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Inspection Detail
Inspection: 1506594.015 - Skyline San Jose Operating Company Lp
Inspection Information - Office: Fremont District Office
Site Address:
Skyline San Jose Operating Company Lp
2065 Forest Ave.
San Jose, CA 95128
Mailing Address:
2065 Forest Ave., San Jose, CA 95128
Union Status: NonUnion
SIC:
NAICS: 623110/Nursing Care Facilities
Inspection Type: Fat/Cat
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Health
Close Conference: 07/08/2021
Emphasis:
Case Closed: 06/13/2022
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1703463 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 1 | 2 | |||
| Current Violations | 1 | 1 | ||||
| Initial Penalty | $15,750 | $0 | $0 | $875 | $0 | $16,625 |
| Current Penalty | $0 | $0 | $0 | $5,000 | $0 | $5,000 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Other | 3203(A) | 07/08/2021 | 08/12/2021 | $0 | $875 | $0 | 10/29/2021 | O - Administrative Law Judge Order | Citation has been deleted. |
| 2. | 02001 | Other | 5199(C)(1) | 07/08/2021 | 08/12/2021 | $5,000 | $15,750 | $0 | 10/29/2021 | O - Administrative Law Judge Order |
Investigation Summary
At approximately 1:25 p.m. on December 6, 2020, an employee worked as a CNA for a nursing home facility and worked at the nurse's work station. The employee took a COVID-19 test November 30, 2020, and the employee worked until test results came back December 4, 2020. The employee died on December 9, 2020 after complications from COVID-19.
Keywords: Infectious Disease
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1506594.015 | 73 | M | Fatality | Registered nurses |