Deficiencies (last 5 years)
Deficiencies (over 5 years)
0.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
80% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Occupancy
Latest occupancy rate
64% occupied
Based on a January 2026 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Annual Inspection
Census: 9
Capacity: 14
Deficiencies: 0
Date: Jan 26, 2026
Visit Reason
The inspection was an unannounced annual facility inspection conducted by the Licensing Program Analyst to evaluate compliance with licensing requirements for the facility.
Findings
The annual inspection found no citations or deficiencies. The facility met all regulatory requirements including fire safety, emergency plans, infection control, and care tools.
Report Facts
Resident rooms: 12
Food supply duration: 2
Food supply duration: 7
Maximum residents: 14
Inspection start time: 10
Inspection end time: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dorothy Berger | Administrator | Met with Licensing Program Analyst during inspection |
| Mark Jeffries | Licensing Program Analyst | Conducted the annual inspection |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 10
Capacity: 14
Deficiencies: 0
Date: Oct 23, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that a resident was sexually abused in the facility.
Complaint Details
The complaint alleged that Resident 1 suffered multiple dark-purple bruises to the perineal area suggesting sexual abuse. Medical records showed initial bruising reports that were later corrected. Physicians found no signs of excoriation or bruising. Family members doubted abuse and attributed bruising to a fall. Resident 1 was relocated to another facility on hospice and was not interviewed. Staff and other residents reported no concerns. The allegation was unsubstantiated.
Findings
The investigation found conflicting medical records regarding bruising on the resident, but physician exams and interviews provided insufficient evidence to substantiate the allegation. Staff and resident interviews indicated confidence in care and no concerns. The allegation was determined to be unsubstantiated.
Report Facts
Residents observed in common room: 6
Residents in bedrooms: 3
Residents not currently in facility: 2
Staff interviewed: 3
Residents interviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mark Jeffries | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Dorothy Berger | Administrator | Facility administrator involved in interviews and investigation |
| Jorge Rojas | Investigator | Assigned to the complaint investigation |
Inspection Report
Annual Inspection
Census: 13
Capacity: 14
Deficiencies: 0
Date: Mar 13, 2025
Visit Reason
The inspection was an unannounced annual facility inspection conducted to evaluate compliance with licensing regulations.
Findings
The inspection found the facility to be in full compliance with no citations or deficiencies. All resident rooms, safety systems, staff training, medication management, and emergency plans met regulatory standards.
Report Facts
Resident rooms: 12
Single resident occupancy rooms: 10
Double resident occupancy rooms: 2
Food supply days: 2
Food supply days: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dorothy Berger | Administrator | Met with Licensing Program Analyst during inspection |
| Mark Jeffries | Licensing Program Analyst | Conducted the annual inspection |
Inspection Report
Complaint Investigation
Census: 13
Capacity: 14
Deficiencies: 1
Date: Oct 9, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff were not providing the resident's authorized representative with copies of the resident's records, specifically an updated Weekly Client Weight Record.
Complaint Details
The complaint alleged that staff did not provide the resident's authorized representative with copies of all records, including an updated weight log. The allegation was substantiated based on evidence that the updated weight record for the last week was not provided until the complaint investigation visit.
Findings
The investigation found that the facility initially provided the representative with current weight records but delayed providing the updated weight record for the last week of care until the complaint investigation visit. The allegation was substantiated and a technical violation was issued.
Deficiencies (1)
Failure to provide the resident's authorized representative with an updated Weekly Client Weight Record in a timely manner.
Report Facts
Capacity: 14
Census: 13
Complaint Control Number: 29-AS-20241007145012
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Phillips | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Dorothy Berger | Administrator | Facility administrator involved in the investigation |
| Margie Halsell | Licensee | Facility licensee involved in the investigation |
Inspection Report
Complaint Investigation
Census: 13
Capacity: 14
Deficiencies: 0
Date: Oct 3, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted due to an allegation that the facility was charging a resident for services not provided as per the admission agreement addendum.
Complaint Details
The complaint alleged that the facility charged Resident #1 for extra services not provided, specifically additional time for toileting, personal care, and bathing with stand-by assistance. The investigation included interviews, record reviews, and observations. The allegation was found to be unsubstantiated based on documentation and staff interviews confirming appropriate care and supervision.
Findings
The investigation found that the resident (R1) required additional care time for bathing, grooming, and toileting, which was documented and justified by medical and facility records. Staff provided stand-by assistance during activities of daily living, consistent with the resident's needs and fall risk. There was insufficient evidence to prove the alleged violation, and the complaint was unsubstantiated.
Report Facts
Capacity: 14
Census: 13
Additional toileting time: 60
Additional personal care time: 85
Additional shower time: 60
Additional personal care time (range): 85
Number of residents in facility: 13
Number of other residents: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Phillips | Licensing Program Analyst (LPA) | Conducted the complaint investigation and authored the report |
| Yuribeth Reyes | Medical Technician (MedTech) | Met with the investigator during the visit and provided information |
| Dorothy Berger | Administrator | Facility administrator unavailable during the visit |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 14
Deficiencies: 2
Date: Sep 26, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that facility staff mismanaged a resident's medication and did not appropriately communicate a change of condition.
Complaint Details
The complaint investigation was substantiated. Allegations included medication mismanagement on multiple dates (08/19/2024, 08/20/2024, 09/16/2024, 09/20/2024, and 09/21/2024) and failure to appropriately communicate a change of condition to the primary care physician and responsible party. The resident was reported to have no adverse effects. Staff were counseled and trained following the incidents.
Findings
The investigation substantiated the allegations that multiple medication errors occurred involving Resident #1, including incorrect doses, timing errors, and failure to properly communicate changes in condition to the resident's primary care physician and responsible party. The facility staff received training and the pharmacy provided medication in appropriate doses to prevent recurrence.
Deficiencies (2)
Licensee did not comply with requirements when staff caused multiple medication errors for Resident #1, posing an immediate health and safety risk.
Licensee failed to report an incident and change of condition to a resident’s physician, posing a potential health and safety risk.
Report Facts
Medication error incidents: 5
Facility capacity: 14
Resident census: 14
Plan of Correction due dates: 1
Plan of Correction due dates: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Phillips | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Dorothy Berger | Administrator | Facility administrator involved in the investigation and cited in findings. |
Inspection Report
Annual Inspection
Census: 13
Capacity: 14
Deficiencies: 0
Date: Mar 12, 2024
Visit Reason
The visit was an unannounced required annual site inspection to ensure the facility's compliance with Title 22 Regulations and to assess health and safety conditions.
Findings
The facility was found to be in compliance with all applicable regulations, with no health or safety hazards observed. The physical plant, kitchen, common areas, bedrooms, restrooms, records, medications, infection control, and facility documentation were all in good condition and properly maintained. No deficiencies were cited.
Report Facts
Capacity: 14
Census: 13
Non-ambulatory residents allowed: 13
Bedridden residents allowed: 3
Hospice waiver residents allowed: 7
Resident bedrooms: 12
Resident bathrooms: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dorothy Berger | Administrator | Facility Administrator present during inspection |
| Brian Phillips | Licensing Program Analyst | Licensing evaluator conducting the inspection |
| Margie Halsell | Licensee | Facility Licensee present during inspection |
| Susie Halsell | Business Manager | Facility Business Manager present during inspection |
Inspection Report
Annual Inspection
Census: 13
Capacity: 14
Deficiencies: 0
Date: Feb 13, 2023
Visit Reason
The inspection was a required 1-year unannounced infection control annual visit to evaluate compliance with infection control protocols.
Findings
No deficiencies were observed during the visit; all infection control protocols were implemented and followed. The facility demonstrated compliance with COVID-19 mitigation plans, PPE usage, staff training, and environmental cleaning.
Report Facts
PPE supply duration: 30
Resident bedrooms: 12
Resident bathrooms: 6
Food supply duration - perishable: 2
Food supply duration - nonperishable: 7
Fire extinguisher inspection date: Dec 9, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dorothy Berger | Administrator | Met with Licensing Program Analyst during inspection and responsible for infection control and staffing. |
| Rachael De Leon | Licensing Program Analyst | Conducted the on-site 1 year infection control annual visit. |
| Kelly Burley | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Annual Inspection
Census: 11
Capacity: 14
Deficiencies: 1
Date: Mar 1, 2022
Visit Reason
An unannounced One Year Infection Control Annual visit was conducted to evaluate compliance with infection control and safety regulations.
Findings
The inspection found a deficiency related to an unlocked cabinet containing cleaning products accessible to residents with dementia, posing an immediate health and safety risk. The facility was also advised to improve the visibility of posted signs.
Deficiencies (1)
Unlocked cabinet containing cleaning products accessible to residents with dementia, violating storage requirements for toxic substances.
Report Facts
Deficiency counts: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dorothy Berger | Administrator | Met with Licensing Program Analyst during inspection and involved in deficiency correction. |
| Toan Luong | Licensing Program Analyst | Conducted the inspection and issued deficiencies. |
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