Citations (last 6 years)
Citations (over 6 years)
2.2 citations/year
Citations are regulatory findings recorded during state inspections.
45% better than California average
California average: 4 citations/yearCitations per year
8
6
4
2
0
Occupancy
Latest occupancy rate
82% occupied
Based on a December 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Annual Inspection
Census: 178
Capacity: 216
Citations: 0
Date: Dec 2, 2025
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate compliance with licensing requirements and assess the facility's conditions and operations.
Findings
The inspection found no deficiencies. The facility was well maintained with appropriate safety measures, adequate food supplies, and proper staff engagement. Reviews of resident and staff files were conducted without issue.
Report Facts
Resident files reviewed: 7
Staff files reviewed: 6
Fire extinguisher last serviced: Sep 11, 2025
Perishable food supply: 2
Nonperishable food supply: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during inspection |
| Murial Han | Licensing Program Analyst | Conducted the annual inspection |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 178
Capacity: 216
Citations: 0
Date: Dec 2, 2025
Visit Reason
The visit was a case management follow-up conducted to review an incident reported by the facility involving a resident who was hospitalized with a fracture.
Findings
The Licensing Program Analyst found no deficiencies during the visit. The resident was observed to be comfortable and under hospice care, with no reported recent falls or incidents that could have caused the injury.
Report Facts
Capacity: 216
Census: 178
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and provided information about the resident's condition |
| Murial Han | Licensing Program Analyst | Conducted the case management visit and authored the report |
| April Cowan | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 171
Capacity: 216
Citations: 0
Date: May 13, 2025
Visit Reason
The inspection was an unannounced Case Management - Incident visit triggered by a reported incident involving two residents who had unwitnessed falls and the discovery of unknown medications without valid prescriptions in their apartment.
Complaint Details
The visit was complaint-related due to an incident reported on April 25, 2025, involving unwitnessed falls of two residents and the presence of unknown medications without valid prescriptions. The facility has been in communication with the Foster City Police Department regarding the medications. The complaint was investigated and no deficiencies were cited.
Findings
The facility reported multiple falls for two residents since their admission, including a fall resulting in a closed fracture of the right hip. The facility found alcohol and unknown medications in the residents' room, communicated with police, and issued a 30-day eviction notice due to safety concerns. No deficiencies were cited during the visit.
Report Facts
Number of falls for resident #1: 6
Number of falls for resident #2: 6
Eviction notice timeframe: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met during inspection and provided information about residents and incident |
| Murial Han | Licensing Program Analyst | Conducted the unannounced inspection visit |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 144
Capacity: 216
Citations: 2
Date: Dec 10, 2024
Visit Reason
The inspection was an unannounced annual inspection conducted to evaluate the facility's compliance with regulatory requirements.
Findings
The inspection found deficiencies related to the medication destruction process documentation and the possession of personal hygiene items in the memory care unit. The facility was unable to provide proof that the administrator participated in the medication destruction process, and hand soap bottles were left unattended in shared bathrooms, posing health and safety risks.
Citations (2)
Facility was not able to provide documentation to prove that the administrator was one of the participants for the Medication Destruction Process.
Hand soap bottles for rooms 209B and 218B were not in residents' own possession and were left unattended in shared bathrooms.
Report Facts
POC Due Date: Dec 18, 2024
POC Due Date: Dec 11, 2024
Resident files reviewed: 5
Staff files reviewed: 5
Fire extinguisher last serviced: Nov 24, 2024
Hot water temperature range: 106-118
Facility floors: 6
Perishable food supply: 2
Nonperishable food supply: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Seema Chand | Community Business Director | Met with Licensing Program Analyst during inspection and discussed findings |
| Freddie Fullon | Administrator | Named in medication destruction process deficiency |
| Murial Han | Licensing Program Analyst | Conducted the annual inspection and authored the report |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 169
Capacity: 216
Citations: 1
Date: Sep 12, 2024
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2024-06-27 regarding allegations about resident record inaccuracies, improper billing, and failure to report incidents.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not ensure resident records contained correct information. The allegations that staff charged a resident for services not rendered and failed to report an incident to appropriate parties were unsubstantiated.
Findings
The investigation substantiated that staff did not ensure resident records contained correct information, specifically an incorrect date of birth on a resident's facesheet. Allegations of charging for services not rendered and failure to report incidents were found to be unsubstantiated.
Citations (1)
Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility. The date of birth on resident #1's facesheet was incorrect, posing a potential health risk.
Report Facts
Capacity: 216
Census: 169
Deficiencies cited: 1
Plan of Correction Due Date: Sep 18, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Freddie Fullon | Administrator | Facility administrator met during the investigation and involved in findings discussion |
| Kari Jane | Assistant Administrator | Reviewed the report and findings |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Follow-Up
Census: 169
Capacity: 216
Citations: 0
Date: Sep 12, 2024
Visit Reason
An unannounced Case Management visit was conducted to follow up on an incident reported by the facility involving a resident's concern about a caregiver's unprofessional behavior.
Complaint Details
The visit was triggered by a reported incident where resident #1 was afraid of a caregiver due to unprofessional behavior. The facility conducted an investigation and reported it to authorities. The resident confirmed improvements during the visit.
Findings
The facility investigated the incident, reported it to the Local Police Department and Ombudsman, and implemented new interventions to ensure the resident feels safe. During the visit, the resident stated improvements and professionalism of caregivers. No deficiencies were cited.
Report Facts
Capacity: 216
Census: 169
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and involved in incident follow-up |
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Kari Jane | Assistant Administrator | Discussed the report with the Licensing Program Analyst |
Inspection Report
Complaint Investigation
Census: 155
Capacity: 216
Citations: 1
Date: May 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not allow resident direct access to personal grooming and hygiene items, and that the licensee did not abide by the terms of the resident's admission agreement.
Complaint Details
The complaint investigation was substantiated for the allegation that staff locked resident #1's grooming and toileting items, violating the Admission Contract and residents' personal rights. The allegations that staff did not appropriately evaluate resident's service needs and did not ensure privacy were unsubstantiated.
Findings
The investigation substantiated that the facility locked resident #1's grooming items such as toothpaste and toothbrush, which violated residents' personal rights to access their own possessions. Another complaint regarding inappropriate evaluation of resident service needs was unsubstantiated after review of care profiles and interviews. A privacy allegation was also unsubstantiated as the facility took corrective actions.
Citations (1)
Facility locked resident #1's toothbrush and toothpaste, posing a potential health risk and violating residents' personal rights to access their own possessions.
Report Facts
Capacity: 216
Census: 155
Monthly rent increase: 1700
Plan of Correction due date: May 7, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and involved in findings discussion |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Cara Smith | Licensing Program Manager | Oversaw the complaint investigation process |
Inspection Report
Annual Inspection
Census: 146
Capacity: 216
Citations: 0
Date: Dec 26, 2023
Visit Reason
The visit was an annual unannounced inspection conducted by Licensing Program Analyst Murial Han to evaluate the facility's compliance with regulatory requirements.
Findings
The inspection found no deficiencies. The facility was toured, safety measures were verified, resident and staff records were reviewed and found complete, and all safety equipment and protocols were adequate.
Report Facts
Resident records reviewed: 5
Staff files reviewed: 5
Fire extinguisher last serviced: Aug 3, 2023
Perishable food supply: 2
Nonperishable food supply: 7
Hot water temperature range: 106-111
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during inspection and provided facility tour |
| Murial Han | Licensing Program Analyst | Conducted the annual inspection |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Citations: 0
Date: Dec 5, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility was not refunding a pre-admission fee.
Complaint Details
The complaint alleged that the facility was not refunding a $9,100 pre-admission fee paid to secure a room. The investigation determined the allegation to be unfounded as the fee was not charged and the payment was applied to monthly rent.
Findings
The investigation found that the allegation was unfounded. The facility did not charge a pre-admission fee but referred to the payment as a New Resident Services Fee, which was credited and used to cover monthly rent according to the resident account summary and admission agreement.
Report Facts
Pre-admission fee amount: 9100
Capacity: 216
Census: 148
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| John Calandra | Licensing Program Analyst | Conducted the complaint investigation |
| Seema Chand | Business Office Manager | Interviewed during investigation |
| Freddie Fullon | Administrator | Facility administrator named in report |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager overseeing investigation |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 216
Citations: 0
Date: Oct 6, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2023-04-25 regarding failure to provide comfortable temperature, facility disrepair, unsafe environment, and failure to issue a refund.
Complaint Details
The complaint investigation was unannounced and addressed allegations including failure to provide comfortable temperature, facility disrepair, unsafe environment, and failure to issue a refund. The heating units were not working properly from December 2022 through repairs in 2023, but residents were provided space heaters and monitored. The refund allegation was confirmed resolved. The findings were unsubstantiated or unfounded accordingly.
Findings
The investigation found that heating units were in disrepair but HVAC was contacted and repairs were ongoing; residents were provided space heaters and checked on regularly. The allegations regarding heating and environment were unsubstantiated due to lack of preponderance of evidence. The allegation of failure to issue a refund was found to be unfounded as a refund was confirmed to have been provided.
Report Facts
Capacity: 216
Census: 144
Complaint receipt date: Apr 25, 2023
Heating repair period: 150
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and provided information about heating repairs and refund |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Cara Smith | Supervisor | Supervisor overseeing the complaint investigation |
Inspection Report
Census: 143
Capacity: 216
Citations: 0
Date: Sep 13, 2023
Visit Reason
The visit was a case management follow-up on an incident reported by the facility involving a resident who left the facility unassisted.
Complaint Details
The visit was triggered by an incident report regarding resident #1 leaving the facility unassisted. The resident has dementia but was determined not to be at risk for unsupervised exit based on a physician's report dated May 10, 2023.
Findings
The investigation found that the resident exited the facility through the back elevator and returned within 15 minutes. The resident was not at risk for leaving unsupervised according to a recent physician's report. No deficiencies were cited during this visit.
Report Facts
Capacity: 216
Census: 143
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and involved in verifying resident risk status |
| Murial Han | Licensing Program Analyst | Conducted the case management visit |
| Cara Smith | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 143
Capacity: 216
Citations: 0
Date: Sep 13, 2023
Visit Reason
The visit was an announced case management follow-up on an incident reported by the facility involving a resident who left the facility unassisted.
Findings
The investigation found that the resident exited the facility through the back elevator and returned within 15 minutes. Based on the resident's physician report, the resident was not at risk for leaving unsupervised. No deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and was present during verification of resident's risk status. |
| Murial Han | Licensing Program Analyst | Conducted the announced case management visit. |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 216
Citations: 0
Date: Aug 4, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-09-02 regarding multiple falls of a resident, failure to observe changes in condition, delayed medical attention, and prolonged bed rest.
Complaint Details
The complaint was unsubstantiated. The allegations included multiple falls, failure to observe condition changes, delayed medical attention, and prolonged bed rest. The facility denied the allegations and provided documentation supporting timely medical attention and care. There was no preponderance of evidence to prove violations.
Findings
The investigation found that although the resident did have multiple falls, the facility documented and communicated these incidents with the physician and responsible party, and timely medical attention was sought. Allegations regarding staff leaving the resident in bed for long periods and failure to observe changes were unsubstantiated due to lack of evidence.
Report Facts
Resident falls: 5
Capacity: 216
Census: 145
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met during investigation and provided information regarding allegations |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 216
Citations: 1
Date: Apr 4, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-11-09 regarding staff mismanagement of resident medication and failure to report an incident as required.
Complaint Details
The complaint investigation was substantiated for staff mismanaging resident medication due to staffing shortages caused by COVID illness. The allegation that staff did not report an incident as required was found to be unfounded and dismissed.
Findings
The investigation substantiated the allegation that memory care residents did not receive medications on a morning in June 2022 due to med techs calling out sick with COVID symptoms. Another allegation that staff did not report an incident was found to be unfounded. A deficiency was cited related to medication administration compliance.
Citations (1)
Failure to ensure that medication was given according to physician's directions as med techs were unavailable due to COVID symptoms, resulting in memory care residents not receiving medications.
Report Facts
Capacity: 216
Census: 145
Deficiencies cited: 1
Plan of Correction Due Date: 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Freddie Fullon | Administrator | Facility administrator met with evaluator and was involved in investigation discussions |
| Cara Smith | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Citations: 0
Date: Feb 17, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-11-16 concerning staff abandonment of a resident, failure to meet needs while COVID positive, not following admission agreement, unauthorized photographing of a resident, and sharing confidential information.
Complaint Details
The complaint involved multiple allegations including staff abandonment of a resident during COVID isolation, failure to meet resident needs, breach of admission agreement, unauthorized photography, and sharing of confidential information. After review of documentation, interviews, and file examination, all allegations were found unsubstantiated.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. The facility staff attempted to manage the resident's COVID isolation appropriately, followed admission agreement terms, and maintained confidentiality protocols. The allegations were determined to be unsubstantiated.
Report Facts
Facility capacity: 216
Resident census: 148
Complaint receipt date: Nov 16, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director | Met during investigation and provided information regarding resident care and facility policies |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Census: 149
Capacity: 216
Citations: 0
Date: Feb 2, 2023
Visit Reason
The visit was conducted to deliver an immediate exclusion letter to exclude an employee of the facility.
Findings
An immediate exclusion letter was delivered and reviewed with the facility administrator. The report was discussed and a copy provided to the administrator.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and reviewed the exclusion letter. |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced visit and delivered the immediate exclusion letter. |
| Cara Smith | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 161
Capacity: 216
Citations: 0
Date: Dec 9, 2022
Visit Reason
An unannounced annual infection control inspection was conducted to evaluate compliance with infection control practices and facility safety.
Findings
The facility was found to be clean, sanitary, and odorless with proper infection control practices observed, including COVID-19 signage, daily monitoring logs, PPE supplies, and containment strategies. No fire safety hazards or accessible bodies of water were observed, and chemicals and toxins were secured appropriately.
Report Facts
Laundry rooms observed: 5
Perishable food items observed: 2
Non-perishable food items observed: 7
Temperature range maintained: 71
Temperature range maintained: 74
PPE supply duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director | Met with Licensing Program Analyst and provided information during the inspection |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Cara Smith | Supervisor | Named as supervisor on the report |
Inspection Report
Complaint Investigation
Census: 157
Capacity: 216
Citations: 0
Date: Nov 18, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility was providing inadequate food services to residents in care.
Complaint Details
The complaint alleged inadequate food services to residents. The investigation included interviews with staff and review of policies. It was found that one-on-one feeding is not provided by the facility but must be arranged by the resident's responsible party. The allegation was unsubstantiated.
Findings
The investigation found that food is regularly provided to all residents, but one-on-one or hand-to-mouth feeding is not provided by staff in the memory care unit as outlined in the admission agreement. The allegation was determined to be unsubstantiated due to lack of evidence that the facility violated its policies.
Report Facts
Facility capacity: 216
Resident census: 157
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Met with Licensing Program Analyst during investigation |
| Angel Bustos | Resident Services Director (RSD)/Nurse | Interviewed regarding food services and feeding in memory care unit |
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 160
Capacity: 216
Citations: 0
Date: Sep 28, 2022
Visit Reason
The visit was an unannounced case management follow-up on an incident reported on June 23, 2022, involving a resident who was absent without official leave (AWOL).
Complaint Details
The visit was triggered by a complaint regarding resident #1 being AWOL. The complaint was investigated and found that the facility took appropriate actions; no citations were issued.
Findings
The facility attempted to ensure basic services were met for the resident who eloped, including assigning a private caregiver and notifying all required parties. No citations were issued at this time.
Report Facts
Distance resident found from facility (miles): 3
Facility capacity: 216
Resident census: 160
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident. |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Jackie Jin | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Capacity: 216
Citations: 0
Date: Sep 27, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations of inadequate staffing resulting in lack of care for residents and mismanagement of residents' medications.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included inadequate staffing and medication mismanagement, but no evidence was found to prove or disprove these claims.
Findings
The investigation found staffing to be adequate in the areas observed and no evidence of medication mismanagement. There were no incident reports or staff reports supporting the allegations. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 216
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the complaint investigation |
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Jackie Jin | Supervisor | Supervisor overseeing the complaint investigation |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 216
Citations: 4
Date: Mar 29, 2022
Visit Reason
An unannounced case management visit was conducted to follow-up on a complaint investigation regarding allegations of a resident sustaining a fracture while in care, the facility refusing to accept the resident back, and failure to report/provide information to the resident's family.
Complaint Details
The complaint involved a resident sustaining a fracture while in care, the facility refusing to accept the resident back after hospital discharge, and failure to report/provide information to the injured resident’s family. The caregiver present at the time was uncooperative, and the administrator failed to provide requested camera footage. The resident was readmitted with new health conditions without a formal reappraisal, leading to an illegal eviction.
Findings
The investigation found that the facility administrator failed to provide requested camera footage and that a caregiver was uncooperative with the investigation. The facility illegally evicted a resident without proper reappraisal and failed to update emergency contact information. Multiple regulatory deficiencies were cited related to inspection authority, administrator qualifications, and personnel requirements.
Citations (4)
Failure to ensure provisions for private interviews and examination of all records relating to the operation of the facility (CCR 87755(b)).
Failure to allow the licensing agency to inspect, audit, and copy resident or facility records upon demand during normal business hours (CCR 87755(c)).
Administrator failed to have knowledge of and ability to conform to applicable laws, rules and regulations (CCR 87405(d)(2)).
Facility personnel were not sufficient in numbers and competent to provide the services necessary to meet resident needs (CCR 87411(a)).
Report Facts
Deficiencies cited: 4
Plan of Correction Due Date: Apr 12, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Named in relation to failure to provide camera footage and illegal eviction of resident |
| Murial Han | Licensing Program Analyst | Conducted the unannounced case management visit and investigation |
| Julio Montes | Supervisor | Supervisor overseeing the licensing evaluation |
| Siobhan Surracao | Assistant Administrator | Met with Licensing Program Analyst during the visit |
Inspection Report
Plan of Correction
Census: 144
Capacity: 216
Citations: 1
Date: Mar 29, 2022
Visit Reason
An unannounced plan of correction (POC) visit was conducted to verify and confirm that the facility is in compliance with a citation issued on 2022-03-08 for not providing medical records to the responsible party as requested.
Findings
The facility failed to provide the requested medical records and related documents to the responsible party and Community Care Licensing by the due date, resulting in reissuance of the citation and assessment of civil penalties. The deficiency posed potential health and safety risks to the resident in care.
Citations (1)
Facility failed to provide R1's medical records as requested by the responsible party promptly and appropriately, posing potential health and safety risks to the resident in care.
Report Facts
Civil penalty amount: 600
Civil penalty daily rate: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced plan of correction visit. |
| Freddie Fullon | Administrator | Facility administrator who assisted with the visit and was discussed the report. |
| Siobhan Surracao | Assistant Administrator | Met with Licensing Program Analyst at the start of the visit. |
| Julio Montes | Supervisor | Supervisor named in the report. |
Inspection Report
Complaint Investigation
Census: 146
Capacity: 216
Citations: 1
Date: Mar 8, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2021-12-22 regarding the facility's failure to provide documentation related to injuries to the responsible party and an allegation of questionable death due to physical abuse.
Complaint Details
Complaint investigation was substantiated regarding failure to provide documentation related to injuries to the responsible party. The allegation of questionable death due to physical abuse was found to be unfounded.
Findings
The investigation substantiated that the facility failed to provide requested medical records and documentation promptly and appropriately, violating residents' personal rights. However, the allegation of questionable death caused by physical abuse was found to be unfounded based on medical records and death certificate review.
Citations (1)
Facility failed to provide resident #1's medical records as requested by the responsible party promptly and appropriately, posing potential health and safety risks.
Report Facts
Capacity: 216
Census: 146
Deficiency count: 1
Plan of Correction Due Date: Mar 22, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Julio Montes | Licensing Program Manager | Oversaw the complaint investigation |
| Freddie Fullon | Administrator | Facility administrator met during the investigation and discussed findings |
Inspection Report
Annual Inspection
Census: 148
Capacity: 216
Citations: 0
Date: Dec 7, 2021
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and infection control practices at the facility.
Findings
The inspection found that COVID-19 signage was posted, infection control practices were followed, residents and staff were mostly masked and vaccinated, shared bathrooms were equipped with soap and paper towels, and medications and sharps were stored safely. The facility had sufficient food supplies and emergency preparedness documentation was requested.
Report Facts
Document submission deadline: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Siobhan Surraco | Assistant Executive Director | Met with Licensing Program Analyst during inspection |
| Seema Chand | Community Business Director | Joined the inspection shortly after it began |
| Julio Montes | Supervisor | Supervisor named in the report |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Citations: 1
Date: Nov 22, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 10/19/2021 regarding allegations that the facility was not meeting residents' dietary needs and not providing supervision per doctor's orders.
Complaint Details
The complaint investigation included two allegations: 1) Facility not meeting resident's dietary needs, which was unsubstantiated; 2) Staff not providing supervision per doctor's orders, which was substantiated. The substantiated deficiency was cited under California Code of Regulations, Title 22, Section 87611(e).
Findings
The allegation that the facility was not meeting a resident's dietary needs was unsubstantiated based on record review and interviews. However, the allegation that staff failed to provide supervision during meals as ordered by the resident's Nurse Practitioner was substantiated, resulting in a cited deficiency.
Citations (1)
Facility failed to carry out Resident #1's Nurse Practitioner's order to provide supervision during meals due to a recent change in health condition, posing potential health and safety risks.
Report Facts
Capacity: 216
Census: 148
Plan of Correction Due Date: Dec 6, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Angel Bustos | Resident Service Director | Met with the Licensing Program Analyst during the investigation |
| Julio Montes | Supervisor | Supervisor overseeing the investigation |
| Freddie Fullon | Administrator | Facility Administrator involved in the report discussion |
Inspection Report
Complaint Investigation
Census: 130
Capacity: 216
Citations: 0
Date: Mar 30, 2021
Visit Reason
The inspection was conducted as an unannounced case management tele-inspection in response to a self-reported Unusual Incident Report dated March 26, 2021.
Complaint Details
The visit was triggered by a self-reported unusual incident. No substantiation status or findings of deficiencies were stated in the report.
Findings
The Licensing Program Analyst interviewed the facility administrator and requested several documents related to the incident, including a staff written statement, employee handbook, resident's physician report, and police report. The resident involved was also asked to contact the analyst for confirmation.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael Garcia | Licensing Program Analyst | Conducted the unannounced case management tele-inspection. |
| Freddie Fullon | Executive Director/Administrator | Interviewed during the inspection and responsible for providing requested documents. |
| Brenda Chan | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 216
Citations: 1
Date: Mar 4, 2021
Visit Reason
An unannounced complaint investigation was conducted in response to allegations including lack of supervision resulting in a resident breaking their hip and multiple unexplained falls with injury while in care.
Complaint Details
The complaint investigation was unannounced and initiated based on allegations received on 09/20/2019. The allegations included lack of supervision resulting in a resident breaking their hip and multiple unexplained falls with injury. These were found unsubstantiated. A separate allegation regarding tripping hazards from tables was substantiated.
Findings
The investigation found the allegations of lack of supervision and multiple unexplained falls unsubstantiated due to sufficient staffing and lack of evidence. However, a separate allegation that tables in the facility posed a tripping hazard was substantiated based on evidence including surveillance video and staff interviews.
Citations (1)
R1 was not accorded safe, healthful and comfortable furnishings and equipment. R1 unassisted by walker, tripped over a coffee table, which poses a potential Health, Safety or Personal Rights risk to residents in care.
Report Facts
Capacity: 216
Census: 90
Plan of Correction Due Date: Mar 15, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bertha Raygoza | Licensing Program Analyst | Conducted the complaint investigation |
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and was involved in findings review |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 115
Capacity: 216
Citations: 0
Date: Jan 20, 2021
Visit Reason
The visit was a Case Management tele-visit conducted to provide Technical Assistance to the facility regarding COVID-19.
Findings
There were no active COVID-19 cases at the time of the visit. A staff member, private duty aide, and a resident had tested positive earlier in the month but all cases were resolved. The facility had contacted the local public health department for mass testing and was conducting contact tracing.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael Garcia | Licensing Program Analyst | Conducted the Case Management tele-visit and provided Technical Assistance. |
| Freddie Fullon | Executive Director/Administrator | Facility administrator who participated in the tele-visit and provided information about COVID-19 cases. |
| Paul Portem | Program Clinical Consultant, MSN, RN | Assisted in the tele-visit providing clinical consultation. |
Inspection Report
Census: 141
Capacity: 216
Citations: 0
Date: Nov 24, 2020
Visit Reason
An announced case management continuation visit was conducted remotely to provide Technical Assistance to the facility regarding COVID-19 protocols and safety measures.
Findings
The facility's COVID-19 protocol and screening area were reviewed, and staff were interviewed and observed demonstrating proper hand washing technique. Two staff members had tested positive for COVID-19, and mass testing was conducted for all staff and residents with results pending. Recommendations were made to improve screening area placement and staff mask handling.
Report Facts
Staff tested positive for COVID-19: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Met with Licensing Program Analyst during the visit and provided information about COVID-19 status |
| Brenda Chan | Licensing Program Manager | Participated in the Technical Assistance visit |
| Veronica Nazareth | Nurse | Department of Public Health nurse involved in the visit |
| Michael Garcia | Licensing Program Analyst | Conducted the announced case management continuation visit |
Inspection Report
Census: 141
Capacity: 216
Citations: 0
Date: Nov 20, 2020
Visit Reason
An announced case management visit was conducted remotely via video call to provide Technical Assistance regarding COVID-19 infection control, mitigation, and staffing plan.
Findings
The facility currently has two staff members who tested positive for COVID-19 and are isolating at home. The facility is coordinating with the Department of Public Health for mass testing scheduled on November 24 and 25, has conducted contact tracing and surveillance testing with negative results, and plans to continue weekly surveillance testing of 25% of staff after two rounds of negative tests.
Report Facts
COVID-19 positive staff: 2
Scheduled mass testing dates: Mass testing scheduled for November 24 and November 25, 2020
Surveillance testing frequency: 25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Participated in the case management visit and discussed COVID-19 plans |
| Michael Garcia | Licensing Program Analyst | Conducted the case management visit |
| Brenda Chan | Licensing Program Manager | Conducted the case management visit |
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