Senior Care Records.

Facility Evaluation Report

Montgomery Springs Manor, Hayward08/24/2021Licence 015601506

Capacity15
Census12
Date signed08/24/2021 03:24:15 PM
The inspector’s account

On 08/24/2021 at 8:50am, Licensing Program Analysts (LPAs) Allison O'Hollaren and Jill Clancy-Czuleger conducted a case management while at the facility for another matter. LPAs met with Administrator Mirriam Paras.

PIN 21-38-AS C states " Well-fitting face mask is required in indoor settings (double mask or surgical mask recommended), unless an N95 respirator is required pursuant to Title 8 regulations" for all staff and Licensees. However, LPAs observed Administrator Mirriam Paras, S1, S2, and S3 in facility without a mask in common areas.

LPAs observed moldy cantaloupe in cabinet.

The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22 and California health and safety code. Failure to correct the deficiencies may result in civil penalties.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction