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Inspection visit

Routine inspection

BURLINGAME SENIOR HOMELicense 4156000898 citations on this visit
8 citations recorded

Inspector’s narrative

What the inspector wrote

On June 5, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers, Helen Soriano and Jesusa Madueno and LPA explained the purpose of the visit. The administrator, Fereshteh Ehsanipour arrived shortly thereafter and assisted with the rest of the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 4 resident rooms (2 shared and 2 private rooms) with bathrooms and 1 staff room. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. shower was observed equipped with non-skid mats and grab bars. Comfortable temperature is maintained and lighting is sufficient for comfort. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. Hot water temperature in the kitchen and bathroom were measured at 106-121 degrees Fahrenheit. Fire extinguishers were checked. A review of (4) resident files was conducted and noted on the LIC 858. A review of (1) staff files was conducted and noted on the LIC 859. During today's visit, civil penalty in the amount of $300 is being assessed ($200 for S1 and S2's criminal records were not transferred and $100 for Failure to Correct a deficiency that was issued in 2024). Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.

Citations

8 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.

  • 1569.695(c)Type A

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the administrator was not able to provide documentation to proof that emergency drills were conducted after Jan 2024 which poses an immediate health, safety or personal rights risk to persons in care.

  • 87355(e)(3)Type A

    Request a transfer of criminal record clearance

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S1 and S2 did not complete the transfer criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.

  • 87412(g)Type B

    Maintain personnel records at facility location

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S2's personnel file was not maintained at the facility and the administrator/licensee stated that it was at the sister facility which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87458(c)(1)(A)Type A

    Record findings for communicable tuberculosis conditions

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed resident #4 (R4)'s TB a status for Tuberculosis was blank on the Medical Assessment and the administrator/licensee was not able to provide documentation that it was completed which poses an immediate health, safety or personal rights risk to persons in care.

  • 87463(a)Type B

    Update reappraisal at required intervals

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R2 did not have a current reappraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87608(a)(3)Type A

    Maintain physician order documentation in resident record

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as resident #1 (R1) has bed rails and the facility was not able to provide a written order by the physician which poses an immediate health, safety or personal rights risk to persons in care.

  • 87618(b)(3)(A)Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R1 and R4 are on Oxygen and the facility was not able to provide proof that the local fire jurisdiction was notified which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87618(b)(3)(B)Type A

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R1 and R4 are on oxygen and LPA did not observed any "No Smoking - Oxygen" posted which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the June 5, 2025 inspection of BURLINGAME SENIOR HOME?

This was an inspection of BURLINGAME SENIOR HOME on June 5, 2025. 8 citations were issued: 5 Type A (serious) and 3 Type B.

Were any citations issued to BURLINGAME SENIOR HOME on June 5, 2025?

Yes, 8 citations were issued (5 Type A, 3 Type B). The first citation was for: "Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the ad..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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