Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hayward Hills Health Care Center during CMS and state inspections, most recent first.
The facility failed to ensure timely submission and action on Medical Regimen Review (MRR) reports, leading to delays in therapeutic recommendations for several residents. Despite the Pharmacy Consultant's claim of submitting reports within 48 hours, the Medical Director and nursing staff reported consistent delays, impacting medication and treatment decisions. Specific instances showed months-long delays in acting on recommendations for monitoring dehydration, electrolytes, and other conditions, contrary to the facility's policy of acting within 30 days.
The facility's dishwasher failed to reach the required temperature of 120°F, as observed on multiple occasions, posing a risk of unsanitized dishes. The Dietary Manager confirmed the issue, and the Maintenance Supervisor admitted the broken booster was not logged. The Administrator was unaware of the problem, highlighting a communication breakdown.
The facility failed to properly store and manage narcotic medications, with some found in an unlocked drawer and discrepancies in medication counts. Two residents had narcotic records that did not match the MAR, indicating missing documentation. Additionally, a resident was undermedicated with diazepam, and another received an incorrect dose of lactulose.
A long-term care facility was found to have a medication error rate of 30% during a survey. Errors included a nurse improperly administering multiple medications via a G-tube by crushing and mixing them together, contrary to policy, and failing to administer prescribed medications. Another nurse failed to give a multivitamin to a resident, despite documenting it as given.
The facility failed to ensure proper storage, labeling, and disposal of medications and vaccines, including unlabeled eye drops, expired inhalers, and improperly monitored refrigerator temperatures. These lapses could affect medication efficacy and safety.
The facility was found to have expired chocolate pudding in the refrigerator and uncovered, freezer-burned soup in the freezer. The Dietary Manager confirmed these issues, acknowledging that expired foods should not be stored or served and that freezer burn could affect food taste.
A resident reported an inappropriate touch by a CNA during pericare, but the facility failed to report the incident to the ombudsman or CDPH as required. The DON only conducted a brief interview with the CNA, who denied the event, and no further investigation was documented. The facility's policy mandates reporting such incidents, which was not followed until later.
A facility failed to complete the required PASARR for a resident with an intellectual disability. The resident was admitted with multiple diagnoses, including a developmental disorder of scholastic skills. Despite the requirement to resubmit a new screening after 30 days, the facility did not complete a PASARR after the resident had been in the facility for more than 31 days. This was confirmed by the DON during an interview.
A resident suffered multiple injuries after a CNA attempted a solo transfer using a Hoyer lift, contrary to the care plan requiring two-person assistance. The resident, who was dependent on assistance for transfers, fell during the process, resulting in rib fractures, a pneumothorax, and a femur fracture. The facility's policy and training emphasized the need for two caregivers during such transfers, which was not adhered to in this incident.
Delayed Action on Pharmacy Recommendations
Penalty
Summary
The facility failed to ensure that the Pharmacy Consultant (PC) provided the Medical Regimen Review (MRR) recommendations and Executive Summary to the facility within the timeframes established in the facility's policies and procedures. This issue persisted for four consecutive months, and the facility did not act on the reports within 30 days for five of the ten sampled residents. The delay in receiving and acting upon the MRR reports had the potential to result in residents not receiving timely therapeutic recommendations on drug therapies. Interviews with the PC, Regional Supervisor, and Medical Director revealed discrepancies in the submission and receipt of the MRR reports. The PC claimed to submit the reports within 48 hours of completion, but the Medical Director noted that the reports were consistently late, impacting the ability of medical and nursing staff to make informed decisions regarding residents' medication and treatment plans. The facility's Director of Nursing (DON) and Nurse Supervisor (NS) confirmed the reports were received late and acknowledged delays in acting upon the recommendations. Record reviews indicated specific instances where recommendations for residents were not acted upon promptly. For example, recommendations for monitoring dehydration, electrolytes, and other conditions for several residents were delayed by months. The facility's policies and procedures required that MRR recommendations be acted upon within 30 days, but this was not adhered to, as evidenced by the delayed actions for residents 56, 26, 2, 66, and 54. These delays in addressing the MRR recommendations highlight a significant deficiency in the facility's medication management process.
Dishwasher Temperature Deficiency
Penalty
Summary
The facility failed to maintain a safe and sanitary method for cleaning dishes due to the dishwasher not reaching the required temperature. Observations on multiple occasions revealed that the dishwasher's highest temperature was consistently 110 degrees Fahrenheit, below the minimum safe temperature of 120 degrees Fahrenheit as specified by both the manufacturer's guidelines and the facility's policy. The Dietary Manager confirmed the inadequate temperature readings and acknowledged the risk of dishes not being properly sanitized, which could compromise resident safety. Further investigation revealed that the dishwasher booster, responsible for heating the water, was broken. The Maintenance Supervisor admitted that this issue was not logged in the maintenance records, contrary to the facility's policy requiring documentation of needed repairs. The facility Administrator was unaware of the malfunctioning dishwasher booster and the temperature issue, indicating a communication breakdown within the facility's maintenance and reporting processes.
Improper Storage and Administration of Medications
Penalty
Summary
The facility failed to provide adequate pharmaceutical services by improperly storing and managing narcotic medications. Narcotic medications were found in an unlocked drawer in the Director of Nursing's (DON) office, with discrepancies in the count of medications for several residents. Specifically, seven narcotic medications were missing, and there was no log maintained for narcotics awaiting destruction. The DON acknowledged that these medications should have been stored securely until they could be destroyed with the Pharmacy Consultant. Additionally, during a random audit, discrepancies were found in the narcotic reconciliation records for two residents. The Medication Administration Record (MAR) did not match the Controlled Drug Record, indicating that narcotics were signed out without proper documentation. This lack of documentation meant that the narcotics were not accounted for, as confirmed by the DON. The facility also failed to administer medications as prescribed by physicians. One resident was undermedicated with diazepam, receiving only half of the prescribed dose on multiple occasions. Another resident received an incorrect dose of lactulose, as the Licensed Vocational Nurse (LVN) administered 10 ml instead of the prescribed 15 ml. These errors in medication administration were confirmed through interviews and record reviews.
Medication Administration Errors in LTC Facility
Penalty
Summary
The facility failed to maintain a medication error rate below 5%, resulting in a cumulative error rate of 30% during a medication pass observation. This was observed in a sample size of 30 opportunities for error, where nine errors were identified. One significant error involved a registered nurse (RN) who improperly prepared medications for a resident with a gastrostomy tube (G-tube). The RN crushed multiple medications together, mixed them with valproic acid liquid and warm water, and administered the mixture via the G-tube, contrary to the facility's policy which requires each medication to be crushed and administered separately with a flush of water in between. Additionally, the RN failed to administer MiraLAX and lactulose as ordered, with the lactulose being unavailable in the medication cart. Another error was noted when a licensed vocational nurse (LVN) failed to administer a multivitamin to a resident, despite documenting that it had been given. The LVN later admitted to forgetting to administer the multivitamin. The facility's policy on enteral tubes, dated September 2018, clearly states that medications should not be mixed together and should be administered separately to avoid interactions and clumping. These practices were not followed, leading to the identified deficiencies.
Medication Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure the safe storage, labeling, and disposal of medications and vaccinations, leading to several deficiencies. Over-the-counter eye drops were found in a medication cart without a resident's name, and two inhalers were opened without an open date, with one being expired and still in use. Additionally, a multidose TB vial was opened without a documented open date, and twenty-one vaccine syringes were stored past their expiration date in the medication refrigerator. Further observations revealed that intravenous heparin flushes in the emergency kit were expired, and one emergency kit was unsealed with a documented open date of May 2024. The medication/vaccine refrigerator temperature was not monitored twice daily as required, with gaps in documentation for eight months. These lapses in medication management had the potential to compromise the potency and efficacy of medications and vaccines administered to residents. Interviews with staff, including LVNs, the DON, and the DSD, confirmed the lack of adherence to proper medication labeling and storage protocols. The facility's policies and procedures were not followed, as evidenced by the failure to document open dates on multi-dose vials and the improper monitoring of refrigerator temperatures. The Pharmacy Consultant also noted that monthly oversight was in place, but staff failed to consistently monitor the medication refrigerator temperature every shift.
Food Storage and Preparation Deficiencies
Penalty
Summary
The facility failed to adhere to professional standards of food service safety, as evidenced by two specific observations. During an inspection, expired chocolate pudding was found in the refrigerator, with the Dietary Manager (DM) confirming that it should not be stored or served past its use-by date. Additionally, uncovered frozen soup with white crystals, indicative of freezer burn, was observed in the freezer. The DM acknowledged that the soup was improperly stored and noted that freezer burn could affect the taste of the food when served.
Failure to Report Alleged Abuse to Authorities
Penalty
Summary
The facility failed to report an alleged incident of abuse or mistreatment involving a resident to the appropriate authorities. The incident involved a Certified Nursing Assistant (CNA) who allegedly touched the resident inappropriately during pericare. The resident, who had an intact cognitive status with a Brief Interview for Mental Status score of 15, reported feeling uncomfortable and reported the incident to the facility staff shortly after it occurred. However, the facility did not document any follow-up with the resident after the event. The Director of Nursing (DON) conducted an interview with the CNA, who denied the incident, but no further investigation was documented. The facility did not notify the ombudsman or the California Department of Public Health (CDPH) about the incident, as required by their policy. The CNA later stated that he did not remember being interviewed about the incident. The facility's policy indicated that all alleged violations involving abuse, neglect, exploitation, or mistreatment should be reported to CDPH and the ombudsman, which was not done in this case until much later.
Failure to Complete PASARR for Resident with Intellectual Disability
Penalty
Summary
The facility failed to complete the required Preadmission Screening and Resident Review (PASARR) for a resident with a diagnosis of an intellectual disability. The resident was initially admitted to the facility in January 2024 with multiple diagnoses, including a developmental disorder of scholastic skills and other specified disorders of the brain. According to the PASARR dated December 27, 2023, if the resident remains in the nursing facility longer than 30 days, a new screening should be resubmitted on the 31st day. However, the facility did not complete a PASARR for the resident after they had been at the nursing facility for more than 31 days. This oversight was confirmed during an interview with the Director of Nursing, who acknowledged that a PASARR should have been completed due to the resident's diagnosis of an intellectual disability.
Failure to Follow Transfer Protocols Leads to Resident Injury
Penalty
Summary
The facility failed to implement appropriate safety measures during the transfer of a resident using a Hoyer lift, resulting in a serious accident. The incident involved a long-term resident who was dependent on assistance for transfers due to conditions such as generalized muscle weakness, obesity, and anxiety. The resident's care plan specified the need for a Hoyer lift and assistance from two staff members during transfers. However, a Certified Nursing Assistant (CNA) attempted to transfer the resident alone, leading to the resident falling and sustaining multiple injuries, including rib fractures, a pneumothorax, and a femur fracture. The incident occurred when the CNA, without assistance, used the Hoyer lift to transfer the resident from the bed to a shower chair. The resident expressed fear and discomfort, noting that the sling felt too small, which contributed to the fall. The fall was witnessed by the CNA, and the resident was found on the floor by a Registered Nurse (RN), who called 911 due to the resident's difficulty speaking and complaints of chest pain. The resident was subsequently hospitalized for treatment of the injuries sustained during the fall. Interviews with the facility's Director of Nursing (DON) and the RN confirmed that the facility's policy required a two-person assist for Hoyer lift transfers, as emphasized in staff training. The facility's training materials and policy documents also highlighted the importance of using the correct sling size and following manufacturer's instructions to prevent falls and injuries. Despite these guidelines, the CNA proceeded with the transfer alone, directly leading to the resident's fall and subsequent injuries.
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What surveyors actually found near you
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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A prioritized, do-first checklist
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Nursing homes near Hayward
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Sage Post Acute | 0.1 mi | ★★★★★ | 1 | 0 |
| Hayward Gardens Post Acute | 0.1 mi | ★★★★★ | 13 | 0 |
| Canyon Creek Post-acute | 0.4 mi | ★★★★★ | 2 | 0 |
| Baywood Court Health Center | 0.6 mi | ★★★★★ | 0 | 0 |
| Vista Post Acute | 1.1 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.