Burlingame Senior Home 2

Type of visit: Required - 1 Year

On February 25, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with Caregiver, Ligaya Munoz, and caregiver, Jonaan Jaochico. LPA explained the purpose of today's visit. Administrator, Fereshteh Ehsanipour arrived an hour later and assisted with the inspection. LPA toured the facility and grounds with caregiver. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 6 resident bedrooms, 1 staff bedroom, 1 full bathroom and 5 half bathrooms.. LPA observed all 6 resident rooms; 1 with a full bathroom and 5 with half baths. Resident's rooms were observed to be private rooms. Bedrooms were equipped with the required furniture for resident to use, Bathrooms were equipped with grab bars, and non-skid mats. Hot water temperature was measured at 108- 117 degrees F. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. A comfortable temperature is maintained, lighting is sufficient for comfort. Centrally stored medications, toxins and chemicals were observed to be locked and inaccessible to residents in care. 2 knives and 2 pairs of scissors were observed to be unlocked in the kitchen drawers and accessible to residents in care. 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. Emergency Drills were observed to be adequate. Upon entry, caregiver, S1 was not able to provide, annual training records for herself and for S2, resident # 5 (R5)'s physician's report, and emergency disaster drills. According to S1, the administrator has all the files and will bring them to the facility after she was done with escorting a resident to a medical appointment. This observation was observed during the annual inspections in 2024 and 2025. Due to the above observation, an immediate civil penalty of $250 is being assess today for repeat violation- 87755(c) Inspection Authority. 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 administrator; a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

Allegation investigated: The facility does not ensure the medication is safely stored

On September 4, 2025, Licensing Program Analyst (LPA) Murial Han conducted a 10-day complaint visit. Upon entry, LPA met with caregiver, Ligaya Munoz, and LPA explained the purpose of today's visit. The administrator, Fereshteh Ehsanipour arrived shortly thereafter and assisted with the visit. Regarding to the allegation of - the facility does not ensure medication is safely stored, there is no additional details provided by the reporting party. During today's visit, LPA observed medication cabinet was not locked, and there were multiple bottles of medication placed outside of the medication cabinet. LPA observed some medications were stored on top of the medication cabinet and some were stored on a wooden file cabinet next the medication cabinet. Substantiated LPA interviewed resident #1(R1) who stated that he/she is satisfied with the meals that the facility serves and the meals are nutritious and well balanced. LPA interviewed staff #1 (S1) who stated that the residents are getting quality and quantity meals. S1 also stated when the food is runny low, she would make a grocery list for the administrator and the administrator would purchase everything within a few hours. Based on observation and interviews, this allegation is deemed to be unsubstantiated. Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed with the administrator; a copy is provided. According to staff #1 (S1) the medication cabinet is too small to fit all the medications. The administrator acknowledged that the medication is not stored properly because the cabinet is too small to fit all the medications, and it does not lock at all times. Based on interviews, observation, and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation was determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with the Administrator; a copy is provided with Appeal Rights provided.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 14-AS-20250826095648

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 5, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons.... This requirement is not met as evidenced by based on observation and interview, LPA observed the medication cabinet was unlocked and there were medications stored outside of the medication cabinet which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: During the visit, the administrator has locked all the medication in a locked closet. The administrator will submit a plan of correction to CCL by 9/6/2025 and the plan will indicate that the facility will purchase a new medication cabinet to ensure compliance. The plan will also indicate the estimated date of arrival for the new cabinet.

Type of visit: Required - 1 Year

On March 11, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with Caregiver, Ligaya Munoz, and caregiver, Isabelita Nojadera. LPA explained the purpose of today's visit. Administrator, Fereshteh Ehsanipour arrived shortly thereafter and assisted with the inspection. LPA toured the facility and grounds with caregiver. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 6 resident bedrooms, 1 staff bedroom, 1 full bathroom and 5 half bathrooms.. LPA observed all 6 resident rooms; 1 with a full bathroom and 5 with half baths. Resident's rooms were observed to be private rooms. Bedrooms were equipped with the required furniture for resident to use, Bathrooms were equipped with grab bars, and non-skid mats. Hot water temperature was measured at 108- 117 degrees F. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. A comfortable temperature is maintained, lighting is sufficient for comfort. Centrally stored medications and sharps were observed to be unlocked and accessible to residents in care. Toxins, chemicals and disinfectants were observed to be locked and inaccessible to residents. Upon entrance, staff #2 was not able to provide staff and resident files for LPA to review as part of the inspection process and stated that the administrator has the key to the cabinets. This observation was identified during the annual inspection in 2024. 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. Emergency Drills were observed to be inadequate because the administrator was not able to provide documents that it was conducted accordingly. During today's visit, an immediate civil penalty of $500 is being assess as LPA observed 3 repeat violations that were cited during the annual inspection in 2024 :87465(h)(2), 87755(c), and 1569.695(c). The administrator will provide a copy of the liability insurance to CCL by 3/12/2025. 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 administrator; a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: POC

On February 28, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced plan of correction visit to follow up on a civil penalty that was assessed on 2/22/2024. LPA met with caregiver, Ligaya and explained the purpose of the visit. On February 22, 2024. LPA conducted an unannounced Plan of Correction visit to follow up on the citations that were issued during the annual visit on February 13, 2024. During the visit, LPA reviewed and validated the plan of correction that was submitted by the facility and cleared 8 out of 9 citations. However, LPA observed the remaining citation of 87755(c) Inspection Authority Of The Licensing Agency was not corrected and due to the citation not being corrected by 2/14/2024, a civil penalty in the amount of $800 was assessed from 2/15/2024 through 2/22/2024. During today’s visit, LPA interviewed staff and observed the above citation has been corrected and citation is now cleared. Civil penalties will be stopped on 2/23/2024. This report is reviewed and discussed with caregiver; A copy is provided.the state’s words, verbatim · CDSS document, Feb 28, 2024

Type of visit: POC

On February 22, 2024, Licensing Program Analyst (LPA) conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on February 13, 2024 during an annual inspection. Upon arrival, LPA was greeted by caregiver, Ligaya Munoz and LPA explained the purpose of the visit. The administrator, Fereshteh Ehsanipour arrived later and assist with the visit. During today's visit LPA observed the following deficiency was not corrected. The administrator submitted a plan of correction on February 14, 2024 stating that facility staff will have access to all locked record drawers. However, upon arrival, facility staff was not able to provided staff and residents records for inspection and they stated that they did not have the key to open the locked record drawers. LPA was not able to conduct record reviews until the arrival of the administrator who has the key(s) the lock drawers. 87755 Inspection Authority of the Licensing Agency..(c)The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). Due to the above observation and deficiency not being corrected, a civil penalty is being assessed in the amount of $100 a day from 2/15/2024 through 2/22/2024 and will continue to accrue until corrected. A total civil penalty of $800 is being assessed. LPA observed the following deficiencies were corrected: 87309(a), 87113, 80065(i)(2), 87468(c)(2), 87468(c)(2)(A), 87468(d), 87465(h)(2), 87468.1(a)(2). This report is reviewed and discussed with the administrator; A copy is provided with the appeal rights..the state’s words, verbatim · CDSS document, Feb 22, 2024

Type of visit: Case Management - Annual Continuation

On February 22, 2024, Licensing Program Analysts (LPA) Murial Han arrived unannounced to conduct an annual continuation for an annual required inspection that was conducted on February 13, 2024. LPA met with caregiver, Ligaya Munoz and explained the purpose of the visit. The administrator arrived momentarily and assisted with the inspection. During today's visit, LPA toured the facility, interviewed staff and residents, review records and resident and staff files. 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 the administrator. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 22, 2024

Type of visit: Required - 1 Year

On February 13, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with Caregiver, Ligaya Munoz, and caregiver, Isabelita Nojadera. Administrator, Fereshteh Ehsanipour was not available to join the inspection. LPA explained the purpose of the visit. LPA toured the facility and grounds with caregiver. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 6 resident bedrooms, 1 staff bedroom, 1 full bathroom and 5 half bathrooms.. LPA observed all 6 resident rooms; 1 with a full bathroom and 5 with half baths. Resident's rooms were observed to be private rooms. Bedrooms were equipped with the required furniture for resident to use, Bathrooms were equipped with grab bars, and non-skid mats. Hot water temperature was measured at 106- 110 degrees F. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. A comfortable temperature is maintained, lighting is sufficient for comfort. Centrally stored medications, toxins, and sharps were observed to be unlocked and accessible to residents. LPA reviewed centrally stored medication and observed 2 medications for resident #1 (R1) to be expired. LPA requests the following forms to be submitted to CCLD by 2/15/2024 LIC308 Designation of Administrative Responsibility LIC309 Administrative Organization Liability Insurance Administrator Certificate LPA was not able to complete the inspection today and will return on another day as the resident and staff records were locked and not accessible for review. According to the staff, they do not have access to the files and the administrator is the only one who has the keys to the files. 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 caregiver. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 13, 2024