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Inspection visit

Follow-up on corrections

BURLINGAME SENIOR LIVINGLicense 4156011262 citations on this visit
2 citations recorded

Inspector’s narrative

What the inspector wrote

On July 20, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit in relation to complaint investigation (complaint number: 14-AS-20230714123226). LPA met with Operation Specialist, Kathleen Calobeer and explained the purpose of the visit. During the complaint investigation visit, LPA found that the facility failed to submit the incident report for the incident that occurred on July 12, 2023 where Resident 1 (R1) signed out and left the facility unassisted. According to the Resident Care Coordinator, Rowena Cancino, it was acknowledged an incident report was not submitted to CCL. 87211 Reporting Requirements- A civil penalty of $250 is assessed on 7/20/2023 for a repeat violation within 12 months. This violation was cited on 6/29/2023. During the visit, LPA observed Staff 1 (S1) to not be fingerprint cleared. Based on personnel record review with facility, LPA observed S1 to not be fingerprint cleared and association status to be pending. Operations specialists immediately notified S1 and S1 left the facility during LPAs visit and will not return until fingerprints are cleared. This violation results in a civil penalty of $100 per day x 1 day = $100 Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in additional civil penalties. Report is reviewed with Operations Specialist and a copy is provided with civil penalties and appeal rights.

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.

  • 87211(a)(1)Type A

    Report specified resident events within seven days

    87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(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...Violation of this regulation is not met as evidenced by: Based on record review and interviews conducted, facility acknowledged to not submitted CCL a incident report for an incident that occurred on July 12, 2023.

  • 87355(e)(1)Type A

    Submit and maintain current mailing address

    87355 Criminal Record Clearance: (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department or..Violation of this regulation is not met as evidenced by: Based on observations and record review, LPA observed S1 to not be fingerprint cleared.

  • 87464(f)(1)Type A

    Care and supervision as defined by statute and rules

    87464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).Violation of this regulation is not met as evidenced by: Based on interviews conducted and files reviewed, R1 has a secondary diagnosis of dementia and is unable to leave the facility unassisted, however on July 12, 2023, R1 left the facility unassisted. In addition, according to staff interviewed R1 has left the facility mulitple times in the past without a staff member accompanying R1. Furthermore, LPA observed R1's service plan in a resident service plan binder on the front desk to indicate R1 is not allowed to leave the facility unassisted.

FAQ · About this visit

Common questions about this visit

What happened during the July 20, 2023 inspection of BURLINGAME SENIOR LIVING?

This was an other inspection of BURLINGAME SENIOR LIVING on July 20, 2023. 2 citations were issued: 2 Type A (serious).

Were any citations issued to BURLINGAME SENIOR LIVING on July 20, 2023?

Yes, 2 citations were issued (2 Type A, 0 Type B). The first citation was for: "87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may..."

What type of inspection was this?

This was an other inspection. other 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.