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| Deficiency Category | Inspection Date: 8/28/23 Complaint Reporting Period: 3/1/24 - 2/28/25 | Inspection Date: 1/16/20 Complaint Reporting Period: 3/1/23 - 2/29/24 | Inspection Date: 4/25/19 Complaint Reporting Period: 3/1/22 - 2/28/23 |
|---|---|---|---|
| Emergency Preparedness Deficiencies | |||
| Automatic Sprinkler Systems Deficiencies | |||
| Building Construction Deficiencies | |||
| Services Deficiencies | |||
| Corridor Walls and Doors Deficiencies | |||
| Egress Deficiencies | |||
| Electrical Deficiencies | |||
| Emergency Plans and Fire Drills Deficiencies | |||
| Fire Alarm Systems Deficiencies | |||
| Smoke Deficiencies | |||
| Interior Finish Deficiencies | |||
| Gas, Vacuum, and Electrical Systems Deficiencies | |||
| Hazardous Area Deficiencies | |||
| Illumination and Emergency Power Deficiencies | |||
| Laboratories Deficiencies | |||
| Medical Gases and Anesthetizing Areas Deficiencies | |||
| Smoking Regulations Deficiencies | |||
| Miscellaneous Deficiencies |
| Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in California: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States: |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Address subsistence needs for staff and patients. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Establish policies and procedures for medical documentation. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Conduct testing and exercise requirements. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Establish roles under a Waiver declared by secretary. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
List the names and contact information of those in the facility. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Develop and maintain an Emergency Preparedness Program (EP). | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Create arrangements with other facilities to receive patients. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Include a process for Emergency Preparedness collaboration. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Establish policies and procedures for volunteers. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Provide emergency officials' contact information. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
| No Automatic Sprinkler Systems Deficiencies were found during this inspection period. |
| No Building Construction Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have elevators that firefighters can control in the event of a fire. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Few |
| No Corridor Walls and Doors Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have properly located and lighted "Exit" signs. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
| No Electrical Deficiencies were found during this inspection period. |
| No Emergency Plans and Fire Drills Deficiencies were found during this inspection period. |
| No Fire Alarm Systems Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Install a fire alarm system that can be heard throughout the facility. | 8/28/23 | 8/3/23 | 2 - Minimal harm or potential for actual harm | Many |
Inspect, test, and maintain automatic sprinkler systems. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Few |
Provide properly protected cooking facilities. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
Install corridor and hallway doors that block smoke. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Some |
| No Interior Finish Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Ensure proper usage of power strips and extension cords. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Have generator or other power source capable of supplying service within 10 seconds. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Many |
Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Few |
| No Hazardous Area Deficiencies were found during this inspection period. |
| No Illumination and Emergency Power Deficiencies were found during this inspection period. |
| No Laboratories Deficiencies were found during this inspection period. |
| No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period. |
| No Smoking Regulations Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have restrictions on the use of portable space heaters. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Few |
Provide a written emergency evacuation plan. | 8/28/23 | 10/20/23 | 2 - Minimal harm or potential for actual harm | Few |
| Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in California: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States: |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Conduct testing and exercise requirements. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Conduct risk assessment and an All-Hazards approach. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish policies and procedures for medical documentation. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish procedures for tracking staff and patients during an emergency. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Implement emergency and standby power systems. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Develop and maintain an Emergency Preparedness Program (EP). | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Address subsistence needs for staff and patients. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
List the names and contact information of those in the facility. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Provide family notifications of emergency plan. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish policies and procedures including evacuation. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish policies and procedures for volunteers. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish roles under a Waiver declared by secretary. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Establish methods for sharing information. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Provide a means of sharing information on occupancy/needs. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Provide emergency officials' contact information. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
| No Automatic Sprinkler Systems Deficiencies were found during this inspection period. |
| No Building Construction Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have properly installed electrical wiring and gas equipment. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
| No Corridor Walls and Doors Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Keep aisles, corridors, and exits free of obstruction in case of emergency. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Some |
Have stairways and smokeproof enclosures used as exits that meet safety requirements. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Some |
| No Electrical Deficiencies were found during this inspection period. |
| No Emergency Plans and Fire Drills Deficiencies were found during this inspection period. |
| No Fire Alarm Systems Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Properly provide smoke detection systems in areas open to corridors. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Inspect, test, and maintain automatic sprinkler systems. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Some |
Install a fire alarm system that can be heard throughout the facility. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
| No Interior Finish Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have generator or other power source capable of supplying service within 10 seconds. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Some |
Have proper medical gas storage and administration areas. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
Ensure proper usage of power strips and extension cords. | 1/16/20 | 2/4/20 | 2 - Minimal harm or potential for actual harm | Few |
| No Hazardous Area Deficiencies were found during this inspection period. |
| No Illumination and Emergency Power Deficiencies were found during this inspection period. |
| No Laboratories Deficiencies were found during this inspection period. |
| No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period. |
| No Smoking Regulations Deficiencies were found during this inspection period. |
| No Miscellaneous Deficiencies were found during this inspection period. |
| Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in California: | |
| Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States: |
| No Emergency Preparedness Deficiencies were found during this inspection period. |
| No Automatic Sprinkler Systems Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Use approved construction type or materials. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have properly installed electrical wiring and gas equipment. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
| No Corridor Walls and Doors Deficiencies were found during this inspection period. |
| No Egress Deficiencies were found during this inspection period. |
| No Electrical Deficiencies were found during this inspection period. |
| No Emergency Plans and Fire Drills Deficiencies were found during this inspection period. |
| No Fire Alarm Systems Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Provide properly protected cooking facilities. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
Properly select, install, inspect, or maintain portable fire extinguishes. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
Install corridor and hallway doors that block smoke. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
Inspect, test, and maintain automatic sprinkler systems. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Some |
| No Interior Finish Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have proper medical gas storage and administration areas. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
Ensure proper usage of power strips and extension cords. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Some |
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Few |
| No Hazardous Area Deficiencies were found during this inspection period. |
| No Illumination and Emergency Power Deficiencies were found during this inspection period. |
| No Laboratories Deficiencies were found during this inspection period. |
| No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period. |
| No Smoking Regulations Deficiencies were found during this inspection period. |
| Inspectors determined that the nursing home failed to: | Inspection Date | Date of Correction | Level of Harm (Least to most) | Residents Affected (Few, Some, Many) |
|---|---|---|---|---|
Have simulated fire drills held at unexpected times. | 4/25/19 | 5/13/19 | 2 - Minimal harm or potential for actual harm | Some |
| This nursing home has not been cited for any deficiencies from incidents reported by the nursing home or complaints in the last 3 years. |