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Fire Safety Inspection & Emergency Preparedness Summary
Health Care Ctr at the Forum at Rancho San Antonio
23600 via Esplendor
Cupertino, CA 95014
(650) 944-0200

Below, swipe left and right to view more info.

Deficiency Category
Inspection Date:
7/24/24
Complaint Reporting Period:
3/1/24 - 2/28/25
Inspection Date:
6/14/23
Complaint Reporting Period:
3/1/23 - 2/29/24
Inspection Date:
7/10/19
Complaint Reporting Period:
3/1/22 - 2/28/23
Emergency Preparedness Deficiencies000
Automatic Sprinkler Systems Deficiencies000
Building Construction Deficiencies000
Services Deficiencies000
Corridor Walls and Doors Deficiencies000
Egress Deficiencies000
Electrical Deficiencies000
Emergency Plans and Fire Drills Deficiencies000
Fire Alarm Systems Deficiencies000
Smoke Deficiencies000
Interior Finish Deficiencies000
Gas, Vacuum, and Electrical Systems Deficiencies000
Hazardous Area Deficiencies000
Illumination and Emergency Power Deficiencies000
Laboratories Deficiencies000
Medical Gases and Anesthetizing Areas Deficiencies000
Smoking Regulations Deficiencies000
Miscellaneous Deficiencies000
Detailed result for inspection on 7/24/24
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:3
Average number of Fire Safety & Emergency Preparedness Deficiencies in California:7
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.8
Emergency Preparedness Deficiencies
No Emergency Preparedness Deficiencies were found during this inspection period.
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
No Services Deficiencies were found during this inspection period.
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
No Egress Deficiencies were found during this inspection period.
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Install corridor and hallway doors that block smoke.

7/24/247/25/24
2 - Minimal harm or potential for actual harm
Few
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate 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.

7/24/247/25/24
2 - Minimal harm or potential for actual harm
Many
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Have simulated fire drills held at unexpected times.

7/24/247/25/24
2 - Minimal harm or potential for actual harm
Few
Detailed result for inspection on 6/14/23
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:3
Average number of Fire Safety & Emergency Preparedness Deficiencies in California:7.5
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.6
Emergency Preparedness Deficiencies
No Emergency Preparedness Deficiencies were found during this inspection period.
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
No Services Deficiencies were found during this inspection period.
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
No Egress Deficiencies were found during this inspection period.
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Inspect, test, and maintain automatic sprinkler systems.

6/14/237/5/23
2 - Minimal harm or potential for actual harm
Few
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Ensure proper usage of power strips and extension cords.

6/14/237/5/23
2 - Minimal harm or potential for actual harm
Few
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Ensure that any exit in an area undergoing construction, repair, or improvements shall be inspected daily to ensure its ability to be used instantly in case of emergency.

6/14/237/5/23
1 - Potential for minimal harm
Many
Detailed result for inspection on 7/10/19
Total number of Fire Safety & Emergency Preparedness Deficiencies for this nursing home:1
Average number of Fire Safety & Emergency Preparedness Deficiencies in California:6.8
Average number of Fire Safety & Emergency Preparedness Deficiencies in the United States:4.2
Emergency Preparedness Deficiencies
No Emergency Preparedness Deficiencies were found during this inspection period.
Automatic Sprinkler Systems Deficiencies
No Automatic Sprinkler Systems Deficiencies were found during this inspection period.
Building Construction Deficiencies
No Building Construction Deficiencies were found during this inspection period.
Services Deficiencies
No Services Deficiencies were found during this inspection period.
Corridor Walls and Doors Deficiencies
No Corridor Walls and Doors Deficiencies were found during this inspection period.
Egress Deficiencies
Inspectors determined that the nursing home failed to:Inspection DateDate of Correction
Level of Harm
(Least to most)
Residents Affected
(Few, Some, Many)

Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

7/10/197/17/19
2 - Minimal harm or potential for actual harm
Few
Electrical Deficiencies
No Electrical Deficiencies were found during this inspection period.
Emergency Plans and Fire Drills Deficiencies
No Emergency Plans and Fire Drills Deficiencies were found during this inspection period.
Fire Alarm Systems Deficiencies
No Fire Alarm Systems Deficiencies were found during this inspection period.
Smoke Deficiencies
No Smoke Deficiencies were found during this inspection period.
Interior Finish Deficiencies
No Interior Finish Deficiencies were found during this inspection period.
Gas, Vacuum, and Electrical Systems Deficiencies
No Gas, Vacuum, and Electrical Systems Deficiencies were found during this inspection period.
Hazardous Area Deficiencies
No Hazardous Area Deficiencies were found during this inspection period.
Illumination and Emergency Power Deficiencies
No Illumination and Emergency Power Deficiencies were found during this inspection period.
Laboratories Deficiencies
No Laboratories Deficiencies were found during this inspection period.
Medical Gases and Anesthetizing Areas Deficiencies
No Medical Gases and Anesthetizing Areas Deficiencies were found during this inspection period.
Smoking Regulations Deficiencies
No Smoking Regulations Deficiencies were found during this inspection period.
Miscellaneous Deficiencies
No Miscellaneous Deficiencies were found during this inspection period.
Complaints and facility-reported incidents in the past 3 years
This nursing home has not been cited for any deficiencies from incidents reported by the nursing home or complaints in the last 3 years.
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