7 Reports
Inspection Report — Oct 30, 2025
Annual Inspection
Date: Oct 30, 2025
Visit Reason
The inspection was an unannounced annual required inspection conducted to evaluate compliance with licensing requirements at the facility.
Findings
No deficiencies were observed during the visit. The facility was found to have proper infection control measures, emergency plans, sufficient supplies, and operational safety equipment.
Report Facts
Staff files reviewed: 4
Resident files reviewed: 5
PPE supply: 30
Food supply - perishable: 2
Food supply - non-perishable: 7
Hot water temperature: 114
Facility temperature: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elvira Vahid Santos | Co-Administrator | Named as co-administrator met during inspection |
| Marc Rico | Administrator | Named as administrator met during inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Named in report |
Inspection Report — Apr 10, 2025
Complaint Investigation
Date: Apr 10, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints received on 2022-08-23 regarding resident pressure injuries, infection requiring hospitalization, missing medication, and inadequate diaper supply.
Complaint Details
The complaint investigation was substantiated for allegations that a resident developed pressure injuries and an infection requiring hospitalization due to neglect. The allegations that resident's medication was missing and that the facility did not ensure an adequate amount of diapers were unsubstantiated.
Findings
The investigation substantiated that a resident developed pressure injuries and an infection requiring hospitalization due to neglect and inadequate care by staff. Two other allegations regarding missing medication and inadequate diaper supply were found unsubstantiated. An immediate civil penalty of $500 was assessed for serious bodily injury related to the substantiated findings.
Citations (2)
Failure to provide adequate care and supervision to residents, posing an immediate health and safety risk.
Failure to document and address changes in resident condition, posing an immediate health and safety risk.
Report Facts
Civil penalty: 500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Vahid Santos | Administrator | Named in investigation findings related to inconsistent statements about resident's pressure injuries. |
| Marc Rico | Administrator | Met with Licensing Program Analyst during inspection visit. |
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
Inspection Report — Nov 22, 2024
Annual Inspection
Date: Nov 22, 2024
Visit Reason
An unannounced annual required inspection was conducted to evaluate the facility's compliance with licensing regulations.
Findings
No deficiencies were observed during the visit. The facility was found to have proper infection control measures, adequate supplies, operational safety equipment, and appropriate documentation.
Report Facts
Staff files reviewed: 5
Resident files reviewed: 4
Hot water temperature: 117
Facility temperature: 74
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elvira Vahid Santos | Administrator | Met with Licensing Program Analyst during inspection and identified as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Supervisor | Supervisor overseeing the inspection |
Inspection Report — Nov 16, 2023
Annual Inspection
Date: Nov 16, 2023
Visit Reason
The inspection was an unannounced annual required inspection conducted to evaluate compliance with licensing regulations at the facility.
Findings
No deficiencies were observed during the visit. The facility was found to have proper infection control measures, emergency plans, adequate supplies, and safe environmental conditions.
Report Facts
Staff files reviewed: 5
Resident files reviewed: 5
Staff interviews conducted: 2
Resident interviews conducted: 2
Hot water temperature: 117
Facility temperature: 74
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elvira Vahid Santos | Administrator | Met with Licensing Program Analyst during the inspection and identified as infection control leader |
Inspection Report — Nov 15, 2022
Annual Inspection
Date: Nov 15, 2022
Visit Reason
The inspection was an unannounced annual infection control inspection conducted to evaluate compliance with infection control protocols and facility readiness.
Findings
The facility was found to be in compliance with infection control requirements, maintaining adequate PPE supplies, proper signage, and a mitigation plan. No deficiencies were cited during the visit.
Report Facts
PPE supply duration: 30
Food supply duration - perishable: 2
Food supply duration - non-perishable: 7
Facility temperature: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elvira Vahid Santos | Administrator | Administrator authorized staff to act on her behalf and is the infection control leader |
| Josefina Cayanan | Staff | Staff member met with Licensing Program Analyst during inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the infection control inspection |
| Bennett Fong | Supervisor | Supervisor overseeing the inspection |
Inspection Report — Aug 25, 2022
Complaint Investigation
Date: Aug 25, 2022
Visit Reason
The inspection was conducted as a result of the department receiving a priority 2 complaint to perform a Health and Safety check.
Complaint Details
The visit was triggered by a priority 2 complaint. No deficiencies were cited during the health and safety check.
Findings
During the health and safety check, no imminent health or safety concerns were observed and no deficiencies were cited. Residents appeared safe and the facility was toured including bedrooms, kitchen, bathroom, and common areas.
Report Facts
Staff present: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the health and safety check |
| Elvira Vahid Santos | Administrator | Facility administrator who accompanied the evaluator during the inspection |
Inspection Report — Aug 25, 2022
Date: Aug 25, 2022
Visit Reason
The visit occurred as a Case Management - Other type of visit to evaluate compliance related to facility modifications and fire clearance.
Findings
The inspection found that the facility converted a one-car garage into a bedroom unit without proper fire clearance approval, violating the facility's approved fire clearance. An immediate civil penalty of $500 was assessed, and the administrator agreed to secure and submit a fire clearance.
Citations (1)
Failure to maintain an approved fire clearance for the converted one-car garage to a bedroom unit.
Report Facts
Civil penalty amount: 500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elvira Vahid Santos | Administrator | Discussed fire clearance violation and agreed to submit proof of correction. |
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