All Saint's Maubert
15731 Maubert Avenue · San Leandro, CA · 94578 · 5104813200
14 certified beds For profit - Limited Liability company Chain: Pacs Group
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- Staffing hours comfortably above national benchmarks.
- Inspection results have improved across recent cycles.
The composite number cleared 71 points, but Recommended is gated: inspection record below the Recommended bar. That rule is part of the published method.
Red flags
1 immediate-jeopardy citation in prior inspection cycles
Serious past findings — check whether the underlying problems were fixed and stayed fixed.
$131,856 in federal fines in the last 24 months
1 fine — CMS fines are reserved for verified, serious non-compliance.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 1 of 5 Inspections: 2 of 5 Staffing: 4 of 5 Quality measures: 1 of 5
| Total nurse hours / resident-day | 8.47 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 2.66 | 0.55–0.75 |
| Weekend hours / resident-day | 7.95 | ≈ weekday level |
| Nursing turnover / year | 54% | median 45% |
| Fines (3-yr window) | 1 · $131,856 |
Inspection citations (27 in the current record)
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Potential for harm · D August 22, 2025
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected December 11, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D August 22, 2025
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected December 11, 2025 · Resident Assessment and Care Planning
-
Potential for harm · E August 22, 2025
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 11, 2025 · Resident Assessment and Care Planning
-
Potential for harm · D August 22, 2025
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected December 11, 2025 · Quality of Life and Care
-
Potential for harm · F August 22, 2025
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected December 11, 2025 · Nursing and Physician Services
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Potential for harm · E August 22, 2025
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected December 11, 2025 · Pharmacy Service
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Potential for harm · E August 22, 2025
Ensure medication error rates are not 5 percent or greater.
Corrected December 11, 2025 · Pharmacy Service
-
Potential for harm · F August 22, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 11, 2025 · Nutrition and Dietary
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Immediate jeopardy · L March 25, 2025 · found via complaint
Provide and implement an infection prevention and control program.
Corrected April 14, 2025 · Infection Control
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Potential for harm · E March 25, 2025 · found via complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected April 14, 2025 · Resident Assessment and Care Planning
-
Potential for harm · F March 25, 2025 · found via complaint
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected April 14, 2025 · Infection Control
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Potential for harm · D February 5, 2024 · found via complaint
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected March 5, 2024 · Pharmacy Service
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Potential for harm · D October 26, 2023
Keep residents' personal and medical records private and confidential.
Corrected November 23, 2023 · Resident Rights
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Potential for harm · E October 26, 2023
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected November 23, 2023 · Resident Rights
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Potential for harm · D October 26, 2023
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected November 23, 2023 · Resident Assessment and Care Planning
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Potential for harm · D October 26, 2023
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected November 23, 2023 · Quality of Life and Care
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Potential for harm · E October 26, 2023
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected November 23, 2023 · Quality of Life and Care
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Potential for harm · D October 26, 2023
Provide safe, appropriate pain management for a resident who requires such services.
Corrected November 23, 2023 · Quality of Life and Care
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Potential for harm · E October 26, 2023
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Corrected November 23, 2023 · Nursing and Physician Services
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Potential for harm · D October 26, 2023
Ensure medication error rates are not 5 percent or greater.
Corrected November 23, 2023 · Pharmacy Service
-
Potential for harm · E October 26, 2023
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected November 23, 2023 · Nutrition and Dietary
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Potential for harm · F October 26, 2023
Provide and implement an infection prevention and control program.
Corrected November 23, 2023 · Infection Control
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Potential for harm · D October 26, 2023
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Corrected November 23, 2023 · Infection Control
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Potential for harm · E October 26, 2023
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected November 23, 2023 · Environmental
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Potential for harm · E October 13, 2022
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected November 15, 2022 · Quality of Life and Care
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| March 25, 2025 | Fine | $131,856 |
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
Sign in to share your family's experience — reviews are moderated and never affect the Safety Score.
Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 555879 · certified since February 21, 2013. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.