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Inspection visit

Complaint

HAVEN HOUSE OF SAN RAFAELLicense 2168039313 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

Continued from LIC9099 second half bed rail and the gait belt as a safety precaution for R1. Per interviews, the gait belt is used as a safety precaution for R1 when staff are doing other tasks such as cooking or providing care to other residents. LPA was informed that the video camera has no audio and was placed as an additional safety precaution to notify Night Shift staff when R1 gets up at night. Interviews further revealed that R1's family was verbally notified of the camera/video monitoring. Interview conducted with R1 revealed that they preferred to go to bed at 10:00PM but usually get put into bed at 9PM. Per R1, they are unable to get out of bed on their own due to their recent injury and would require assistance to leave. LPA conducted a walkthrough of the facility and observed the following: R1's bed had two half bed rails creating a full bed rail (picture taken). LPA also observed that R1 had a white gait belt around their wheelchair. Review of R1's file showed that they are not receiving hospice services at this time and do not have a physician's order for use of bed rails or for use of a gait belt. There is also no documentation in the file regarding camera/video monitoring for R1's room. Based on record review, interviews conducted, and observations made, these allegations are Substantiated . A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Licensee. Signature on form confirms receipt of documents.

Citations

3 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87608(a)(5)(B)Type A

    *Amended* 87608 Postural Supports:(a)...supports may be used...(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of...hands or feet. (B) Bed rails that extend the entire length...prohibited except for residents currently receiving hospice care...This requirement was not met as evidenced by: Based on records, observations, and interviews, Licensee did not comply with the section cited above. R1 had a gait belt around their wheelchair and two half bed rails as a full bed rail. This poses an immediate health and safety risk to residents in care.

  • Dignity in personal relationships

    87468.1 Personal Rights of Residents in All Facilities:(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. Thisrequirement was not met as evidenced by: *Amended* Based on interviews conducted, Licensee did not comply with the section cited above. R1 has a camera in their room without the written approval/consent of the Department or R1's Responsible Party. This is a potential health and safety risk to residents in care.

  • 87468.2(a)(6)Type B

    87468.2 Additional Personal Rights of Residents in Privately Operated Facilities:(a)...residents...shall have all of the following personal rights:(6) To make choices concerning their daily lives in the facility. This requirement was not met as evidenced by:Based on interviews, Licensee did not comply with the section cited above. R1 stated that they go to bed earlier than they prefer and are also unable to get out of bed on their own. This is a potential health and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the August 1, 2025 inspection of HAVEN HOUSE OF SAN RAFAEL?

This was a complaint inspection of HAVEN HOUSE OF SAN RAFAEL on August 1, 2025. 3 citations were issued: 1 Type A (serious) and 2 Type B.

Were any citations issued to HAVEN HOUSE OF SAN RAFAEL on August 1, 2025?

Yes, 3 citations were issued (1 Type A, 2 Type B). The first citation was for: "*Amended* 87608 Postural Supports:(a)...supports may be used...(5) Under no circumstances shall postural supports includ..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.