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Inspection Detail
Case Status: CLOSED
Inspection: 1514699.015 - Jacob Healthcare Center
Inspection Information - Office: San Diego District Office
Inspection Nr: 1514699.015
Report ID: 0950632
Date Opened: 02/12/2021
Site Address:
Jacob Healthcare Center
4075 54th Street
San Diego, CA 92105
Mailing Address:
4075 54th Street, San Diego, CA 92105
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: 08/06/2021
Emphasis:
Case Closed: 07/31/2023
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1729292 |
Case Status: CLOSED
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 3 | 4 | |||
| Current Violations | 1 | 3 | 4 | |||
| Initial Penalty | $6,750 | $0 | $0 | $5,750 | $0 | $12,500 |
| Current Penalty | $2,700 | $0 | $0 | $3,600 | $0 | $6,300 |
| 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 | 342(A) | 08/06/2021 | $3,000 | $5,000 | $0 | 10/31/2021 | F - Formal Settlement | ||
| 2. | 01002 | Other | 5193(C)(2) | 08/06/2021 | 09/10/2021 | $300 | $375 | $0 | 10/31/2021 | F - Formal Settlement | |
| 3. | 01003 | Other | 3203(A) | 08/06/2021 | $300 | $375 | $0 | 10/31/2021 | F - Formal Settlement | ||
| 4. | 02001 | Serious | 5199(C)(2) | 08/06/2021 | 08/20/2021 | $2,700 | $6,750 | $0 | 10/31/2021 | F - Formal Settlement |
Investigation Summary
Investigation Nr: 133268.015
Event: 02/03/2021
Employee with COVID-19 infection dies
An employee was an LVN for a medical facility. The employee was exposed to COVID-19. The employee was vaccinated on January 11, 2021 and died on January 14, 2021.
Keywords: Infectious Disease
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1514699.015 | 65 | M | Fatality | Licensed practical nurses |