Carlton Plaza of Fremont

87303(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.This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having a leak in the main lobby by the receptionist area which poses a potential safety risk to persons in care.

87632(a) Hospice Care Waiver(a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department...This requirement is not met as evienced by Based on observation and interview, the licensee did not comply with the section cited above by having a total of 13 residents on hospice while the facility is only approved for 6 which poses a potential safety risk to persons in care.

(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.This requirement is not met as evidenced by: The licensee did not comply with the section cited above when the licensee had items such as hoyer lifts, bed frame, bed mattress, portraits, and vacuum which poses a potential safety risk to persons in care.

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects...locked storage and are not left unattended if outside the locked storage.This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section above by having two scissors unlocked in R1's room with a dementia diagnosis which poses an immediate safety risk to persons in care.

87615(a)(1) (a) Persons who require health services for or have a health condition including...shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries.This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above when facility retained a resident with a stage III pressure wound which posed a potential health risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having multiple food items such as Greek Nonfat yogurt with a best buy date of 10/08/2025, sauce with best buy date 09/30/2025, Chipotle Southwest with a best buy date of 04/22/2022, smoked guada best buy date of 08/29/2025, etc., which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having the emergency food supplies in the same storage as paint, lighter fluid, and other debris which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above by not having S4 associated with the facility on Guardian which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above by not having R3, R5, R6 and R7’s physician report (LIC602A) updated which poses a potential health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above by having staff files incomplete which poses a potential personal rights risk to persons in care.

Based on interview and observation, the licensee did not comply with the section cited above by not having 4 PRN medications in the facility for R1 which poses a potential safety risk to persons in care.

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by having a over capacity of 130 residents which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having a hammer, wrench, Antacids Tablets, Nystatin Powder, and Cortizone in R3’s room and unlocked Method All-Purpose Cleaning Wipes, Clorox Spray, and Airborne in the activities closet which poses an immediate safety risk to persons in care.

87211(a)(1) Reporting Requirements A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not sending R1's incident report to the department within the seven day timeframe which posed a safety risk to persons in care.

87211(a)(1) Reporting Requirements(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...This requirement is not met as evidenced by: The licensee did not comply with the section cited above by not reporting to the licensing department of any falls that R1 had at the facility which posed a potential health and safety risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on investigation, licensee did not comply with section cited above by escorting R1 to the incorrect room and unaware R1's whereabouts which poses a potential health and safety risk to the persons in care.

Based on observation the licensee did not comply with the section cited above in having an incomplete first aid kid in the second floor, third floor, and in the kitchen which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having prescribed medication of solution in R1's bathroom which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in not having a PRN medication for R2 in the Med Tech room and in R2's medication bin, there was medication found not listed in doctor's order which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having a knife in R2's room, Lysol spray and dish soap in R3's room, and cleaning supplies such as Lysol spray and the Pink Stuff in R1's room which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having lysol sprays stored in the same area as food supplies which poses a potential health and safety risk to persons in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities...(3) To be free from punishment...abuse, or other actions... This requirement was not met as evidence by: Based on LPA's interviews licensee did not comply wi tthe section cited above which poses a potential health and safety risk to persons in care.