Inspection visit

Routine inspectionJune 17, 2025

FIVE STAR CARE HOME IILicense 41560070513 citations on this visit

13 citations recorded

Inspector’s narrative

What the inspector wrote

On June 17, 2025, 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 was notified by phone of LPA's visit. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. 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 138-143 degrees Fahrenheit. Fire extinguishers were checked. During the tour, LPA observed strong urine odor in resident rooms, a layer of black dust on top of the kitchen vent, dirty floor edges in the kitchen and around the facility, resident rooms were cluttered, etc. A review of (5) 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 6/19/2025 - LIC 500, Liability Insurance, Administrator Certification A civil penalty of $ 1,250.00 is being assessed today for 5 repeat violations that were cited during the annual visit on June 17, 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 the caregiver. A copy of this report and the appeal rights were provided.

Citations

13 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 S1 and S2's CPR/Fire aid training expired May 2024 which poses an immediate health, safety or personal rights risk to persons in care.
1569.625(b)(2)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA observed 2 out of 2 staff did not have their training records which poses an immediate 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 the emergency drills were completed accordingly which poses an immediate health, safety or personal rights risk to persons in care.
1569.696(a)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA observed 2 out of 2 staff did not have their training records which poses an immediate 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 during the tour, LPA observed strong urine odor in resident rooms, a layer of black dust on top of the kitchen vent, dirty floor edges in the kitchen and around the facility, resident rooms were cluttered, etc. which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(e)(2)Type A
Provide resident hot water for personal care
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed water temperature in the kitchen and the resident bathroom were measured at 139-143 F which poses an immediate 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 LPA observed R4 was admitted in May 2025 and there is no pre-admission appraisal which poses an immediate health, safety or personal rights risk to persons in care.
87456(a)(3)Type A
Obtain and evaluate recent medical assessment
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R4 was admitted in May 2024 and the facility did not have a copy of the recent medical assessment which poses an immediate 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 LPA observed R2 and R4 have bed rails without a physician's order 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 2 residents with Oxygen in their room 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.
87633(a)(1)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility has an approved hospice waiver for 1 but currently has 2 residents who are on hospice which poses an immediate 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 LPA did not observed any "No Smoking - Oxygen in Use" signs inside and outside of the facility which poses an immediate health, safety or personal rights risk to persons in care.
87465(c)(3)Type A
Document each PRN medication dose taken
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R4 was admitted in May 2025 and there is no medication record 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, 2025 inspection of FIVE STAR CARE HOME II?

This was an inspection of FIVE STAR CARE HOME II on June 17, 2025. 13 citations were issued: 11 Type A (serious) and 2 Type B.

Were any citations issued to FIVE STAR CARE HOME II on June 17, 2025?

Yes, 13 citations were issued (11 Type A, 2 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, 2025