15 Reports
Inspection Report — Jun 30, 2025
Annual Inspection
Date: Jun 30, 2025
Visit Reason
An unannounced subsequent required annual visit was conducted to evaluate compliance with licensing requirements and assess the facility's operations and safety.
Findings
The facility was found to be generally compliant with safety, staffing, and resident care standards. However, two staff members had expired First Aid/CPR training certificates, and the administrator's certificate had expired but renewal was submitted.
Citations (1)
CCR 87411(c)(1) Personnel Requirements - General: Two out of five staff files reviewed had expired First Aid/CPR training, posing a potential health and safety risk to residents.
Report Facts
Staff members: 20
Resident files reviewed: 5
Resident bedrooms: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Assisted with inspection and named in deficiency regarding expired certificates |
| Bennette Pena | Licensing Program Analyst | Conducted the inspection and signed the report |
| David Sicairos | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report — Jun 16, 2025
Annual Inspection
Date: Jun 16, 2025
Visit Reason
Licensing Program Analyst Bennette Pena conducted an unannounced required 1-year inspection visit to evaluate compliance with licensing requirements.
Findings
No deficiencies were observed during the visit. Infection control practices, emergency plans, and operational requirements were found compliant. Some inspection domains were not completed due to time constraints and will be completed at a later date.
Report Facts
Fire drill last conducted: Mar 7, 2025
Liability insurance coverage per occurrence: 1000000
Liability insurance total annual aggregate: 3000000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bennette Pena | Licensing Program Analyst | Conducted the inspection visit. |
| Greg Tillman | Administrative Assistant | Met with the Licensing Program Analyst during the inspection. |
| Ian Baker | Administrator/Director | Facility Administrator was on vacation during the inspection. |
Inspection Report — Jan 15, 2025
Date: Jan 15, 2025
Visit Reason
Licensing Program Analyst Bennette Pena conducted an unannounced Case Management Health Checks visit regarding the repopulation of residents following a fire incident and relocation from a sister facility.
Findings
The health and safety check found no concerns. Residents were repopulated with sufficient beds, hygiene supplies, and food. Fire inspections and drills were up to date, and the facility was given permission to repopulate.
Report Facts
Residents transferred: 16
Residents repopulated: 32
Water bottles observed: 2
Water bottles observed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with Licensing Program Analyst during visit and provided information about resident relocation and facility status |
| Bennette Pena | Licensing Program Analyst | Conducted the unannounced Case Management Health Checks visit and inspection |
Inspection Report — Dec 23, 2024
Complaint Investigation
Date: Dec 23, 2024
Visit Reason
The visit was an unannounced Case Management Deficiencies inspection to investigate an incident reported on 2024-12-16 regarding a resident who is a hoarder, resulting in a roach infestation in the facility.
Complaint Details
The investigation was triggered by an anonymous complaint about a resident hoarding and resulting roach infestation. The complaint was substantiated based on observations and interviews.
Findings
The Licensing Program Analyst observed dead roaches in the resident's bedroom and bathroom, confirming the infestation. The Administrator reported the issue to the Regional Center and scheduled pest control services, but the deficiency was cited for failure to maintain a clean, safe, and sanitary environment.
Citations (1)
CCR 87303(a) requires the facility to be clean, safe, sanitary, and in good repair at all times. Dead roaches were observed in Resident #1's bedroom and bathroom, posing a potential health and safety risk to residents.
Report Facts
Deficiency Type: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Named in relation to the hoarding and infestation findings |
| Bennette Pena | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
Inspection Report — Dec 10, 2024
Complaint Investigation
Date: Dec 10, 2024
Visit Reason
The visit was conducted to investigate a complaint alleging that facility staff handle residents in a rough manner.
Complaint Details
The complaint alleged rough handling of Resident #1 by staff, resulting in a bruise. The investigation included interviews with staff, residents, and the Regional Center. The allegation was unsubstantiated due to lack of evidence.
Findings
The investigation found insufficient evidence to substantiate the allegation that staff handled residents roughly. Interviews with staff, residents, and the Regional Center indicated the injury was caused by the resident's behavior and not staff misconduct.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with Licensing Program Analyst during investigation |
| Tena Herrera | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report — May 9, 2024
Annual Inspection
Date: May 9, 2024
Visit Reason
The inspection was an unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) tools to evaluate compliance with licensing regulations.
Findings
The facility was found to have several deficiencies including inadequate hot water temperature in resident rooms, presence of drain flies in a bathroom, an inoperable washing machine missing a door, lack of evacuation chairs at stairwells, and absence of a physician's order for a half bedrail. Infection control practices and operational requirements were generally met, but these deficiencies pose potential health, safety, or personal rights risks to residents.
Citations (5)
CCR 87303(e)(2): Two out of five resident rooms inspected did not meet the required hot water temperature readings, with temperatures below 105 degrees Fahrenheit.
CCR 87303(f)(1): Drain flies were observed inside the bathroom in Room #9, posing a potential health risk.
CCR 87303(g)(1): One washing machine in the laundry room is inoperable and missing a door, posing a potential health and safety risk.
HSC 1569.695(f)(1): The facility does not have an evacuation chair at each stairwell available to staff during emergencies.
CCR 87608(a)(3): The facility uses a half bedrail in a resident's bedroom without a written physician's order.
Report Facts
Staff count: 27
Fire drill date: Mar 27, 2024
Liability insurance amount: 1000000
Liability insurance aggregate: 3000000
Surety bond amount: 65000
Resident medication supply: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Named in relation to assisting with the visit and deficiencies. |
| Bennette Pena | Licensing Evaluator | Conducted the inspection and signed the report. |
| David Sicairos | Supervisor | Supervisor overseeing the inspection. |
Inspection Report — Jul 21, 2023
Annual Inspection
Date: Jul 21, 2023
Visit Reason
The inspection was an unannounced Required - 1 Year annual inspection conducted by the Licensing Program Analyst to assess compliance with regulations for the facility licensed to serve elderly residents.
Findings
The facility was found to be in compliance with no deficiencies observed. The physical plant, safety equipment, medication storage, and resident records were all inspected and found satisfactory.
Report Facts
Hospice residents: 1
Fire drill date: May 12, 2023
Liability insurance expiration: Oct 1, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| Ashley Calderon | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection. |
Inspection Report — Jun 1, 2023
Complaint Investigation
Date: Jun 1, 2023
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation that staff interacted with a resident in an inappropriate manner.
Complaint Details
The complaint was substantiated based on interviews with staff, residents, and review of records. Staff admitted inappropriate behavior and a corrective action plan including sexual harassment training was planned.
Findings
The investigation substantiated that Staff #1 admitted to making inappropriate hand gestures towards Resident #1, which made the resident feel uncomfortable. Interviews with staff and residents confirmed inappropriate interactions and lack of respect by staff.
Citations (1)
CCR 87468.1 Personal Rights of Resident in all Facilities. Each resident shall be accorded dignity in personal relationships with staff and others. Staff admitted to inappropriate hand gestures that made a resident feel uncomfortable.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with Licensing Program Analyst and involved in investigation |
| Ashley Calderon | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report — May 5, 2023
Complaint Investigation
Date: May 5, 2023
Visit Reason
Unannounced complaint investigation visit to investigate allegations that facility staff did not ensure residents received adequate showers, were adequately fed, and that residents' rooms were cleaned while in care.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included inadequate showers, feeding, and room cleaning. Interviews and observations did not support these claims.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews with staff and residents, observations of the facility, and review of resident records indicated that residents received showers, food, and room cleaning as required.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Interviewed during complaint investigation and named in findings |
| Ashley Calderon | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report — Apr 28, 2023
Complaint Investigation
Date: Apr 28, 2023
Visit Reason
The visit was an unannounced complaint investigation regarding allegations that the facility failed to address a pest infestation and was not reporting a scabies outbreak.
Complaint Details
The complaint investigation was unsubstantiated as there was insufficient evidence to prove the alleged violations regarding pest infestation and scabies outbreak.
Findings
The investigation found no current evidence of pest infestation or scabies outbreak at the facility. Pest control measures were in place and effective, and no residents or staff reported scabies symptoms. The allegations were unsubstantiated.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met during the investigation and provided information about pest control and scabies |
| Cynthia D Chan | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report — Sep 7, 2022
Annual Inspection
Date: Sep 7, 2022
Visit Reason
The inspection was an unannounced Required - 1 Year annual inspection to evaluate compliance with licensing regulations, including infection control and physical plant conditions.
Findings
The facility was generally compliant with Title 22 regulations, with clean and operational physical plant areas, proper medication storage and administration, and adequate food supplies. Two deficiencies were noted related to resident safety and facility maintenance.
Citations (2)
Care of Persons with Dementia requires toxic substances to be stored inaccessible to residents. Two bottles of laundry detergent were found accessible in the laundry room, posing immediate health and safety risks.
Maintenance and Operation requires the facility to be clean, safe, sanitary, and in good repair. One private bathroom in room #20 had no running hot water; the resident will be moved until repairs are made.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Facility administrator named in report header |
| Ann Hamilton | Licensee Representative | Met with LPAs during inspection |
| Monique Jordan | Administrator Assistant | Assisted with the inspection visit |
| YaTing Yang | Licensing Evaluator | Conducted the inspection and signed the report |
| Wei Siew Ho | Supervisor | Supervisor overseeing the inspection |
Inspection Report — Jul 20, 2022
Complaint Investigation
Date: Jul 20, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that facility staff did not follow Covid-19 quarantine, PPE, and masking protocols.
Complaint Details
The complaint investigation was unannounced and addressed allegations of noncompliance with Covid-19 quarantine, PPE, and masking protocols. The quarantine and PPE allegations were unsubstantiated, while the masking allegation was substantiated.
Findings
The investigation found the allegations regarding quarantine and PPE protocols unsubstantiated based on interviews and observations. However, the allegation that staff did not follow Covid-19 masking protocols was substantiated due to observed failure of staff to wear masks properly while interacting with visitors.
Citations (1)
CCR 87470(c)(1)(F) Infection Control Requirements: Staff shall demonstrate knowledge of and skill in infection control. LPA observed staff member did not wear a mask while talking to a visitor, posing a potential risk to residents.
Report Facts
Plan of Correction Due Date: Aug 3, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with during investigation and exit interview |
| Christine Wong | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report — Mar 28, 2022
Complaint Investigation
Date: Mar 28, 2022
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation that a resident was hit by another resident, resulting in broken eyeglasses.
Complaint Details
The allegation was that Resident 2 hit Resident 1, breaking Resident 1's eyeglasses. The incident occurred on 01/28/2019. Resident 1 did not sustain injuries and received replacement glasses. Resident 2 was taken for psychiatric evaluation and did not return. The allegation was unsubstantiated due to lack of evidence.
Findings
The investigation found the incident was isolated with no injuries sustained and replacement glasses provided. There was insufficient evidence to substantiate the allegation, and the facility staff could not have prevented the incident.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with Licensing Program Analyst during investigation |
| Joe Katrdzhyan | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report — Sep 10, 2021
Complaint Investigation
Date: Sep 10, 2021
Visit Reason
The visit was conducted to investigate a complaint alleging that staff did not prevent an inappropriate interaction between clients at the facility.
Complaint Details
The complaint alleged that staff did not prevent an inappropriate interaction between clients. The allegation involved Resident #2 allegedly touching Resident #1's breasts on 8/18/2021. The allegation was unsubstantiated after investigation including interviews, camera footage review, and prior facility history.
Findings
The investigation found that Resident #2 allegedly touched Resident #1 inappropriately, but there was no preponderance of evidence to prove the allegation. Interviews, camera footage, and prior history were reviewed, and the allegation was determined to be unsubstantiated.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Met with during investigation and named in report |
| Tony Vasallo | Licensing Program Analyst | Conducted the complaint investigation |
| Wei Siew Ho | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report — Jul 2, 2021
Annual Inspection
Date: Jul 2, 2021
Visit Reason
The inspection was a required annual unannounced visit to evaluate compliance with licensing regulations for the Bella Vista facility.
Findings
The facility was generally found to be in compliance with health and safety regulations, but several deficiencies were noted including inoperable auditory chimes on exit doors, improper hot water temperatures in some bathrooms, and missing window screens with cobwebs and dust.
Citations (3)
Care of Persons with Dementia. The licensee shall have an auditory device or other staff alert feature to monitor exits. The auditory chimes on both exit doors on the south side were inoperable.
Maintenance and Operation. Faucets used by residents shall deliver hot water between 105 and 120 degrees F. Hot water temperatures in several bathrooms were below or above this range, including 71.6 F and 125 F readings.
Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair. Missing window screens were observed on bathroom windows in rooms #5 and #10, with screens full of cobwebs and dust.
Report Facts
Hot water temperature readings: 71.6
Hot water temperature readings: 125
Hot water temperature readings: 72.3
Hot water temperature readings: 69.8
Hot water temperature readings: 95
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ian Baker | Administrator | Assisted with the inspection visit and was present during exit interview |
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