies were cited during this visit.
Findings
The facility did not have proper documentation of Resident 1's care plan, specifically lacking indication of services needed for 1:1 care. No deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Vilarmina Paje-Forsythe | Wellness Manager | Met with Licensing Program Analysts during the visit. |
| Kelly Nguyen | Licensing Evaluator | Conducted the inspection and signed the report. |
| Bennett Fong | Supervisor | Supervisor of the Licensing Program Analysts. |
Inspection Report
Complaint Investigation
Census: 178
Capacity: 376
Deficiencies: 0
Date: Mar 7, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that a resident sustained injuries due to lack of care and supervision, and that staff did not ensure the resident's toileting needs were met.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included resident injury due to lack of care and unmet toileting needs. Evidence showed the resident was not a fall risk, staff responded when the resident pressed the pendant, and toileting needs were met.
Findings
The investigation found the allegations unsubstantiated. Records and interviews showed the resident was independent with toileting assistance only when requested via a pendant. The resident sustained a minor cut but no major injury and reported satisfaction with staff care.
Report Facts
Facility Capacity: 376
Resident Census: 178
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Evaluator | Conducted the complaint investigation visit and delivered findings |
| Chuck Major | Administrator | Facility administrator named in report header |
| Sandra C. Simonn | Executive Director | Met with Licensing Evaluator during inspection |
| Bennett Fong | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Routine
Deficiencies: 6
Date: Feb 6, 2025
Visit Reason
The inspection was a routine regulatory survey to assess compliance with healthcare facility standards, including skin and wound care, medication storage, food safety, sanitation, call light accessibility, and environmental safety.
Findings
The facility was found deficient in multiple areas including failure to properly label pressure ulcer dressings, expired medications in emergency drug kits, improper food labeling and storage, unsanitary dumpster area, inaccessible call lights for some residents, and a non-operational hand sanitizer dispenser in a resident room. These deficiencies posed risks of delayed wound healing, medication errors, foodborne illness, pest harborage, resident safety, and infection spread.
Deficiencies (6)
F 0686: The facility failed to follow skin and wound care policy when Resident 69's pressure ulcer dressing was not labeled with last change date and nurse initials, risking delayed wound healing and infection.
F 0761: The facility failed to ensure safe medication storage when expired medications were found in an emergency drug kit, risking residents receiving ineffective medications.
F 0812: The facility failed to ensure food items in the walk-in refrigerator were properly labeled with received, open, and use-by dates, and the ice machine was dusty and discolored, risking foodborne illness.
F 0814: The facility failed to maintain a sanitary garbage and refuse storage area, with trash and used gloves littering the dumpster surroundings, risking pest harborage.
F 0919: The facility failed to ensure call lights were within easy reach for three residents, risking inability to request assistance when needed.
F 0921: The facility failed to provide a safe and sanitary environment when a hand sanitizer dispenser in a resident bedroom was non-operational for four days, risking infection spread.
Report Facts
Weight loss percentage: 9.02
Number of residents sampled for call light accessibility: 71
Number of expired emergency drug kits: 1
Number of unlabeled food items: 8
Number of residents affected by deficiencies: Few or Some
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Vocational Nurse 2 (LVN 2) | Stated facility policy requires dressing changes to be dated and initialed; acknowledged nurses sometimes forget. | |
| Licensed Registered Nurse (RN2) | Confirmed expired emergency drug kit found in medication room. | |
| Pharmacy Manager (PM) | Confirmed expired emergency drug kit and planned replacement. | |
| Director of Dining Services (DD) | Participated in kitchen tour and confirmed food labeling expectations. | |
| Registered Dietician (RD) | Participated in kitchen tour and dumpster area observation. | |
| Maintenance Staff (MS) | Observed dumpster area sanitation issues. | |
| Facility Manager (FM) | Acknowledged dumpster sanitation issues and planned ice machine replacement. | |
| Licensed Vocational Nurse (LVN 1) | Confirmed call lights were not within reach for residents 3, 59, and 64. | |
| Director of Nursing (DON) | Stated residents should have call lights within reach at all times. | |
| Registered Nurse 1 (RN 1) | Attempted to repair non-operational hand sanitizer dispenser and alerted maintenance. | |
| Certified Nursing Assistant (CNA) | Reported use of hand sanitizer dispensers in resident rooms and importance for infection control. | |
| Administrator | Alerted to non-operational hand sanitizer dispenser and planned follow-up. |
Inspection Report
Complaint Investigation
Census: 160
Capacity: 376
Deficiencies: 0
Date: Dec 5, 2024
Visit Reason
The visit was an unannounced Health and Safety check conducted due to the department receiving a priority 2 complaint.
Complaint Details
The visit was triggered by a priority 2 complaint. No deficiencies were cited, indicating no substantiated issues during this inspection.
Findings
The facility was observed to be preparing for a tree light event. Residents appeared comfortable and safe with no imminent health or safety concerns noted, and no deficiencies were cited during the check.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Simon | Executive Director | Met with during the inspection and explained the purpose of the visit. |
| Kelly Nguyen | Licensing Program Analyst | Conducted the unannounced Health and Safety check. |
| Bennett Fong | Supervisor | Named as supervisor overseeing the inspection. |
Inspection Report
Deficiencies: 1
Date: Aug 28, 2024
Visit Reason
The inspection was conducted to assess compliance with care standards related to treatment and care of residents, specifically focusing on Resident 1's significant weight loss and skin condition.
Findings
The facility failed to ensure Resident 1 received appropriate treatment and care according to professional standards. Resident 1's significant weight loss and bilateral buttock redness were not addressed in the comprehensive care plan, and the physician and family were not notified of these changes.
Deficiencies (1)
F 0684: The facility did not address Resident 1's continued weight loss and bilateral buttock redness on the comprehensive care plan with appropriate interventions. The facility also failed to notify Resident 1's physician and representatives of the continued weight loss.
Report Facts
Weight loss in pounds: 17.8
Weight loss in pounds: 5.3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Dietician (RD) | Interviewed regarding Resident 1's weight loss and skin condition | |
| MDS Coordinator (MDS 1) | Interviewed regarding care plan and CAA summary for Resident 1 | |
| Licensed Vocational Nurse (LVN 1) | Interviewed regarding notification of family and physician about Resident 1's weight loss | |
| Registered Nurse-Supervisor (RN 1) | Interviewed regarding facility's weight variance protocol and notification process | |
| Director of Nursing (DON) | Interviewed regarding expectations for notification and care plan updates |
Inspection Report
Annual Inspection
Census: 159
Capacity: 376
Deficiencies: 0
Date: May 29, 2024
Visit Reason
The visit was an unannounced annual required inspection conducted by the Licensing Program Analyst to evaluate compliance with licensing regulations.
Findings
No deficiencies or citations were observed or issued during the inspection. The facility was found clean, odor free, and compliant with health and safety standards including fire safety and food storage.
Report Facts
Residents in assisted living: 6
Fire extinguisher last serviced date: Jan 17, 2024
Fire alarm inspection date: Apr 26, 2024
Freezer temperature: -2
Freezer temperature: 0
Refrigerator temperature: 37.5
Refrigerator temperature: 35.4
Staff files reviewed: 6
Resident files reviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the annual inspection and evaluation. |
| Chuck Major | Executive Director | Facility Administrator met during inspection. |
Inspection Report
Complaint Investigation
Census: 147
Capacity: 376
Deficiencies: 0
Date: Aug 29, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff smoked marijuana at the facility.
Complaint Details
The complaint alleged that staff smoked marijuana at the facility. The allegation was investigated through interviews with 5 residents and 4 staff members, and review of internal reports. The allegation was found to be unsubstantiated.
Findings
The investigation found no substantial evidence to prove that staff smoked marijuana at the facility. Interviews with residents and staff, as well as internal reports, concluded the allegation was unsubstantiated.
Report Facts
Capacity: 376
Census: 147
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Chuck Major | Administrator | Met with Licensing Program Analyst during the investigation |
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 147
Capacity: 376
Deficiencies: 0
Date: Aug 29, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff do not safeguard residents' personal items.
Complaint Details
The complaint alleged that staff do not safeguard resident's personal items. The investigation included interviews with staff and residents and review of facility policies. The allegation was unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation found insufficient evidence to substantiate the allegation that staff do not safeguard residents' personal items. The allegation was determined to be unsubstantiated.
Report Facts
Capacity: 376
Census: 147
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Chuck Major | Administrator | Facility administrator present during investigation and findings delivery |
Inspection Report
Routine
Deficiencies: 3
Date: Jul 13, 2023
Visit Reason
The inspection was conducted to evaluate compliance with medication administration, food safety, and sanitation standards at the nursing home.
Findings
The facility failed to prevent a medication error rate of 13.51% due to crushing medications without orders, served bland food lacking flavor which could reduce residents' nutritional intake, and failed to maintain proper food handling and sanitation practices in the kitchen, risking foodborne illness.
Deficiencies (3)
F 0759: The facility failed to prevent a 13.51% medication error rate when medications were crushed together without an order, including an enteric coated medication, risking malabsorption.
F 0804: The facility failed to provide palatable food; meals were bland, which could reduce residents' food and nutrient intake.
F 0812: The facility failed to store and prepare food safely, including ungloved ice handling, unlabeled spices, undated and expired food in refrigerators, dirty kitchen surfaces, and improper glove use during food preparation.
Report Facts
Medication pass observations: 37
Medication pass errors: 5
Medication error rate: 13.51
Residents affected by food safety issues: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Vocational Nurse (LVN 1) | Prepared and crushed medications without order | |
| Registered Nurse (RN 1) | Reviewed physician orders and medication instructions | |
| Registered Dietitian 3 (RD3) | Observed food preparation and commented on recipe adherence | |
| Dietary Staff 1 (DS1) | Observed preparing food and improper glove use | |
| Dietary Staff 2 (DS2) | Observed scooping ice without gloves | |
| Director of Dining Services (DSS) | Verified and acknowledged food safety and sanitation deficiencies |
Inspection Report
Complaint Investigation
Census: 147
Capacity: 376
Deficiencies: 0
Date: Jun 28, 2023
Visit Reason
This was an unannounced complaint investigation visit triggered by allegations of staff abusing residents and mismanaging residents' medications.
Complaint Details
The complaint was investigated and found to be unfounded, meaning the allegations were false, could not have happened, or were without reasonable basis.
Findings
The investigation found that the individuals involved in the incident did not work or reside at the facility, rendering the allegations unfounded. No deficiencies were observed or cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Chuck Major | Administrator | Facility administrator met during the investigation. |
Inspection Report
Annual Inspection
Census: 154
Capacity: 376
Deficiencies: 2
Date: Apr 14, 2023
Visit Reason
Unannounced annual required inspection to evaluate compliance with licensing regulations.
Findings
The facility was generally clean and well-maintained with adequate food supplies and safety equipment. Two deficiencies were cited related to improper storage of chemicals and freezer cleaner posing potential health and safety risks.
Deficiencies (2)
CCR 87309(a) Storage Space: Chemicals in housekeeping carts were left unlocked and unattended in hallways, posing an immediate health and safety risk to persons in care.
CCR 87555(b)(25) General Food Service Requirements: Freezer cleaner was stored in the non-perishable food storage area, posing a potential health and safety risk to persons in care.
Report Facts
Residents present: 154
Licensed capacity: 376
Residents in assisted living: 7
Freezer temperature: -2
Freezer temperature: 0
Refrigerator temperature: 37.5
Refrigerator temperature: 35.4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted inspection and cited deficiencies |
| Chuck Major | Administrator | Facility administrator met with inspectors and participated in exit interview |
Inspection Report
Routine
Census: 159
Capacity: 376
Deficiencies: 0
Date: May 23, 2022
Visit Reason
The visit was an unannounced Infection Control Inspection conducted as a required one-year routine inspection.
Findings
The facility was found to have proper infection control measures including screening, PPE use, and sufficient supplies. No deficiencies were cited during the visit.
Inspection Report
Routine
Census: 178
Capacity: 376
Deficiencies: 0
Date: Jun 30, 2021
Visit Reason
The visit was an unannounced Infection Control Inspection conducted as a required one-year routine check.
Findings
The facility was found to have adequate infection control measures including proper PPE use, screening procedures, and sufficient food supplies. No deficiencies were cited during the visit.
Inspection Report
Routine
Deficiencies: 5
Date: Aug 2, 2019
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care planning, accident prevention, food sanitation, and infection control at the nursing home.
Findings
The facility failed to develop baseline care plans within 48 hours of admission for several residents, did not implement comprehensive care plans for medication management, failed to ensure supervision to prevent accidents related to a missing wander guard device, did not follow proper sanitation and food storage practices, and failed to observe infection control practices related to hand hygiene after glove removal.
Deficiencies (5)
F 0655: The facility failed to develop baseline care plans within 48 hours of admission for residents with pacemakers, blood thinning medication, and COPD, risking delayed recognition and care.
F 0656: The facility failed to develop and implement a comprehensive care plan for a resident receiving Eliquis, risking delayed care for bleeding emergencies.
F 0689: The facility failed to ensure supervision to prevent accidents when a resident's wander guard device was not in place, risking elopement.
F 0812: The facility failed to follow proper sanitation and food storage practices, including dirty ice machine filters and improper temperature logs, risking foodborne illness.
F 0880: The facility failed to observe infection control practices when staff handled oxygen tubing with gloves and did not perform hand hygiene after glove removal, risking infection spread.
Report Facts
Residents sampled: 22
Medication dosage: 40
Medication dosage: 2.5
Temperature range: 36
Temperature range: 46
Temperature range: 33
Temperature range: 41
Oxygen flow rate: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 1 | Registered Nurse | Named in infection control deficiency for not performing hand hygiene after glove removal |
| ADON | Assistant Director of Nursing | Named in infection control deficiency for not performing hand hygiene after glove removal |
| MDSC 2 | Minimum Data Set Coordinator | Interviewed regarding missing baseline care plans for multiple residents |
| DON | Director of Nursing | Interviewed regarding care plan deficiencies and food refrigerator temperature logs |
| LVN 2 | Licensed Vocational Nurse | Interviewed regarding resident food refrigerator temperature logs |
| CNA 3 | Certified Nursing Assistant | Interviewed regarding missing wander guard device on Resident 32 |
| DSD | Director of Staff Development | Interviewed regarding hand hygiene policies |
| AFD | Assistant Facility Director | Interviewed regarding ice machine cleaning responsibilities |
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