Serra Highlands Senior Living

Maintain separate complete record for each resident

Based on resident records reviewed, 5/5 resident records reviewed did not have a complete and current record of file as it was missing the admissions agreement, personal rights form, and safeguarding of property valuables form which poses/posed a potential health, safety or personal rights risk to persons in care.

Request a transfer of criminal record clearance

Based on records reviewed, 1/5 staff members was fingerprint cleared to work at a facility, however was not associated which poses/posed a potential health, safety or personal rights risk to persons in care.

Annual routine visit with medical professional

Based on resident records reviewed, 5/5 resident records reviewed did not have documentation in their files to show that annual routine visits were being done once every twelve months which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by Based on observations, R1's room smelled like urine and LPA observed stains on R1's carpet which poses a potentional health and safety risk to residents in care.

Document required staff training and orientation

87412 Personnel Records: (c) Licensees shall maintain in the personnel records verification of required staff training and orientation.This requirement is not met as evidenced by: Based on 7 personnel records reviewed, LPA did not observe any staff training records in the files. In addition, facility was unable to provide it to LPA during the complaint visit on 3/5/26 which poses a potential health and safety risk to residents in care.

§1569.69 Employees assisting residents with self-administration of medication; training requirements: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 16 hours of initial training... This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medication which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on training records reviewed, S1 and S2 did not have their initial 16 hours of training documented prior to administering medication to residents in care which poses an immediate health and safety risk to residents in care.

87411 Personnel Requirements - General: (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (3) The training shall include, but not be limited to, the following:(D) Policies and procedures regarding medications, including the knowledge in Section 87411(d)(4). This requirement is not met as evidenced by: The facility was unable to provide LPA documentation to show med-techs have been receiving their annual on-the-job training. LPA did not observe any annual trainings in med-techs files during file review.

Eviction report must be filed within five days

87224 Eviction Procedures: (f) A written report of any eviction shall be sent to the licensing agency within five (5) days.This requirement is not met as evidenced by: Based on record review, the facility was unable to provide LPA documentation to show that a copy of the 30-day eviction for R1 was submitted to CCLD. In addition, based on CCLD's record, a copy of the eviction notice was not observed which poses a potential health and safety risk to residents in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by: Based on LPA's observations, R1's room to have a urine odor which poses a potential health and safety risk to residents in care.

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).This requirement is not met as evidenced by: Based on R1’s file reviewed, R1 is unable to leave the facility unassisted, however, R1 left the facility unassisted on 1/8/26 at around 10:40am and did not return back to the community till 7pm when R1 was found by a good samaritan. Staff indicated they were not aware that R1 was not allowed to leave the facility unsupervised which 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...This requirement is not met as evidenced by: Based on interviews, R1 indicated that S1 says the F word or use other profanity towards him/her several times. According to staff interviewed, he/she witnessed S1 cursing at R1 while assisting S1 with providing care to R1 which poses a potential health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on R1's medication list, R1 was required to take one tablet of Pregabalin (75mg) medication daily every morning, and one 75mg tablet at bedtime, however the med-tech administered one 50mg capsule instead. The facility failed to provide R1's medication as prescribed by the physician.

Annual routine visit with medical professional

87463 Reappraisals: (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment.This requirement is not met as evidenced by: Based on records reviewed, R1 has not received an annual routine visit since 9/2021 which poses a potential health and safety risk to residents in care.

Mark taps at high-temperature threshold

Based on bservation, the licensee did not comply with the section cited above due to hot water being tested in random rooms and 7 out of 9 showed a temperature of between 99-103 deg F. which poses an immediate health, safety or personal rights risk to persons in care.

Request transfer of criminal record exemption

Based on records review, the licensee did not comply with the section cited above due to four staff members does not have criminal record clearances which poses an immediate health, safety or personal rights risk to persons in care.

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: (13)To have access to individual storage space for private use.This requirement is not met as evidenced by: LPA observed R1's room and observed R1's dresser against R1's bed and LPA was unable to fully open the dresser which poses a potential health and safety risk for residents in care.

Maintain comfortable room temperature at all times

87303 Maintenance and Operation: (b) A comfortable temperature for residents shall be maintained at all times.This requirement is not met as evidenced by Based on interviews and observations, the facility does not have working heating units in some parts of the facility. According to the administrator, there has been issues with some of the HVAC units and facility currently looking for repairs, however for the meantime, residents are being provided space heaters as an alternative option.

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).This requirement is not met as evidenced by: Based on staff interviews, there was a resident (R1) who did leave the facility unassisted once and was found by a caregiver and redirected back to the facility. Based on R1's physician's report reviewed, it was noted R1 had a diagnosis of dementia and is unable to leave the facility unassisted which poses an immediate health and safety risk for residents in care.

87206 Advertisment and License Number: (a) In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence.Violation of this regulation is not met as evidenced by: Based on LPA’s observation, the facility is observed to be advertising online as Serra Highlands Senior Living and has signage of the facility name as Serra Highlands Senior Living outside the facility building without a valid RCFE License. Licensee has failed to operate consistent with licensure as ATRIA AT DALY CITY, which poses a potential health, safety, or personal rights risk to clients in care.

87109(b) Transferability of License: The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least 30 days prior to the transfer of the property or business...as specified in Health and Safety Code Section 1569.191. This requirement was not met, as evidenced by absence of proof that written notice was issued to residents or their responsible parties. Licensee failed to ensure that proper notices were issued prior to doing business as Pacfica Senior Living, which poses a potential health, safety or personal rights risk to clients in care.

87206 Advertisment and License Number: (a) In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence.Violation of this regulation is not met as evidenced by: Based on LPA’s observation, the facility is observed to be advertising online as Serra Highlands Senior Living and has signage of the facility name as Serra Highlands Senior Living outside the facility building without a valid RCFE License. Licensee has failed to operate consistent with licensure as ATRIA AT DALY CITY, which poses a potential health, safety, or personal rights risk to clients in care.

87109(b) Transferability of License: The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least 30 days prior to the transfer of the property or business...as specified in Health and Safety Code Section 1569.191. This requirement was not met, as evidenced by absence of proof that written notice was issued to residents or their responsible parties. Licensee failed to ensure that proper notices were issued prior to doing business as Pacfica Senior Living, which poses a potential health, safety or personal rights risk to clients in care.