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Nursing HomeMedicaid Investigative

All Saint's Maubert

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

15731 Maubert Avenue, San Leandro, CA 9457814 bedsLicensed & Active
1/5
Medicare
Inspection
Quality
Staffing
Google rating
4.5/5

based on 83 Google reviews

5
4
3
2
1
All Saint's Maubert Nursing Home in San Leandro, CA — Street View
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2/ 10
low Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Low overall rating (1/5 stars)

Bottom 25% in CA · Meets national RN staffing standard · Above recommended total nurse staffing · Worst in PACS GROUP chain · $131,856 in fines

Source: Medicare data

What this means for your family

This facility is highly regarded for its compassionate nursing and clean environment, making it a strong candidate for long-term care or rehab. However, families should closely monitor the consistency of physical therapy schedules and staffing levels, as recent reports indicate potential delays in therapy due to understaffing.

Google Reviews

Google Reviews

83 reviews on Google
Families generally praise All Saint's for its compassionate, attentive nursing staff and a clean, well-maintained environment. However, there are serious, critical allegations regarding patient neglect and insufficient staffing levels that lead to delays in physical therapy.

Quality Themes

Tap a score for details
Food5.0Staff9.0Clean9.0ActivitiesN/AMedsN/AMemoryN/AComms8.0ValueN/A

Strengths

  • Compassionate and attentive nursing staff
  • Clean and organized facility
  • Skilled rehabilitative and respiratory therapy
  • Friendly and approachable administration

Concerns

  • Understaffing leading to delays in physical therapy
  • Allegations of patient neglect and lack of basic care
  • Issues with fall prevention and professional nursing conduct

Rating Trends

Tap a year to see what changed

234'14(1)'16(1)'18(2)'20(2)'22(3)'24(37)'26(20)

Distribution · 86 analyzed

5
70
4
7
3
1
2
2
1
6
32 reviews posted between Jun 3, 2024Jun 7, 2024 · 30 were 5-star

How They Respond to Reviews

55%response rate

This facility responds to some reviews.

Questions for Your Tour

  • 1We've heard wonderful things about how clean and organized the facility is; what are your daily routines for maintaining that level of care?
  • 2Since we know the administration is very approachable, how can we best communicate with you if we have concerns about our loved one's daily care?
  • 3With the small resident capacity, how do you ensure that every individual's specific medical and respiratory therapy needs are met consistently?
  • 4What specific protocols do you have in place to ensure resident safety and prevent falls during the night or during busy shifts?
  • 5How do you manage nursing transitions and ensure that basic care needs are never missed during shift changes?
  • 6What kind of daily activities or social engagement opportunities are available to keep the residents active and connected?

Personalized based on this facility's data


Key Review Excerpts

Every person we came into a contact with, whether it was the people at the front desk, all levels of nursing care, meal staff, administration, physical therapy, occupational therapy, janitorial staff they all went above and beyond in our opinion.

Rehab patient's family · 2025★★★★★

Our Ohana father is being transferred out today because the facility is under staffed, and he is getting worse. He was supposed to receive physical therapy each day. Today is his 6th day there and they have not started any therapy.

Long-term resident's family · 2026☆☆☆☆

I have been under sub acute care at All Saints for more than 12 months and the level of care I have received has been extremely high.

Sub-acute patient · 2024★★★★★
Source: 83 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
2.66hrs
OK
Registered nurses for medical care
Total Nursing
8.47hrs
OK
All nurses + aides combined
Staff Turnover
54%
Lower is better (< 30% = good)
RN Turnover
50%
Lower is better (< 30% = good)

This facility meets the national staffing benchmarks. Higher staffing is linked to fewer falls and better day-to-day care.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 3 measures

Medicare Rating
1/ 5
Better Than Avg

3

measures

Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
81.8%
CA
94.2%
Alameda
91.9%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility97.6%
Better than Avg
Here
97.6%
US
79.7%
CA
93.2%
Alameda
90.6%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
1.6%
CA
1.5%
Alameda
0.7%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

8deficiencies
1penalties
Near state avg (15.4)
4 complaint-triggered
$131,856 in fines

Families filed complaints that triggered inspections revealing recurring problems with care planning, infection control, and medication management across multiple surveys. The facility has faced 54 deficiencies over 5 inspections, with persistent issues including inadequate nursing supervision, medication errors, and incomplete resident care plans that have surfaced repeatedly from 2022 through 2025. While all deficiencies show correction dates, the pattern of recurring problems in core care areas is concerning.

Aug 22, 2025Routine
14
0727Potential for harm · WidespreadCorrected

Nursing and Physician Services Deficiencies

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.

0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0039Potential for harm · WidespreadCorrected

Emergency Preparedness Deficiencies

Conduct testing and exercise requirements.

0918Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0656Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0757Potential for harm · PatternCorrected

Pharmacy Service Deficiencies

Ensure each resident’s drug regimen must be free from unnecessary drugs.

0759Potential for harm · PatternCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0919Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Meet requirements for the use of electrical equipment.

0604Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

0644Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0161Potential for harm · IsolatedCorrected

Construction Deficiencies

Use approved construction type or materials.

0363Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

0026Minimal · WidespreadCorrected

Emergency Preparedness Deficiencies

Establish roles under a Waiver declared by secretary.

Mar 25, 2025Complaint
3
0880Immediate jeopardy · WidespreadCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0882Potential for harm · WidespreadCorrected

Infection Control Deficiencies

Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

0656Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Feb 5, 2024Complaint
1
0761Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

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.

Oct 26, 2023Routine
20
0880Potential for harm · WidespreadCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0584Potential for harm · PatternCorrected

Resident Rights Deficiencies

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.

0686Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

0726Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

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.

0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0921Potential for harm · PatternCorrected

Environmental Deficiencies

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

0321Potential for harm · PatternCorrected

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

0918Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0920Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

0583Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Keep residents' personal and medical records private and confidential.

0656Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0697Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe, appropriate pain management for a resident who requires such services.

0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0887Potential for harm · IsolatedCorrected

Infection Control Deficiencies

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.

0041Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Implement emergency and standby power systems.

0161Potential for harm · IsolatedCorrected

Construction Deficiencies

Use approved construction type or materials.

0347Potential for harm · IsolatedCorrected

Smoke Deficiencies

Properly provide smoke detection systems in areas open to corridors.

0355Potential for harm · IsolatedCorrected

Smoke Deficiencies

Properly select, install, inspect, or maintain portable fire extinguishes.

0363Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

Oct 13, 2022Routine
16
0712Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have simulated fire drills held at unexpected times.

0686Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

0732Potential for harm · IsolatedCorrected

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0004Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Develop and maintain an Emergency Preparedness Program (EP).

0033Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish methods for sharing information.

0034Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Provide a means of sharing information on occupancy/needs.

0035Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Provide family notifications of emergency plan.

0036Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish emergency prep training and testing.

0037Potential for harm · IsolatedCorrected

Emergency Preparedness Deficiencies

Establish staff and initial training requirements.

0321Potential for harm · IsolatedCorrected

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

0351Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install an approved automatic sprinkler system.

0353Potential for harm · IsolatedCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0363Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

0919Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Meet requirements for the use of electrical equipment.

0920Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

Federal Penalties

Fine

Mar 25, 2025

$131,856

Ownership & Operations

Who Operates This Facility

Owner / Operator

All Saint's Maubert

Organization Type

for profit

Chain Affiliation

Chain Name

Pacs Group

Chain Size

279 facilities nationwide

Chain avg rating: 2.9/5 · Rank 238 of 260 (Worst)

Ownership & Management

Key personnel

Muppu, ManjulaContracted Managing EmployeeStock, StevenW-2 Managing EmployeeApt, FrederickOfficer / DirectorHancock, MarkOfficer / DirectorJergensen, JoshuaOfficer / Director
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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