Deficiencies (last 5 years)
Deficiencies (over 5 years)
17.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
335% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
32
24
16
8
0
Occupancy
Latest occupancy rate
61% occupied
Based on a March 2026 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Census: 55
Capacity: 90
Deficiencies: 0
Date: Mar 25, 2026
Visit Reason
The visit was conducted to follow up on a Decision and Order (exclusion) of two staff members at the facility.
Findings
The administrator confirmed that the excluded staff members are no longer working at the facility and acknowledged receipt of the Decision and Order. No deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Raimundo | Administrator | Met with Licensing Program Analyst during the visit and acknowledged receipt of the Decision and Order. |
| Murial Han | Licensing Program Analyst | Conducted the follow-up visit regarding the Decision and Order exclusion of staff. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 55
Capacity: 90
Deficiencies: 2
Date: Mar 25, 2026
Visit Reason
The visit was a case management visit conducted to deliver and discuss the amended report dated 1/28/2026 and to explain changes in civil penalties assessed during the annual inspection.
Findings
The Licensing Program Analyst explained that one civil penalty assessed during the annual inspection was removed, while two remaining civil penalties related to Personnel Records and Criminal Record Clearance were upheld with a reduced amount of $600 instead of $850. The report was reviewed and discussed with the administrator.
Deficiencies (2)
Personnel Records 87412(a)(13)(B)
Criminal Record Clearance
Report Facts
Civil penalty amount: 600
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brina Raimundo | Administrator | Met with Licensing Program Analyst during the visit and discussed the report |
| Murial Han | Licensing Program Analyst | Conducted the case management visit and explained civil penalty changes |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 51
Capacity: 90
Deficiencies: 9
Date: Jan 28, 2026
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and assess the facility's operations and safety.
Findings
The inspection found multiple deficiencies including unclean kitchen conditions, missing personnel files, staff without required criminal background clearance and TB status, incomplete emergency drills, and an unreviewed Emergency and Disaster Plan. Civil penalties were assessed for some violations.
Deficiencies (9)
Administrator was not able to locate Staff #5's personnel file.
Kitchen floor was dirty, dusty, greasy, and full of dark black particles.
Staff #1 was working without a criminal background clearance.
Staff #2 was not associated with the facility.
Staff #2 did not complete on-the-job training.
Last emergency drill was completed on 4/17/2025, not quarterly as required.
Ice machine was dusty, green garbage can had spots, gray tray had black dirt, and stove had grease.
Emergency and Disaster Plan Annual Review was blank.
Staff #5 did not have a TB status.
Report Facts
Civil penalty amount: 850
Civil penalty amount: 500
Civil penalty amount: 100
Civil penalty amount: 250
Resident files reviewed: 6
Staff files reviewed: 4
Staff files requested: 6
Staff files provided: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Raimundo | Administrator | Met with Licensing Program Analyst during inspection |
| Murial Han | Licensing Program Analyst | Conducted the inspection and authored the report |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 50
Capacity: 90
Deficiencies: 0
Date: Nov 13, 2025
Visit Reason
An unannounced Case Management - Other visit was conducted by Licensing Program Analyst Murial Han to deliver immediate exclusion letters for two staff members and to discuss the purpose of the visit with the facility administrator.
Findings
Immediate exclusion letters were delivered for staff #1 and staff #2, who are no longer working at the facility. The report was reviewed and discussed with the administrator, and a copy was provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Raimundo | Administrator | Met with Licensing Program Analyst during the visit and confirmed staff exclusions. |
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit and delivered exclusion letters. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 90
Deficiencies: 2
Date: Nov 13, 2025
Visit Reason
An unannounced case management visit was conducted to deliver the finding of an incident reported by the facility involving staff forcibly administering medication to a resident.
Complaint Details
The complaint involved staff forcibly holding resident #1's arms down to administer medication. The allegation was substantiated based on interviews, observation, and record review.
Findings
The investigation substantiated that staff members held resident #1's arms down while forcing medication administration, violating the resident's right to receive or reject medical care. Staff involved were terminated and deficiencies were cited related to personal rights and personnel training.
Deficiencies (2)
Violation of resident personal rights by holding resident's arms down while administering medication.
Facility personnel did not attend required medication pass training, posing immediate health and safety risks.
Report Facts
Capacity: 90
Census: 50
Plan of Correction Due Date: Nov 14, 2025
In-service training date: Oct 8, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Raimundo | Administrator | Met with Licensing Program Analyst during visit and discussed findings |
| Murial Han | Licensing Program Analyst | Conducted the unannounced case management visit and investigation |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 51
Capacity: 90
Deficiencies: 0
Date: Oct 15, 2025
Visit Reason
An unannounced case management visit was conducted to follow up on an incident reported by the facility involving staff allegedly forcing a resident to take medicine.
Findings
The Licensing Program Analyst toured the Memory Care Unit, interviewed the resident and staff, and requested documents related to the incident and administrator submission. No deficiencies were cited during this visit.
Report Facts
Capacity: 90
Census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced case management visit |
| Lynda Connelly | Sales Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 90
Deficiencies: 0
Date: Oct 15, 2025
Visit Reason
An unannounced case management visit was conducted to follow up on an incident reported by the facility involving staff allegedly forcing a resident to take medicine.
Complaint Details
The visit was triggered by a complaint reported on 10/9/2025 that staff #2 and staff #3 were holding resident #1's arm and forcing the resident to take medicine. No deficiencies were cited during the investigation.
Findings
The Licensing Program Analyst toured the Memory Care Unit, interviewed the resident and staff, and requested documents related to the incident and administrator submission. No deficiencies were cited during this visit.
Report Facts
Capacity: 90
Census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced case management visit and investigation |
| Lynda Connelly | Sales Director | Met with Licensing Program Analyst during the visit |
| Rowena Cancino | Administrator | Former administrator no longer working at the facility |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 90
Deficiencies: 0
Date: Aug 20, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff caused injury to a resident in care.
Complaint Details
The complaint alleged that staff caused injury to resident #1, who had a significant avulsion injury to the left hand. The investigation included interviews with the resident, staff, administrator, and responsible party, as well as document review. The allegation was deemed unsubstantiated due to lack of evidence.
Findings
The investigation found that the allegation of staff causing injury to the resident was unsubstantiated. Interviews, observations, and a police report indicated the injury appeared accidental with no evidence of elder abuse or neglect.
Report Facts
Facility capacity: 90
Census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Ignacio Lopez | Administrator | Facility administrator interviewed during investigation |
| April Cowan | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Follow-Up
Census: 52
Capacity: 90
Deficiencies: 0
Date: Jul 8, 2025
Visit Reason
An unannounced Case Management visit was conducted to follow-up on an incident reported by the facility involving a resident's unwitnessed fall and subsequent injury.
Findings
The resident was observed to be comfortable with no further falls reported. The facility has implemented status checks every 2 hours and physical therapy for the resident. No deficiencies were cited during this visit.
Report Facts
Census: 52
Total Capacity: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Rowena Cacino | Interim Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident and follow-up actions |
Inspection Report
Follow-Up
Census: 52
Capacity: 90
Deficiencies: 0
Date: Jul 8, 2025
Visit Reason
The visit was an unannounced Case Management follow-up on an incident reported by the facility involving a resident's unwitnessed fall.
Findings
The resident involved in the fall was observed to be comfortable and not in pain. The facility has implemented status checks every 2 hours and physical therapy for the resident. No deficiencies were cited during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rowena Cacino | Interim Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident and follow-up care. |
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 90
Deficiencies: 3
Date: Jul 8, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2025-05-09 regarding facility maintenance, staff qualifications, and resident care at Burlingame Senior Living Facility.
Complaint Details
The complaint investigation was substantiated with multiple allegations confirmed including unclean carpeting, broken heater, broken facility vehicle, unqualified administrator, and broken elevators. Some allegations such as internet service and resident care needs were unsubstantiated. Civil penalties were assessed for repeat elevator violations.
Findings
The investigation substantiated several allegations including unclean carpeting, broken heater, facility vehicle in disrepair, unqualified interim administrator, and malfunctioning elevators. Some allegations such as internet service issues and resident showering/incontinence needs were found unsubstantiated. Civil penalties were assessed for repeat violations related to elevator maintenance.
Deficiencies (3)
Facility was not clean, safe, sanitary and in good repair; dirty carpet, broken heater, broken elevators, and broken facility van posed immediate health and safety risks.
Facility did not have a qualified and currently certified administrator since March 2025, posing immediate health and safety risks.
Comfortable temperature was not maintained due to malfunctioning heater posing potential health and safety risk.
Report Facts
Capacity: 90
Census: 52
Civil penalty: 250
Plan of Correction Due Date: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| Rowena Cancino | Interim Administrator | Met with Licensing Program Analyst during investigation and involved in findings |
| Ignacio Lopez | Administrator | Facility administrator named in report |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 90
Deficiencies: 3
Date: Jul 8, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2025-05-09 regarding facility maintenance, staff qualifications, and resident care issues at Burlingame Senior Living Facility.
Complaint Details
The complaint investigation was substantiated based on evidence including interviews, observations, and record reviews. Allegations included unclean carpeting, broken heaters, broken elevators, unqualified administrator, and broken facility vehicle. Some allegations such as internet service and resident showering/incontinence care were unsubstantiated. A civil penalty of $250 was assessed for repeat elevator violation.
Findings
The investigation substantiated several allegations including unclean carpeting, malfunctioning heaters, broken elevators, a facility van in disrepair, and an unqualified interim administrator. Some allegations such as internet service issues and resident showering/incontinence care were found unsubstantiated.
Deficiencies (3)
Dirty carpet in resident #1's room, broken heater, broken elevators, and broken facility van posing immediate health and safety risks.
Facility did not have a qualified and currently certified administrator since March 2025, posing immediate health and safety risks.
Facility did not maintain a comfortable temperature for residents; resident #1 was admitted to a cold room due to malfunctioning heater.
Report Facts
Capacity: 90
Census: 52
Civil penalty: 250
Plan of Correction Due Date: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
| Ignacio Lopez | Administrator | Facility administrator mentioned in the report |
| Rowena Cancino | Interim Administrator | Met with Licensing Program Analyst during investigation and provided information |
Inspection Report
Follow-Up
Census: 54
Capacity: 90
Deficiencies: 0
Date: Apr 21, 2025
Visit Reason
An unannounced Case Management visit was conducted to follow up on an incident reported by the facility regarding a resident who left the facility.
Findings
The resident who left the facility was found to be independent and able to leave unassisted. The facility issued a 30-day eviction notice due to non-payment and is assisting with discharge planning. No deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Rowena Cancino | Interim Executive Director | Met with Licensing Program Analyst and provided information about the resident and incident. |
| Batool Alsmabi | Business Office Manager | Met with Licensing Program Analyst and was informed about the purpose of the visit. |
Inspection Report
Census: 54
Capacity: 90
Deficiencies: 0
Date: Apr 21, 2025
Visit Reason
The visit was an unannounced Case Management follow-up on an incident reported by the facility involving a resident who left the facility.
Findings
The resident was found to be fully independent and able to leave and return to the facility unassisted. The facility issued a 30-day eviction notice due to non-payment and is working on discharge planning. No deficiencies were cited during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rowena Cancino | Interim Executive Director | Assisted with the visit and provided information about the resident and eviction. |
| Batool Alsmabi | Business Office Manager | Met with Licensing Program Analyst and explained the purpose of the visit. |
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
Inspection Report
Capacity: 90
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was an unannounced office inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The report does not provide specific findings or deficiencies; it includes general information about the licensing process, deficiency types, plans of correction, and appeal rights.
Inspection Report
Capacity: 90
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was an unannounced office inspection of the Burlingame Senior Living Facility conducted on April 4, 2025.
Findings
The report does not contain any narrative or detailed findings. It includes general information about deficiencies, plans of correction, civil penalties, and appeal rights, but no specific deficiencies or violations are listed.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator/Director | Facility administrator named in the report header. |
| Carl Knepler | Person met with during the inspection. | |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Murial Han | Licensing Program Analyst | Named as Licensing Program Analyst on the report. |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 90
Deficiencies: 1
Date: Mar 11, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the licensee did not ensure facility elevators were maintained in good repair.
Complaint Details
The complaint was substantiated. The allegation was that the licensee did not ensure facility elevators were maintained in good repair. Evidence showed one elevator was broken for over a year, and the facility could not prove repairs were underway. Staff and administrators confirmed elevator malfunctions caused delays and safety concerns.
Findings
The investigation substantiated that one of the two elevators had been malfunctioning for over a year, causing significant issues for residents, staff, family members, and emergency responders. The facility was unable to provide documentation proving that repairs or replacement were in progress.
Deficiencies (1)
87303 Maintenance and Operation (a): The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. One of the two facility elevators has been malfunctioned for more than a year and the facility was not able to provide documents to proof that the repair or replacement of the elevator is in progress which poses an immediate health and safety risk to residents in care.
Report Facts
Capacity: 90
Census: 50
Plan of Correction Due Date: Mar 12, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Rowena Cancino | Interim Administrator | Met with Licensing Program Analyst during investigation |
| Ignacio Lopez | Administrator | Facility Administrator named in report |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 90
Deficiencies: 1
Date: Mar 11, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that the licensee did not ensure facility elevators were maintained in good repair.
Complaint Details
The complaint was substantiated. The allegation was that the licensee did not ensure facility elevators were maintained in good repair. Evidence showed one elevator was broken for over a year, and the only working elevator malfunctioned intermittently, causing delays for residents, family members, and paramedics during emergencies.
Findings
The investigation substantiated that one of the two elevators had been malfunctioning for over a year, and the facility was unable to provide documentation proving repairs or replacement were in progress. This posed an immediate health and safety risk to residents, staff, and visitors.
Deficiencies (1)
87303 Maintenance and Operation (a): The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. One of the two facility elevators has been malfunctioned for more than a year and the facility was not able to provide documents to proof that the repair or replacement of the elevator is in progress which poses an immediate health and safety risk to residents in care.
Report Facts
Facility Capacity: 90
Census: 50
Deficiency Plan of Correction Due Date: Mar 12, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
| Rowena Cancino | Interim Administrator | Met with Licensing Program Analyst during the investigation |
| Ignacio Lopez | Administrator | Facility administrator mentioned in the report |
Inspection Report
Annual Inspection
Census: 58
Capacity: 90
Deficiencies: 4
Date: Jan 15, 2025
Visit Reason
The inspection visit was an unannounced continuation visit for an annual inspection conducted to review compliance with licensing regulations.
Findings
The inspection found multiple deficiencies related to staff criminal record clearances, annual training requirements, and personnel health screening documentation. Plans of correction were required to address these issues.
Deficiencies (4)
1 out of 5 staff was not associated with the facility, violating criminal record clearance requirements.
3 out of 5 staff did not have training records indicating required annual training completion in 2024.
4 out of 5 staff did not have criminal record clearances in their personnel files.
2 out of 5 staff files did not have a copy of their TB and Health Screen results.
Report Facts
Staff non-compliance counts: 1
Staff non-compliance counts: 3
Staff non-compliance counts: 4
Staff non-compliance counts: 2
Facility census: 58
Facility capacity: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with during inspection and named in relation to plans of correction |
| Murial Han | Licensing Program Analyst | Conducted the inspection and signed the report |
| April Cowan | Licensing Program Manager | Supervisor named in the report |
Inspection Report
Census: 58
Capacity: 90
Deficiencies: 0
Date: Jan 15, 2025
Visit Reason
An unannounced Case Management visit was conducted to follow up on an Unlawful Detainer order related to a resident's non-payment and planned discharge.
Findings
The resident subject to the Unlawful Detainer order refused to leave the facility, resulting in a delay of discharge for five more days while a safe discharge destination is sought. No deficiencies were cited during this visit.
Report Facts
Resident stay extension: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst and reported on resident discharge situation |
Inspection Report
Annual Inspection
Census: 58
Capacity: 90
Deficiencies: 4
Date: Jan 15, 2025
Visit Reason
The visit was an unannounced continuation visit for an annual inspection originally conducted on 12/30/2024, to review compliance with licensing requirements.
Findings
The inspection identified multiple deficiencies related to staff criminal record clearances, annual training requirements, and personnel health screenings. Plans of correction were required to address these issues to avoid civil penalties.
Deficiencies (4)
1 out of 5 staff was not associated with the facility, violating criminal record clearance requirements.
3 out of 5 staff did not have training records indicating completion of required annual training in 2024.
4 out of 5 staff did not have criminal record clearances documented in their personnel files.
2 out of 5 staff files did not have a copy of their TB and Health Screen results.
Report Facts
Staff files reviewed: 5
Resident files reviewed: 5
Staff without association: 1
Staff without required training: 3
Staff without criminal record clearance documentation: 4
Staff without TB and Health Screen results: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with during inspection and named in plans of correction |
| Murial Han | Licensing Program Analyst | Conducted the inspection and signed the report |
| April Cowan | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Census: 58
Capacity: 90
Deficiencies: 0
Date: Jan 15, 2025
Visit Reason
An unannounced Case Management visit was conducted to follow up on an Unlawful Detainer order related to a resident's non-payment and planned discharge.
Findings
The resident subject to the unlawful detainer order refused to leave the facility, resulting in a delay of discharge for 5 more days while a safe discharge destination is sought. No deficiencies were cited during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst and reported on resident discharge status. |
Inspection Report
Annual Inspection
Census: 58
Capacity: 90
Deficiencies: 0
Date: Dec 30, 2024
Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Murial Han to evaluate compliance with licensing requirements at Pacifica Senior Living Burlingame.
Findings
The inspection included a tour of the 4-story facility, review of emergency call systems, fire extinguisher servicing, water temperature checks, and medication storage. No deficiencies or violations were explicitly noted in this portion of the report.
Report Facts
Apartments: 69
Fire extinguisher last serviced date: Mar 26, 2024
Water temperature range: 105
Water temperature range: 109
Staff files reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst during the inspection |
| Murial Han | Licensing Program Analyst | Conducted the unannounced annual inspection |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 90
Deficiencies: 1
Date: Nov 26, 2024
Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff did not ensure residents were transported to medical appointments because the facility van was broken and no alternative transportation arrangements were made.
Complaint Details
The complaint was substantiated based on interviews and observations. Residents reported missing appointments and not scheduling new ones due to lack of transportation. The facility van had been broken for over eight weeks and residents were not aware of alternative transportation arrangements.
Findings
The investigation substantiated the allegation that residents were missing medical appointments and not scheduling new ones due to lack of transportation. Residents were unaware that the facility was offering Uber or Taxi rides as an alternative while the van was being repaired.
Deficiencies (1)
Failure to provide assistance in meeting necessary medical needs including transportation as required by CCR 87465(a)(2). Residents were missing appointments and unaware of alternative transportation offered.
Report Facts
Capacity: 90
Census: 65
Plan of Correction Due Date: Jan 2, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| Ignacio Lopez | Administrator | Facility administrator involved in investigation and discussions |
| Rowena Cancino | Resident Service Director | Interviewed during investigation regarding transportation issues |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 90
Deficiencies: 1
Date: Nov 26, 2024
Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff did not ensure residents were transported to medical appointments because the facility van was broken and no alternative transportation arrangements were made.
Complaint Details
The complaint was substantiated. Residents reported missing appointments and not scheduling new ones due to lack of transportation. The facility van had been broken for over eight weeks and residents were not aware of alternative transportation arrangements such as Uber or Taxi rides offered by the facility.
Findings
The investigation found that residents were missing medical appointments and not scheduling new ones due to lack of transportation. Residents were unaware that the facility was offering Uber or Taxi rides as alternative transportation while the van was being repaired. The allegation was substantiated based on interviews and observations.
Deficiencies (1)
Failure to provide assistance in meeting necessary medical needs including transportation, as residents were missing appointments and unaware of alternative transportation offered while the facility van was broken.
Report Facts
Capacity: 90
Census: 65
Deficiency Plan of Correction Due Date: Jan 2, 2025
Duration Van Broken: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Ignacio Lopez | Administrator | Facility administrator involved in the investigation and communication about transportation arrangements |
| Rowena Cancino | Resident Service Director | Met with the Licensing Program Analyst during the investigation and provided information about transportation |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 90
Deficiencies: 1
Date: Nov 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations including a resident wandering from the facility due to lack of staff supervision and staff not safeguarding a resident's possessions.
Complaint Details
The complaint investigation was substantiated regarding a resident wandering from the facility due to lack of staff supervision. The allegation about staff not safeguarding resident's possessions was unsubstantiated.
Findings
The investigation substantiated that a resident (R1) wandered from a secured memory care unit unattended and was found outside the facility, with staff unaware how the resident exited. Another allegation regarding misplaced hearing aids was unsubstantiated as records showed the resident did not have hearing aids upon admission.
Deficiencies (1)
Failure to ensure residents will not leave the memory care unit unattended, posing immediate health and safety risks.
Report Facts
Capacity: 90
Census: 63
Plan of Correction Due Date: Nov 18, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst during investigation |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 90
Deficiencies: 1
Date: Nov 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident wandered from the facility due to lack of staff supervision and that staff did not safeguard a resident's possessions while in care.
Complaint Details
The complaint was substantiated regarding the resident wandering incident and unsubstantiated regarding the safeguarding of the resident's possessions. The investigation included interviews with staff and review of documentation, confirming the resident left the secured unit unattended and was found outside the facility.
Findings
The allegation that a resident wandered from the memory care unit unattended was substantiated, as the facility did not know how the resident left the secured unit. The allegation regarding staff not safeguarding the resident's possessions was unsubstantiated because the resident did not have hearing aids upon admission and was not wearing them.
Deficiencies (1)
Failure to ensure residents will not leave the memory care unit unattended, posing immediate health and safety risks.
Report Facts
Capacity: 90
Census: 63
Plan of Correction Due Date: Nov 18, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst during investigation and named in findings |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit |
| April Cowan | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 90
Deficiencies: 1
Date: Jul 30, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2024-05-22 regarding resident care and staff conduct at Pacifica Senior Living Burlingame.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not accord resident privacy while in care, specifically sharing resident #1's personal information without consent. Other allegations including rough handling, bullying, financial abuse, and preventing contact with the Long Term Ombudsman were investigated and found to be unfounded.
Findings
The investigation substantiated that the facility violated resident #1's privacy rights by sharing personal information with relatives without consent. Other allegations including rough handling, bullying, financial abuse, and preventing contact with the Ombudsman were found to be unfounded after interviews and record reviews.
Deficiencies (1)
Facility shared resident #1's personal information with relatives without resident's permission, violating confidentiality requirements.
Report Facts
Facility Capacity: 90
Census: 55
Plan of Correction Due Date: Aug 7, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
| Kathleen Calobeer | Operation Specialist | Met with Licensing Program Analyst during the investigation |
| Glenda Bertccui | Administrator | Facility administrator mentioned in the report |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 90
Deficiencies: 1
Date: Jul 30, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2024-05-22 regarding resident privacy violations, rough handling, bullying, financial abuse, and prevention of contacting the Long Term Ombudsman at Pacifica Senior Living Burlingame.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not accord resident privacy while in care by sharing personal information without consent. Other allegations including rough handling, bullying, financial abuse, and preventing contact with the Ombudsman were investigated and found to be unfounded.
Findings
The investigation substantiated the allegation that the facility violated resident #1's privacy by sharing personal information with relatives without consent. Other allegations including rough handling, bullying, financial abuse, and preventing contact with the Ombudsman were found to be unfounded based on interviews and record reviews.
Deficiencies (1)
Facility shared resident #1's personal information with relatives without permission, violating confidentiality requirements.
Report Facts
Capacity: 90
Census: 55
Deficiency count: 1
Plan of Correction Due Date: Aug 7, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Glenda Bertccui | Administrator | Facility administrator interviewed during investigation |
| Kathleen Calobeer | Operation Specialist | Met with Licensing Program Analyst during inspection |
| April Cowan | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Follow-Up
Census: 55
Capacity: 90
Deficiencies: 1
Date: Apr 4, 2024
Visit Reason
An unannounced case management visit was conducted to follow-up on an incident reported by the facility involving a resident who left the facility unassisted contrary to physician's orders.
Findings
The facility failed to ensure care and supervision for a resident who left the facility unassisted despite a physician's order prohibiting this, posing an immediate health risk. A repeat violation was cited and a civil penalty of $250 was assessed.
Deficiencies (1)
Facility did not ensure care and supervision as resident left unassisted despite physician's order (LIC 602) prohibiting unassisted leaving.
Report Facts
Civil penalty amount: 250
Capacity: 90
Census: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Glenda Bertccui | Administrator | Met during inspection and involved in incident discussion |
| Rowena Cancino | Resident Service Director | Interviewed during inspection regarding incident |
| Murial Han | Licensing Program Analyst | Conducted the inspection visit |
| Cara Smith | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 90
Deficiencies: 1
Date: Apr 4, 2024
Visit Reason
An unannounced case management visit was conducted to follow up on an incident reported by the facility involving a resident who left the facility unassisted contrary to physician's orders.
Complaint Details
The visit was complaint-related, following an incident where a resident left the facility unassisted despite a physician's order. The deficiency was substantiated and a civil penalty of $250 was assessed for a repeat violation.
Findings
The facility failed to ensure care and supervision for a resident who left unassisted despite a physician's order prohibiting this, posing immediate health risks. A civil penalty was assessed for a repeat violation.
Deficiencies (1)
Facility did not ensure care and supervision as required; resident left unassisted contrary to physician's order LIC 602.
Report Facts
Civil penalty amount: 250
Deficiency count: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Glenda Bertccui | Administrator | Met during inspection and named in findings related to resident supervision |
| Murial Han | Licensing Program Analyst | Conducted the inspection |
| Rowena Cancino | Resident Service Director | Interviewed during inspection regarding incident |
| Cara Smith | Supervisor | Named as supervisor in report |
Inspection Report
Annual Inspection
Census: 48
Capacity: 90
Deficiencies: 3
Date: Jan 30, 2024
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and facility standards.
Findings
The inspection found deficiencies related to inadequate CPR/First Aid certification among staff, unclean kitchen areas, and lack of documentation for emergency drills. Plans of correction were requested to address these issues.
Deficiencies (3)
3 out of 4 staff members did not have a valid CPR/First Aid Certificate.
Several areas in the kitchen were observed to be dirty, including dirty floors in the walk-in refrigerator and freezer, black particles on metal shelves, and a dirty metal tray for clean cups.
Facility was not able to provide proof that emergency drills were conducted quarterly as required.
Report Facts
Capacity: 90
Census: 48
Deficiencies cited: 3
Plan of Correction Due Date: Jan 31, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the inspection and authored the report |
| Cara Smith | Licensing Program Manager | Supervisor overseeing the inspection |
| Glenda Bertccui | Administrator | Facility administrator involved in inspection |
| Rowena Cancino | Resident Service Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Annual Inspection
Census: 58
Capacity: 90
Deficiencies: 0
Date: Jan 30, 2024
Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Murial Han to evaluate the facility's compliance with regulatory standards.
Findings
The inspection included a tour of the 4-story facility, review of emergency call systems, fire extinguisher servicing, water temperature checks, and secure storage of medications and chemicals. A review of four staff files was also conducted. The inspection was not completed and will be continued on another day.
Report Facts
Apartments: 69
Fire extinguisher last service date: Mar 26, 2024
Water temperature range: 105
Water temperature range: 109
Staff files reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ignacio Lopez | Administrator | Met with Licensing Program Analyst during inspection |
| Murial Han | Licensing Program Analyst | Conducted the unannounced annual inspection |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 48
Capacity: 90
Deficiencies: 3
Date: Jan 30, 2024
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and facility operations.
Findings
The inspection found deficiencies related to inadequate CPR/First Aid certification among staff, unclean kitchen areas, and lack of documentation for emergency drills. Plans of correction were requested to address these issues by 01/31/2024.
Deficiencies (3)
3 out of 4 staff members did not have a valid CPR/First Aid Certificate, posing an immediate health and safety risk.
Several areas in the kitchen were observed to be dirty, including dirty floors in the walk-in refrigerator and freezer, dirty metal shelves, and a dirty metal tray for clean cups.
Facility was not able to provide proof that emergency drills were conducted quarterly for each shift as required.
Report Facts
Staff without valid CPR/First Aid Certificate: 3
Capacity: 90
Census: 48
Plan of Correction Due Date: Jan 31, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Glenda Bertccui | Administrator | Facility administrator involved in inspection and plans of correction |
| Rowena Cancino | Resident Service Director | Met with Licensing Program Analyst during inspection |
| Murial Han | Licensing Program Analyst | Conducted the inspection |
| Cara Smith | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 90
Deficiencies: 0
Date: Oct 3, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2023-09-26 alleging that facility staff do not ensure resident records are properly maintained.
Complaint Details
The complaint alleged that facility staff did not properly maintain resident records, including missing admission application documents and staff asking a reporting party to complete paperwork meant for physicians. The allegation was found to be unfounded after review of multiple resident files and interviews.
Findings
The investigation reviewed resident files and interviewed staff, finding some missing documents in one resident's file but overall the allegation was deemed unfounded as documentation was largely complete and the facility was working to update incomplete forms.
Report Facts
Capacity: 90
Census: 48
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| John Calandra | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Rowena Cancino | Resident Service Director | Interviewed during the investigation |
| Glenda Bertucci | Administrator | Assisted with the investigation |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 90
Deficiencies: 0
Date: Oct 3, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2023-09-26 alleging that facility staff do not ensure resident records are properly maintained.
Complaint Details
The complaint alleged that facility staff did not ensure resident records were properly maintained, including missing documents in resident #1's file and staff asking the responsible party to complete paperwork meant for the physician. The investigation found the allegation to be unfounded.
Findings
The investigation found that resident records, including clinical and financial files for resident #1 and three others, were generally complete with some minor incomplete documentation being addressed. The allegation was determined to be unfounded.
Report Facts
Capacity: 90
Census: 48
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| John Calandra | Licensing Program Analyst | Conducted the complaint investigation |
| Rowena Cancino | Resident Service Director | Met with investigators and provided information during the investigation |
| Glenda Bertucci | Administrator | Assisted with the investigation |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 90
Deficiencies: 2
Date: Jul 20, 2023
Visit Reason
An unannounced case management visit was conducted in relation to a complaint investigation regarding the facility's failure to submit an incident report for a July 12, 2023 incident where a resident left the facility unassisted.
Complaint Details
Complaint number 14-AS-20230714123226 triggered the investigation. The complaint was substantiated as the facility acknowledged failure to submit the incident report and had a staff member not fingerprint cleared.
Findings
The facility failed to submit the required incident report for the July 12 incident and had a staff member who was not fingerprint cleared working during the visit. Civil penalties were assessed for both violations.
Deficiencies (2)
Failure to submit an incident report for an incident on July 12, 2023 where a resident left the facility unassisted.
Staff member was not fingerprint cleared prior to working in the facility.
Report Facts
Civil penalty: 250
Civil penalty: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rowena Cancino | Resident Care Coordinator | Acknowledged that the incident report was not submitted. |
| Kathleen Calobeer | Operations Specialist | Met with Licensing Program Analyst during the visit. |
| Beau Ayers | Administrator | Facility administrator named in report header. |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 90
Deficiencies: 1
Date: Jul 20, 2023
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 07/14/2023 regarding staff not preventing a resident from eloping.
Complaint Details
The complaint was substantiated. The allegation that staff did not prevent a resident from eloping was confirmed based on file review, staff interviews, and observations.
Findings
The investigation substantiated that Resident 1, who has dementia and is unable to leave unassisted, left the facility unassisted multiple times, including on 07/12/2023. Staff did not accompany or redirect the resident despite the service plan indicating restrictions.
Deficiencies (1)
Failure to provide care and supervision as required by CCR 87464(f)(1), evidenced by a resident with dementia leaving the facility unassisted multiple times.
Report Facts
Capacity: 90
Census: 40
Deficiency Type: 1
Plan of Correction Due Date: Jul 21, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kathleen Calobeer | Operations Specialist | Met with the Licensing Program Analyst during the investigation |
| Beau Ayers | Administrator | Facility administrator named in the report |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 90
Deficiencies: 1
Date: Jul 20, 2023
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 07/14/2023 regarding staff not preventing a resident from eloping.
Complaint Details
The complaint was substantiated. The allegation was that staff did not prevent a resident from eloping. The investigation confirmed the resident left unassisted multiple times despite a service plan indicating otherwise.
Findings
The investigation substantiated that Resident 1, who has dementia and is unable to leave unassisted, left the facility unassisted on July 12, 2023. Staff did not accompany or redirect the resident, and this was not the first occurrence. The resident's service plan indicated they should not leave unassisted.
Deficiencies (1)
Failure to provide care and supervision as required by CCR 87464(f)(1), evidenced by staff not preventing a resident with dementia from eloping unassisted.
Report Facts
Capacity: 90
Census: 40
Deficiencies cited: 1
Plan of Correction Due Date: Jul 21, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| Kathleen Calobeer | Operations Specialist | Met with the Licensing Program Analyst during the investigation |
| Beau Ayers | Administrator | Facility administrator named in the report |
| Cara Smith | Supervisor | Supervisor named in the report |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 90
Deficiencies: 2
Date: Jul 20, 2023
Visit Reason
An unannounced case management visit was conducted in relation to a complaint investigation regarding failure to submit an incident report for a July 12, 2023 incident where a resident left the facility unassisted.
Complaint Details
Complaint number 14-AS-20230714123226 triggered the investigation. The complaint was substantiated as the facility failed to submit the required incident report and had a staff member without fingerprint clearance.
Findings
The facility failed to submit the required incident report for the July 12 incident and had a staff member who was not fingerprint cleared working during the visit. Civil penalties were assessed for both violations.
Deficiencies (2)
Failure to submit an incident report for an incident on July 12, 2023 where a resident left the facility unassisted.
Staff member was not fingerprint cleared prior to working in the facility.
Report Facts
Civil penalty: 250
Civil penalty: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rowena Cancino | Resident Care Coordinator | Acknowledged that incident report was not submitted. |
| Kathleen Calobeer | Operations Specialist | Met with Licensing Program Analyst during visit. |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit. |
Inspection Report
Plan of Correction
Census: 69
Capacity: 90
Deficiencies: 1
Date: Jul 14, 2023
Visit Reason
The visit was an unannounced plan of correction (POC) visit conducted to follow up on previous visits made on 6/29/23 and 7/10/23 to ensure the facility complied with citations issued on 6/29/2023.
Findings
The facility was assessed civil penalties for failing to provide a plan of correction for CCR 87211 Reporting Requirements. The plan of correction was received and verified on 7/10/2023, clearing the citation and stopping civil penalties.
Deficiencies (1)
Failure to provide plan of correction for CCR 87211 Reporting Requirements
Report Facts
Civil penalty amount: 400
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the plan of correction visit and assessment |
| Kristal Robinson | Sales Director | Met with Licensing Program Analyst during the visit |
| Beau Ayers | Administrator | Facility Administrator named in report header |
| Cara Smith | Licensing Program Manager | Named in report header |
Inspection Report
Plan of Correction
Census: 69
Capacity: 90
Deficiencies: 1
Date: Jul 14, 2023
Visit Reason
An unannounced plan of correction visit was conducted to follow up on previous visits made on 2023-06-29 and 2023-07-10 to ensure the facility complied with citations issued related to reporting requirements.
Findings
The facility submitted a plan of correction for CCR 87211, which was verified and cleared. Civil penalties assessed for failure to provide the plan of correction were stopped as of 2023-07-10.
Deficiencies (1)
Failure to provide plan of correction for CCR 87211 Reporting Requirements
Report Facts
Civil penalty amount: 400
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the plan of correction visit and assessment |
| Kristal Robinson | Sales Director | Met with Licensing Program Analyst during visit |
| Beau Ayers | Administrator | Facility administrator named in report header |
Inspection Report
Plan of Correction
Capacity: 90
Deficiencies: 2
Date: Jul 10, 2023
Visit Reason
An unannounced plan of correction (POC) visit was conducted to verify and confirm that the facility is in compliance with citations issued on 2023-06-29.
Findings
The facility was cited for several deficiencies on 2023-06-29. During the visit, the Executive Director was unable to provide a plan of correction for the Reporting Requirements citation, resulting in a civil penalty. Plans of correction for other cited deficiencies were provided and verified as corrected and cleared.
Deficiencies (2)
Failure to provide plan of correction for CCR 87211 Reporting Requirements
Citations issued for CCR 87355 Criminal Record Clearance, 87412 Personnel Records, 87463 Reappraisals, and 87506 Resident Records
Report Facts
Civil penalty amount: 400
Penalty rate: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emaude Tayebi | Executive Director | Met with Licensing Program Analyst during visit and involved in plan of correction discussion |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced plan of correction visit |
| Cara Smith | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Plan of Correction
Capacity: 90
Deficiencies: 1
Date: Jul 10, 2023
Visit Reason
An unannounced plan of correction (POC) visit was conducted to verify and confirm that the facility is in compliance with citations issued on 2023-06-29.
Findings
The facility was found to have corrected deficiencies related to personnel records, reappraisals, and resident records. However, the plan of correction for reporting requirements was not provided, resulting in a civil penalty assessment.
Deficiencies (1)
Failure to provide plan of correction for CCR 87211 Reporting Requirements
Report Facts
Civil penalty amount: 400
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emaude Tayebi | Executive Director | Met with Licensing Program Analyst during visit and involved in plan of correction discussions |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced plan of correction visit |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 90
Deficiencies: 5
Date: Jun 29, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on an incident involving Resident 1 who had an unwitnessed fall on June 7, 2023, with prior falls on 5/1/2023 and 5/23/2023. The visit aimed to review the incident and related facility compliance.
Complaint Details
The visit was complaint-related, following an incident involving Resident 1's unwitnessed fall on June 7, 2023. The complaint investigation found multiple deficiencies including failure to report incidents and reassess the resident, incomplete service plans, and staff association issues.
Findings
The facility failed to report two incident reports to the licensing agency, did not reassess Resident 1 after subsequent falls, and had an incomplete service plan not signed by the responsible party. Additionally, two staff members (S1 and S2) were fingerprint cleared but not associated with the facility, resulting in civil penalties.
Deficiencies (5)
S1 and S2 had fingerprint clearance but were not associated with the facility.
Licensee failed to submit two incident reports from 5/1/2023 and 5/23/2023 to CCLD.
Facility failed to reassess Resident 1 after falls on 5/23/2023 and 6/7/2023.
Resident 1's service plan was incomplete as it was not signed by the responsible party.
Personnel records lacked documentation of criminal record clearance for S1 and S2.
Report Facts
Civil penalty: 200
Civil penalty: 250
Incident reports not submitted: 2
Falls by Resident 1: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Named as facility administrator. |
| Emaude (Alex) Tayebi | Executive Director | Met with Licensing Program Analyst during visit. |
| Rowena Cancino | Resident Services Director | Interviewed regarding Resident 1's falls. |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 90
Deficiencies: 5
Date: Jun 29, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on an incident involving Resident 1 who had an unwitnessed fall on June 7, 2023, with prior falls on 5/1/2023 and 5/23/2023. The visit aimed to review incident reporting and resident reassessment following these falls.
Complaint Details
The visit was complaint-related, following an incident involving Resident 1's unwitnessed fall on June 7, 2023. The complaint investigation found that incident reports for prior falls were not submitted and reassessments were not conducted as required.
Findings
The facility failed to report two incident reports to the licensing agency and did not reassess Resident 1 after two additional falls following the initial reassessment. The resident's service plan was incomplete as it was not signed by the responsible party. Additionally, two staff members (S1 and S2) had fingerprint clearance but were not associated with the facility, resulting in civil penalties.
Deficiencies (5)
Failure to associate fingerprint cleared staff (S1 and S2) to the facility.
Failure to submit two incident reports from 5/1/2023 and 5/23/2023 to the licensing agency.
Failure to reassess Resident 1 after two additional unwitnessed falls on 5/23/2023 and 6/7/2023.
Resident 1's service plan was incomplete as it was not signed by the responsible party.
Lack of documentation of criminal record clearance for staff S1 and S2 in personnel files.
Report Facts
Civil penalty: 200
Civil penalty: 250
Number of falls: 3
Plan of Correction Due Date: 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Named in relation to findings and responsible for reporting and training. |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Emaude (Alex) Tayebi | Executive Director | Interviewed during the visit and discussed findings. |
| Rowena Cancino | Resident Services Director | Interviewed during the visit regarding Resident 1. |
Inspection Report
Census: 40
Capacity: 90
Deficiencies: 1
Date: Jun 6, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on a death report submitted on May 11, 2023, regarding Resident 1 who passed away on May 10, 2023.
Findings
The facility failed to obtain a death certificate for Resident 1 and did not reassess the resident after a change in condition, nor develop an individualized needs and service plan to address the change. A deficiency was cited under the Residential Care Elderly California Code of Regulations, Title 22, Division 6.
Deficiencies (1)
Failure to reassess Resident 1 after showing new behaviors and failure to develop an individualized needs and service plan to address change in condition.
Report Facts
Capacity: 90
Census: 40
Plan of Correction Due Date: Due date for correcting cited deficiency is June 13, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the inspection and authored the report |
| Beau Ayers | Regional Vice President of Operation | Met with during the inspection |
| Rowena Cancino | Resident Care Director | Met with during the inspection |
| W. Sato | Business Office Manager | Mentioned in relation to checking on Resident 1 after call for assistance |
| Cara Smith | Licensing Program Manager | Report reviewed and discussed with Administrator |
Inspection Report
Census: 40
Capacity: 90
Deficiencies: 1
Date: Jun 6, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on a death report submitted to the licensing agency on May 11, 2023.
Findings
The facility failed to obtain a death certificate for the deceased resident and did not reassess the resident after a change in condition, nor develop an individualized needs and service plan to address the change. A deficiency was cited for failure to update the pre-admission appraisal and care plan accordingly.
Deficiencies (1)
Failure to reassess resident after showing new behaviors and failure to develop an individualized needs and service plan to address change in condition.
Report Facts
Plan of Correction Due Date: Jun 13, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report. |
| Beau Ayers | Regional Vice President of Operation | Met with Licensing Program Analyst during the visit. |
| Rowena Cancino | Resident Care Director | Interviewed during the visit. |
| W. Sato | Business Office Manager | Mentioned as the staff who checked on the resident after receiving a call for assistance. |
| Cara Smith | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 90
Deficiencies: 0
Date: Apr 28, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations received on 04/21/2023 regarding food quality, resident dignity, facility disrepair, and pest presence at Pacifica Senior Living Burlingame.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not serving nutritious foods, staff not treating residents with dignity, facility disrepair, and presence of pests. Interviews, observations, and document reviews did not support these claims.
Findings
The investigation found no substantiated evidence supporting the allegations. The facility's food was deemed nutritious and appropriate, staff were not observed to treat residents without dignity, the facility was found to be in good repair, and no pests were observed or reported in recent inspections.
Report Facts
Capacity: 90
Census: 44
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| Beau Ayers | Regional Vice President of Operations | Interviewed regarding allegations and facility operations |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Christina Mejia Dominguez | Food Services Director | Responsible for updating residents' dietary needs |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 90
Deficiencies: 0
Date: Apr 28, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 04/21/2023 regarding staff not serving nutritious foods, staff not treating residents with dignity, facility disrepair, and presence of pests.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not serving nutritious foods, staff not treating residents with dignity, facility disrepair, and presence of pests. Interviews with staff, residents, and review of records did not support these claims.
Findings
The investigation found no substantiated evidence supporting the allegations. Observations and interviews indicated that food served met dietary needs, staff treated residents with dignity, the facility was in good repair, and no pests were observed or reported.
Report Facts
Capacity: 90
Census: 44
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Beau Ayers | Regional Vice President of Operations | Interviewed regarding allegations and facility operations |
| Christina Mejia Dominguez | Food Services Director | Responsible for updating residents' dietary needs |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 90
Deficiencies: 2
Date: Apr 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2023-03-23 regarding residents being left in soiled diapers, facility wall in disrepair, and staff not treating residents with dignity.
Complaint Details
The complaint investigation was substantiated for allegations that residents were left in soiled diapers and that the facility wall was in disrepair. The allegation that staff do not treat residents with dignity was unsubstantiated.
Findings
The investigation substantiated the allegations that residents were left in soiled diapers and that the facility wall was in disrepair, with a hole in the ceiling leaking water. The allegation that staff do not treat residents with dignity was unsubstantiated based on interviews with family members and staff.
Deficiencies (2)
Residents were observed being left in soiled diapers on some days.
Facility wall in disrepair with a hole in the ceiling leaking water near the elevators on the 4th floor.
Report Facts
Capacity: 90
Census: 46
Deficiencies cited: 2
Plan of Correction Due Date: Apr 19, 2023
Repair date: Apr 17, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Cara Smith | Licensing Program Manager | Reviewed the report |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Rowena Cancino | Resident Service Director | Met with Licensing Program Analyst during investigation and reviewed report |
| Beau Ayers | Regional Vice President of Operations | Provided information about facility wall disrepair and repair plans |
Inspection Report
Census: 46
Capacity: 90
Deficiencies: 1
Date: Apr 12, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on a death report submitted on April 6, 2023, regarding a resident who passed away on March 21, 2023.
Findings
The facility failed to report the resident's death within the required seven days as mandated by CCR 87211 Reporting Requirements. The death report was submitted to the licensing agency on April 6, 2023, well beyond the seven-day timeframe.
Deficiencies (1)
Failure to report a death of a resident within seven days of occurrence as required by CCR 87211 Reporting Requirements.
Report Facts
Deficiency Type: 1
Capacity: 90
Census: 46
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report. |
| Cara Smith | Licensing Program Manager | Supervisor overseeing the inspection. |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during the visit. |
| Rowena Cancino | Resident Service Director | Met with Licensing Program Analyst during the visit and discussed the incident. |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 90
Deficiencies: 2
Date: Apr 12, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2023-03-23 regarding allegations of residents being left in soiled diapers, facility wall in disrepair, and staff not treating residents with dignity.
Complaint Details
The complaint investigation was substantiated for allegations that residents were left in soiled diapers and that the facility wall was in disrepair. The allegation that staff do not treat residents with dignity was unsubstantiated. The investigation included interviews with staff, family members, and observations of the facility.
Findings
The investigation substantiated the allegations that residents were left in soiled diapers and that the facility wall was in disrepair, with a hole in the ceiling leaking water. The allegation that staff do not treat residents with dignity was found to be unsubstantiated based on interviews with family members and staff.
Deficiencies (2)
Residents left in soiled diapers
Facility wall in disrepair with a hole in the ceiling leaking water
Report Facts
Capacity: 90
Census: 46
Plan of Correction Due Date: Apr 19, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Rowena Cancino | Resident Service Director | Explained purpose of visit and reviewed report |
| Beau Ayers | Regional Vice President of Operations | Provided information about facility wall disrepair and repair plans |
| Anoop Nair | Administrator | Facility administrator mentioned in report |
Inspection Report
Census: 46
Capacity: 90
Deficiencies: 1
Date: Apr 12, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on a death report submitted on April 6, 2023, regarding a resident who passed away on March 21, 2023.
Findings
The facility failed to report the resident's death within the required seven days as mandated by CCR 87211. The death report was submitted to the licensing agency on April 6, 2023, well beyond the seven-day requirement. A deficiency was cited for this failure.
Deficiencies (1)
Failure to report a resident's death within seven days as required by CCR 87211.
Report Facts
Deficiency due date: Apr 19, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report |
| Winnie Sato | Business Office Manager | Met with Licensing Program Analyst during the visit |
| Rowena Cancino | Resident Service Director | Met with Licensing Program Analyst during the visit and discussed the incident |
| Anoop Nair | Administrator | Facility Administrator responsible for compliance |
| Cara Smith | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Original Licensing
Census: 34
Capacity: 90
Deficiencies: 0
Date: Oct 21, 2022
Visit Reason
The visit was a pre-licensing inspection to follow up on initial pre-licensing inspections and verify corrections prior to licensure.
Findings
All previously referenced corrections have been made, including updates to the Emergency Disaster Plan, signage identification, kitchen waste container lids, laundry machine operability, posting of visitation policy and admission agreement, and staff training on chain of command. Immediate licensure is recommended pending final review.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Named as facility administrator. |
| Audrey Jeung | Licensing Evaluator | Conducted the inspection and signed the report. |
| Stephanie Brice | Met with during the inspection and acknowledged orientation information. | |
| Cara Smith | Supervisor | Named as supervisor overseeing the evaluation. |
Inspection Report
Original Licensing
Census: 34
Capacity: 90
Deficiencies: 0
Date: Oct 21, 2022
Visit Reason
The visit was a prelicensing inspection to follow up on initial pre-licensing inspections conducted on 7/1/22 and 8/19/22, to verify corrections and readiness for licensure.
Findings
All previously noted deficiencies from prior visits were corrected, including updates to the Emergency Disaster Plan, signage identification, waste container lids, laundry machine operability, posting of visitation policy and admission agreement, and staff training on chain of command. Immediate licensure was recommended pending final review.
Report Facts
Capacity: 90
Census: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Named as facility administrator |
| Stephanie Brice | Met with during inspection and acknowledged orientation | |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager |
| Audrey Jeung | Licensing Program Analyst | Named as Licensing Program Analyst who conducted follow-up |
Inspection Report
Original Licensing
Census: 34
Capacity: 90
Deficiencies: 4
Date: Aug 19, 2022
Visit Reason
This visit was a pre-licensing inspection follow-up to the initial inspection conducted on 2022-07-01, to verify corrections and updates prior to licensure of the facility now operating as Pacifica Senior Living Burlingame.
Findings
Several items from the initial inspection were reviewed, including emergency disaster plan updates, signage for storage cages, waste container lids, laundry machine operability, visitor policy posting, and administrator designee presence. Some items were confirmed corrected, while others were pending confirmation.
Deficiencies (4)
Emergency Disaster Plan (LIC610E) needed updating with location of fire extinguishers
Waste containers in kitchen observed without tight fitting lids
Visiting policy must be posted but was not posted due to painting
Administrator designee must always be on-site
Report Facts
Capacity: 90
Census: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Facility administrator met during inspection and responsible for notification of corrections |
| Audrey Jeung | Licensing Evaluator | Conducted the inspection and evaluation |
| Jackie Jin | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Original Licensing
Census: 34
Capacity: 90
Deficiencies: 3
Date: Aug 19, 2022
Visit Reason
This was a pre-licensing unannounced visit to follow up on the initial pre-licensing inspection conducted on 7/1/22, to verify corrections and updates prior to licensure.
Findings
Several items from the initial inspection on 7/1/22 were reviewed, including updates to the Emergency Disaster Plan, signage for cage #4 in the garage, waste container lids in the kitchen, operability of the 3rd floor laundry machine, posting of the visiting policy, and administrator designee presence. Some items were addressed, while others were pending confirmation.
Deficiencies (3)
Waste containers in kitchen are observed without tight fitting lids
Visiting policy must be posted but currently not posted due to painting
Emergency Disaster Plan to be updated with location of fire extinguishers
Report Facts
Capacity: 90
Census: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Facility administrator involved in the inspection and follow-up |
| Audrey Jeung | Licensing Program Analyst | Conducted the follow-up pre-licensing inspection |
| Jackie Jin | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Original Licensing
Census: 31
Capacity: 90
Deficiencies: 3
Date: Jul 1, 2022
Visit Reason
The facility underwent a prelicensing evaluation visit as part of the application process for RCFE licensure for 90 non-ambulatory elderly persons.
Findings
The evaluator toured the facility and grounds, noting the facility layout, secured medication and toxin storage, emergency call systems, and food preparation areas. Some issues were identified including the emergency disaster plan needing updates, fire extinguisher locations needing to be added, signage needed for a garage cage, and an open door to a memory care room occupied by a COVID resident not identified as an isolation room. A follow-up visit was required due to time constraints.
Deficiencies (3)
Emergency Disaster Plan must be updated and location of fire extinguishers must be added.
Cage #4 in garage to be identified by signage.
Door of memory care room occupied by COVID resident is wide open, not identified as isolation room.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Facility Administrator | Named as facility administrator and discussed open door issue with evaluator. |
| Audrey Jeung | Licensing Evaluator | Conducted the facility tour and evaluation. |
| Julio Montes | Supervisor | Supervisor overseeing the evaluation. |
Inspection Report
Original Licensing
Census: 31
Capacity: 90
Deficiencies: 3
Date: Jul 1, 2022
Visit Reason
The visit was a prelicensing inspection for Pacifica Senior Living Burlingame as the applicant applied for RCFE licensure for 90 non-ambulatory elderly persons.
Findings
The facility was toured and found to have appropriate secured medication and toxin storage, emergency call systems, and food preparation areas. However, the Emergency Disaster Plan requires updating and fire extinguisher locations must be added. Additionally, the door to a memory care room occupied by a COVID resident was found open and not identified as an isolation room, which was discussed with the administrator. A follow-up visit is necessary due to time constraints.
Deficiencies (3)
Emergency Disaster Plan must be updated and location of fire extinguishers must be added.
Door of memory care room occupied by COVID resident is wide open and not identified as isolation room.
Cage #4 in garage to be identified by signage.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Facility Administrator | Represented the applicant and was involved in discussion regarding open door to memory care room. |
| Audrey Jeung | Licensing Program Analyst | Conducted the facility tour and inspection. |
| Julio Montes | Licensing Program Manager | Named in report header. |
Inspection Report
Original Licensing
Census: 35
Capacity: 90
Deficiencies: 0
Date: Apr 22, 2022
Visit Reason
The visit was conducted as a Component II evaluation by the Community Care Licensing Division (CCLD) to assess the applicant and administrator's understanding of licensing requirements and facility operation for the initial licensing of the facility.
Findings
The applicant and administrator successfully completed the Component II evaluation via telephone, demonstrating understanding of Title 22 regulations, facility operation, staff qualifications, program policies, and other licensing requirements. Technical assistance and document review were also completed.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Named as participant in Component II evaluation |
| Thai Doan | Licensing Evaluator | Conducted and signed the evaluation |
| Julia Kim | Supervisor | Supervisor overseeing the evaluation |
Inspection Report
Census: 35
Capacity: 90
Deficiencies: 0
Date: Apr 22, 2022
Visit Reason
The visit was an office evaluation conducted via telephone to complete Component II (COMP II) of the licensing process, verifying the applicant and administrator's understanding of Title 22 and related facility operation requirements.
Findings
The Component II evaluation was successfully completed with confirmation of understanding in areas including facility operation, staff qualifications, program policies, grievance procedures, and physical plant requirements. No deficiencies or violations were noted in the report.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Participated in COMP II evaluation and confirmed understanding of regulatory requirements. |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 90
Deficiencies: 1
Date: Mar 24, 2022
Visit Reason
The visit was conducted as a complaint investigation to the facility, which was observed to be advertising itself as a licensed RCFE without having an approved or granted license.
Complaint Details
The complaint investigation found that the facility was advertising as a licensed RCFE without having an approved or granted license, which is a violation of California Code of Regulations, Title 22.
Findings
The facility was found to be advertising and doing business as a licensed RCFE without having a valid RCFE license, which poses a potential health, safety, or personal rights risk to clients in care.
Deficiencies (1)
Facility is doing business as, and advertising as 'Pacifica Senior Living Burlingame,' but without a valid RCFE license. Applicant has failed to operate consistent with licensure as ATRIA BURLINGAME, which poses a potential health, safety, or personal rights risk to clients in care.
Report Facts
Capacity: 90
Census: 36
Plan of Correction Due Date: Mar 31, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Observed deficiency and signed the report |
| Julio Montes | Licensing Program Manager | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 90
Deficiencies: 1
Date: Mar 24, 2022
Visit Reason
The visit was conducted as a complaint investigation regarding the facility operating and advertising as a licensed RCFE without having an approved or granted license.
Complaint Details
Complaint investigation visit was conducted; deficiency was substantiated as the facility was operating and advertising without a valid RCFE license.
Findings
The facility was found to be advertising and doing business as a licensed RCFE without having an approved license, which poses a potential health, safety, or personal rights risk to clients in care.
Deficiencies (1)
Facility is doing business as, and advertising as 'Pacifica Senior Living Burlingame,' but without a valid RCFE license, violating Health and Safety Code Sections 1569.68 and 1569.681 requiring license number disclosure in all public advertisements.
Report Facts
Plan of Correction Due Date: Mar 31, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Evaluator | Observed deficiency during complaint investigation |
| Julio Montes | Supervisor | Supervisor overseeing the inspection |
Viewing
Loading inspection reports...
