Inspection visit

Routine inspectionJune 17, 2024

FIVE STAR CARE HOME IILicense 41560070511 citations on this visit

11 citations recorded

Inspector’s narrative

What the inspector wrote

On June 17, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Irma Perez and LPA explained the purpose of the visit. The administrator, Evelina Melkanyan arrived shortly thereafter. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. LPA observed a bed was blocking the outdoor passageway. A tour of resident's room was conducted and observed to have sufficient furniture and furnishings. 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. Showers were 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 106-115 degrees Fahrenheit. Fire extinguishers were checked. A review of (6) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. The following documents were requested submitted to CCL by 6/24/24: - LIC 500, Liability Insurance, Administrator Certification 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 civil penalties. . This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.

Citations

11 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.

1569.618(c)(3)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed 2 out of 2 staff did not have a valid First Aid Certification which poses an immediate health, safety or personal rights risk to persons in care.
1569.625(b)(2)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 2 out of 2 staff did not have documents to proof that required training was completed which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.625(d)(1)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 2 out of 2 staff members did not have documents to proof that this training was completed which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.695(c)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility was not able to provide proof that emergency drills were completed accordingly which poses an immediate health, safety or personal rights risk to persons in care.
1569.696(a)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 2 out of 2 staff did not have documents to proof that this training was completed which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.696(a)(1)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above 2 out of 2 staff members did not have training records to proof that this was completed which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(a)Type B
Maintain facility in clean, safe, sanitary condition
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed a hold in the wooden deck which poses/posed a potential health, safety or personal rights risk to persons in care.
87307(d)(6)Type B
Passageways and stairways kept clear
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed a bed that was blocking the outdoor passageway which poses/posed a potential health, safety or personal rights risk to persons in care.
87457(c)(1)Type B
Minimum appraisal documentation requirements
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 4 out of 6 residents did not have a completed appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.
87468(d)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observe the personal rights were posted which poses/posed a potential health, safety or personal rights risk to persons in care.
87456(a)(2)Type A
Perform a pre-admission resident appraisal
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 4 out of 6 residents did not have a pre-admission appraisal 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 17, 2024 inspection of FIVE STAR CARE HOME II?

This was an inspection of FIVE STAR CARE HOME II on June 17, 2024. 11 citations were issued: 3 Type A (serious) and 8 Type B.

Were any citations issued to FIVE STAR CARE HOME II on June 17, 2024?

Yes, 11 citations were issued (3 Type A, 8 Type B). The first citation was for: "Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA ob..."

What type of inspection was this?

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

SourceView on CCLD View original report

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Data from CCLD public records. Last updated June 8, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·June 17, 2024