Inspection Report Summary
Most inspections found no deficiencies, with routine annual and case management visits consistently showing compliance and proper care. The most recent report from October 29, 2025, was also free of deficiencies despite being triggered by a substantiated incident involving a resident’s fracture from a fall. Earlier reports did cite some deficiencies related mainly to medication management errors, failure to submit timely incident reports, and inadequate supervision that allowed a resident to leave unsupervised, but these issues were isolated and addressed. Several complaint investigations were unsubstantiated, including allegations of improper charges, retaliation, and staff mistreatment. The facility’s record shows improvement over time, with recent inspections demonstrating no deficiencies following earlier concerns.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 71
Capacity: 85
Deficiencies: 0
Oct 29, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident involving Resident 1's fracture reported by the facility.
Findings
The Licensing Program Analyst reviewed the incident report, interviewed relevant staff, and reviewed Resident 1's care documents. No deficiencies were cited during the visit.
Complaint Details
The visit was triggered by a self-reported incident of an unwitnessed fall by Resident 1 on 2025-10-25 resulting in a lower leg fracture treated on 2025-10-27. The incident was substantiated by the facility's report and medical documentation.
Report Facts
Capacity: 85
Census: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator/Director | Named as facility administrator/director |
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during visit |
| Gigi Tamayo | Health Services Director | Interviewed during visit regarding Resident 1's care |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection visit |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 70
Capacity: 85
Deficiencies: 0
Oct 8, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident involving Resident 1 who had an unwitnessed fall and subsequent hospitalization for a cervical fracture, followed by the resident's death.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst reviewed medical and care records related to the incident and will request additional documentation including full medical records and death certificate.
Report Facts
Facility capacity: 85
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during the visit |
| Gigi Tamayo | Health Services Director | Met with Licensing Program Analyst during the visit |
| Emily Poon | Administrator/Director | Facility Administrator named in report header |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 85
Deficiencies: 0
Oct 8, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident involving Resident 1 who was sent to the hospital for a worsening pressure injury.
Findings
During the visit, documents related to Resident 1's care were reviewed, and no deficiencies were cited. The Licensing Program Analyst will request Resident 1's full medical record and may return later.
Complaint Details
The visit was triggered by a self-reported incident where Resident 1 was hospitalized for a worsening pressure injury on 10/03/2025 and is currently admitted to a skilled nursing facility.
Report Facts
Facility capacity: 85
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met during the inspection and involved in the visit regarding the incident |
| Gigi Tamayo | Health Services Director | Met during the inspection and involved in the visit regarding the incident |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 85
Deficiencies: 1
Jun 18, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident on 06/06/2025 where a resident went AWOL by exiting through the front door.
Findings
The facility failed to provide adequate supervision, resulting in a resident leaving the facility unsupervised, which posed a potential health and safety risk. The resident was later returned by police, and corrective measures such as use of a Wanderguard Bracelet and safety checks were implemented.
Complaint Details
The visit was complaint-related due to a self-reported incident where Resident 1 went AWOL. The incident was substantiated by record review and interviews indicating lack of supervision.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide supervision causing Resident 1 to leave the facility, posing a potential health and safety risk to residents in care. | Type B |
Report Facts
Capacity: 85
Census: 85
Plan of Correction Due Date: Jul 9, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Executive Director | Met with Licensing Program Analyst during inspection and involved in incident report |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection visit |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 74
Capacity: 85
Deficiencies: 0
Apr 22, 2025
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements.
Findings
The Licensing Program Analysts toured the facility and reviewed resident and staff records, medications, and safety equipment. No deficiencies were cited during the visit.
Report Facts
Hot water temperature readings: 117.1
Hot water temperature readings: 112
Hot water temperature readings: 119
Fire extinguisher last serviced date: Jun 20, 2024
Emergency disaster drill last conducted date: Mar 5, 2025
Residents records reviewed: 7
Staff records reviewed: 7
Resident medications samples reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Executive Director | Met with Licensing Program Analysts during inspection |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection |
| K. Nguyen | Licensing Program Analyst | Conducted the inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 74
Capacity: 85
Deficiencies: 0
Apr 22, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident involving a resident hospitalized for a UTI and internal brain bleed.
Findings
The visit found no deficiencies. The internal brain bleed was due to a hemorrhagic stroke as confirmed by review of the After Visit Summary.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Executive Director | Met with Licensing Program Analysts during the visit and self-reported the incident. |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection visit. |
| K. Nguyen | Licensing Program Analyst | Conducted the inspection visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 74
Capacity: 85
Deficiencies: 0
Apr 22, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding a self-reported incident involving a resident who was hospitalized for a lumbar fracture.
Findings
The visit found no deficiencies. The fracture was determined to be due to osteoporosis sequela, and the facility provided relevant medical documentation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Executive Director | Met with Licensing Program Analysts during the visit and self-reported the incident. |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 76
Capacity: 85
Deficiencies: 0
Sep 13, 2024
Visit Reason
The visit was a case management visit regarding an incident report at the facility.
Findings
No deficiencies were cited during the visit. Licensing Program Analysts interviewed involved parties and reviewed the incident.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Executive Director | Met with Licensing Program Analysts during the visit. |
Inspection Report
Annual Inspection
Census: 76
Capacity: 85
Deficiencies: 0
Jun 25, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The Licensing Program Analyst toured the facility and reviewed resident and staff records. No deficiencies were cited during the visit, and all safety and operational standards observed were satisfactory.
Report Facts
Residents' records reviewed: 6
Staff records reviewed: 7
Staff with current first aid training: 6
Fire clearance capacity: 85
Bedridden capacity: 48
Hot water temperature readings: Measured temperatures were 109.3, 117.8, and 111.0 degrees Fahrenheit
Freezer temperature: 0
Refrigerator temperature: 40
Fire extinguisher last serviced: Jun 20, 2024
Emergency Disaster Plan last posted: Jun 13, 2024
Fire drill last conducted: May 25, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during inspection and toured facility |
Inspection Report
Census: 74
Capacity: 85
Deficiencies: 0
Feb 15, 2024
Visit Reason
The visit was an unannounced case management visit to deliver complaint findings from an amended complaint dated 6/13/2023.
Findings
No deficiencies were cited during the visit. Licensing Program Analysts met with the Health Services Director and explained the purpose of the visit. An exit interview was conducted and a copy of the report was provided.
Complaint Details
The visit involved delivery of complaint findings from an amended complaint dated 6/13/2023. No deficiencies were cited during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Health Services Director | Met with Licensing Program Analysts during the case management visit. |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 85
Deficiencies: 0
Dec 13, 2023
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to an allegation that staff charged residents for services not received.
Findings
The investigation found that residents were not charged for tray services during three COVID outbreaks and that escort and small group activities were provided. There was insufficient evidence to substantiate the allegation, and no deficiencies were cited.
Complaint Details
The complaint alleged that staff charged residents for services not received. The investigation was unannounced and included interviews and document reviews. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 85
Census: 76
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Senior General Manager | Met with Licensing Program Analyst during investigation |
| Grace Luk | Licensing Program Analyst | Conducted complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Gigi Tamayo | Health Services Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 85
Deficiencies: 0
Oct 6, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the licensee initiated an eviction process in retaliation against a resident.
Findings
Based on interviews with three staff members and record review, the eviction was due to a higher level of care needed by the resident and not retaliation. There was insufficient evidence to prove the alleged violation occurred, so the allegation was unsubstantiated.
Complaint Details
The complaint alleged that the licensee initiated an eviction process in retaliation against a resident. The investigation found no preponderance of evidence to substantiate the allegation, and it was deemed unsubstantiated.
Report Facts
Census: 98
Total Capacity: 85
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during the investigation and exit interview |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation visit |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 85
Deficiencies: 1
Oct 6, 2023
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation that staff improperly administered a resident's medication.
Findings
The investigation substantiated the allegation that a resident's medication was crushed and administered without a physician's order on July 8, 2023. The physician approved the request to crush the medication on July 12, 2023, after the incident.
Complaint Details
The complaint was substantiated based on evidence that staff crushed and administered medication to resident R1 without prior physician approval. The physician later approved the medication crushing after the incident.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to have a signed, dated written order from a physician before crushing resident R1's medication, posing an immediate health, safety, or personal rights risk. | Type A |
Report Facts
Census: 98
Total Capacity: 85
Deficiency Type Count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met with during the investigation and exit interview |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 85
Deficiencies: 0
Oct 6, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2023-07-12 alleging staff did not treat residents with dignity and respect, did not include resident's responsible party in the reappraisal process, and that the facility was charging residents for services not agreed upon.
Findings
The investigation included interviews with staff and residents and review of records. The allegations were found to be unsubstantiated due to lack of preponderance of evidence. Staff and residents reported respectful care, and documentation confirmed reappraisal and notification of responsible parties. The facility communicated about increased care needs appropriately.
Complaint Details
The complaint included allegations that staff did not treat residents with dignity and respect, did not include resident's responsible party in the reappraisal process, and that the facility was charging residents for services not agreed upon. The investigation found these allegations unsubstantiated.
Report Facts
Capacity: 85
Census: 98
Number of staff interviewed: 5
Number of residents interviewed: 5
Sample size for medication administration record review: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Lee | Director of Operations | Met with during investigation and exit interview |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 85
Deficiencies: 0
Oct 6, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation of illegal eviction received on 07/18/2023.
Findings
The investigation found that although the allegation of illegal eviction may have occurred or be valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, resulting in an unsubstantiated finding.
Complaint Details
The complaint alleged illegal eviction of a resident. The facility stated that eviction notices are given when a resident's level of care increases beyond what the facility can provide. The investigation included interviews with three staff members and review of relevant documents. The allegation was determined to be unsubstantiated.
Report Facts
Capacity: 85
Census: 98
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator | Named as facility administrator |
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during investigation |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 85
Deficiencies: 1
Sep 29, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted due to an allegation that staff did not dispense medication according to doctor's orders.
Findings
The investigation found that a staff member accidentally grabbed the incorrect eye drop bottle and was stopped before administering it to a resident. Additionally, on 6/23/2023, a staff member administered multiple drops instead of one as ordered. These allegations were substantiated based on interviews and record reviews.
Complaint Details
The complaint alleged that staff did not dispense medication according to doctor's orders. The allegation was substantiated based on interviews and record review. A staff member was suspended during the investigation. The licensee did not comply with regulations regarding residents' personal rights and medication administration.
Deficiencies (1)
| Description |
|---|
| Failure to ensure physicians' orders for eye drop medication were followed, resulting in incorrect administration of medication to a resident. |
Report Facts
Capacity: 85
Census: 74
Deficiency Type: 1
Plan of Correction Due Date: Sep 30, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Registered Nurse (RN) | Met with Licensing Program Analyst during investigation and participated in exit interview |
| Angel Lee | Director of Operations | Met with Licensing Program Analyst during investigation |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 74
Capacity: 85
Deficiencies: 0
Sep 29, 2023
Visit Reason
The visit was an unannounced case management visit to deliver an amended report originally dated 08/23/2023.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst obtained the original report from the Registered Nurse and conducted an exit interview.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Registered Nurse | Met with Licensing Program Analyst during the visit. |
Inspection Report
Census: 74
Capacity: 85
Deficiencies: 0
Sep 22, 2023
Visit Reason
The visit was an unannounced case management visit to deliver an amended report originally dated 08/24/2023.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst obtained the original report from the Registered Nurse and conducted an exit interview with the General Manager.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | General Manager | Met with Licensing Program Analyst during the visit. |
| Gigi Tamayo | Registered Nurse | Met with Licensing Program Analyst and provided the original report. |
Inspection Report
Census: 73
Capacity: 85
Deficiencies: 0
Sep 7, 2023
Visit Reason
The visit was an unannounced case management visit to deliver an amended report originally dated 6/9/2023.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst met with the Registered Nurse and obtained the original report.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Registered Nurse | Met with Licensing Program Analyst during the visit. |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 85
Deficiencies: 0
Aug 30, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that facility staff did not seek medical attention for a resident in a timely manner.
Findings
The investigation found that a resident was given the wrong medication and there was a delay of approximately 45 minutes before 9-1-1 was called. However, after reviewing interviews, records, and communications, there was insufficient evidence to substantiate the allegation, and it was determined to be unsubstantiated.
Complaint Details
The complaint alleged that facility staff did not seek medical attention for a resident in a timely manner. The resident was given the wrong medication around 8:00 AM on May 28, 2023, and staff realized the error at 9:24 AM. The resident was assessed and vitals were stable initially, but later changed around 10:15 AM, prompting an immediate 9-1-1 call and hospital transport. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Complaint receipt date: Jun 13, 2023
Medication error time delay: 45
Facility capacity: 85
Census: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator | Named as facility administrator |
| Gigi Tamayo | Registered Nurse (RN) / Health Services Director | Met during investigation and exit interview |
| Angel Lee | Director of Operations | Met during redelivery of complaint findings |
| Laura Hall | Licensing Program Analyst | Conducted investigation and delivered amended report |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing investigation |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 85
Deficiencies: 0
Aug 30, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 06/08/2023 regarding lack of supervision, theft of residents' belongings, confidentiality breaches, discouragement of pendant use, and insufficient staffing.
Findings
After interviews with staff and residents and review of relevant documents, there was no preponderance of evidence to substantiate the allegations. Staff confirmed safety checks and pendant use were unrestricted, and residents denied missing belongings. The allegation of early dining room transport was explained as a preference by some residents. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated based on interviews with five staff and five residents, and review of documents including incident reports and service plans. Allegations included multiple falls due to lack of supervision, staff stealing belongings, confidentiality breaches, discouragement of pendant use, and insufficient staffing causing early dining room transport. No violations were proven.
Report Facts
Capacity: 85
Census: 73
Staff interviewed: 5
Residents interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation visit |
| Gigi Tamayo | Registered Nurse (RN) | Met with Licensing Program Analyst during investigation and participated in exit interview |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 85
Deficiencies: 0
Aug 24, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate the allegation that staff charged residents for services not received.
Findings
Based on interviews with staff and residents' representatives and review of records, there was no evidence that residents were charged for tray services or other services during the COVID-19 outbreak. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that staff charged residents for services not received. The investigation found no preponderance of evidence to prove the alleged violation occurred, and the allegation was unsubstantiated.
Report Facts
Capacity: 85
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Registered Nurse (RN) | Met with during the investigation and involved in the exit interview |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation visit |
| Harpreet Humpal | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 85
Deficiencies: 1
Jul 19, 2023
Visit Reason
An unannounced case management visit was conducted on 07/19/2023 to investigate a 10-day initial complaint regarding the facility's failure to request an exemption before re-admitting a resident with a restricted health condition.
Findings
The facility was found deficient for not submitting an exemption for a resident with a restricted health condition upon re-admission, which poses a potential health, safety, or personal rights risk. The deficiency was cited under California Code of Regulation, Title 22.
Complaint Details
The visit was triggered by a 10-day initial complaint (15-AS-20230711115733) concerning the facility's failure to request an exemption before re-admitting resident R1 with a restricted health condition. The complaint was substantiated by the observed deficiency.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit an exemption for a restricted health condition for resident R1 upon re-admission. | Type B |
Report Facts
Facility capacity: 85
Plan of Correction due date: Jul 26, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Liridon Fici | Licensing Program Analyst | Conducted the inspection and authored the report |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection |
| Gigi Tamayo | Registered Nurse | Facility staff met during the inspection |
Inspection Report
Annual Inspection
Census: 74
Capacity: 85
Deficiencies: 0
Jul 5, 2023
Visit Reason
The visit was an unannounced 1-Year Annual Required Inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The inspection found the facility to be in compliance with no deficiencies cited. The facility was well maintained with adequate safety measures, proper staffing, and appropriate supplies. Updated documents were requested for submission by 7/12/2023.
Report Facts
Staff present during inspection: 5
Residents present during inspection: 7
Bedrooms: 64
Bathrooms: 69
Shared bedrooms: 10
Hot water temperature: 117.7
Fire extinguisher last serviced: Jul 20, 2022
Administrator certificate expiration: Mar 25, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Liridon Fici | Licensing Program Analyst | Conducted the inspection and signed the report |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 73
Capacity: 85
Deficiencies: 0
Jun 23, 2023
Visit Reason
The visit was an unannounced case management visit to deliver an amended report originally dated 6/9/2023.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst obtained the original report from the Registered Nurse and conducted an exit interview.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | Registered Nurse | Met with Licensing Program Analyst during the visit and provided the original report. |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 85
Deficiencies: 1
Jun 9, 2023
Visit Reason
The inspection was conducted as part of an investigation of a complaint (15-AS-20230608092900) regarding multiple falls sustained by a resident (R1) and the facility's failure to submit timely incident reports to the Community Care Licensing (CCL) agency.
Findings
The facility failed to submit incident reports to CCL in a timely manner for resident falls occurring on 10/16/2022, 12/20/2022, and 5/9/2023, which is a violation of Title 22 California Code of Regulations. The deficiency was discussed with facility staff and cited accordingly.
Complaint Details
Investigation of complaint 15-AS-20230608092900 regarding resident falls and failure to submit timely incident reports. The deficiency was substantiated and cited.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit incident reports (Lic624s) to CCL regarding resident falls in a timely manner, posing a potential health, safety, or personal rights risk to persons in care. | Type B |
Report Facts
Resident falls: 3
Capacity: 85
Census: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator | Discussed incidents and reporting requirements during inspection |
| Gigi Tamayo | RN | Met with Licensing Program Analyst and discussed incidents and reporting requirements |
| Angel Lee | Director of Operations | Discussed incidents and reporting requirements during inspection |
| Liridon Fici | Licensing Program Analyst | Conducted investigation and authored report |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 73
Capacity: 85
Deficiencies: 0
Jun 6, 2023
Visit Reason
The visit was an unannounced case management visit regarding an incident report received on 2023-05-20 involving a resident ingesting calligraphy ink during a facility activity.
Findings
The investigation found that the resident ingested calligraphy ink but had no concerning health issues upon return to the facility. Poison control was notified but could not confirm harm from the ink. No deficiencies were cited during the visit.
Report Facts
Incident report date: May 18, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gigi Tamayo | RN | Met with Licensing Program Analyst during visit and involved in incident assessment |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 85
Deficiencies: 2
Jun 6, 2023
Visit Reason
An unannounced complaint investigation visit was conducted due to allegations that staff mismanaged a resident's medications and overmedicated a resident.
Findings
The investigation substantiated that on 5/28/2023, a staff member mistakenly gave a resident 11 types of oral medications intended for another resident, resulting in a medication overdose requiring hospital admission. The facility failed to comply with personnel and medication administration regulations, posing immediate health and safety risks.
Complaint Details
The complaint was substantiated. Staff member S2 mistakenly administered 11 types of oral medications from another resident to R1 on 5/28/2023, causing a medication overdose. Incident reports, progress notes, and staff statements confirmed the error. The resident was hospitalized and returned the next day.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Personnel Requirements - Facility personnel were not sufficient in numbers and competent to meet resident needs, evidenced by medication errors. | Type A |
| Incidental Medical and Dental Care - Overmedicating a resident with incorrect medication that did not belong to them. | Type A |
Report Facts
Number of medications mistakenly given: 11
Facility capacity: 85
Resident census: 73
Plan of Correction due date: Jun 7, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | Administrator | Facility administrator who agreed to submit plans of correction. |
| Liridon Fici | Licensing Program Analyst | Conducted the complaint investigation. |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation. |
| Gigi Tamayo | Registered Nurse | Met with Licensing Program Analyst during the investigation and participated in exit interview. |
Inspection Report
Census: 73
Capacity: 85
Deficiencies: 0
Aug 4, 2022
Visit Reason
The visit was an unannounced case management visit conducted by Licensing Program Analyst L. Fici and Licensing Program Manager Y. Flores-Larios to evaluate the facility's compliance and census status.
Findings
The facility was confirmed to be operating under its licensed capacity with a census of 73 residents out of 85 licensed beds. No deficiencies were cited during this visit.
Report Facts
Census: 73
Total Capacity: 85
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | General Manager | Interviewed regarding census and facility capacity |
| Cathy Zhou | Health and Service Director | Met with Licensing Program Analyst and Manager during the visit |
Inspection Report
Annual Inspection
Census: 97
Capacity: 85
Deficiencies: 0
Jul 20, 2022
Visit Reason
Unannounced annual Infection Control Inspection conducted to assess compliance with infection control protocols and facility safety measures.
Findings
The facility was found to have adequate infection control measures including proper PPE use, sufficient food supply, universal screening, and routine disinfection. No deficiencies were cited during this inspection.
Report Facts
Capacity: 85
Census: 97
PPE supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Zhou | Health Service Director | Met with Licensing Program Analysts during inspection |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 85
Deficiencies: 0
Jul 20, 2022
Visit Reason
The visit was an unannounced case management inspection conducted to investigate an incident report dated 07/03/2022 concerning an allegation that Staff 5 hit Resident 1 on 07/02/2022.
Findings
The investigation found no evidence that Staff 5 hit Resident 1. Staff 5 had no previous complaints and up-to-date training. No deficiencies were cited during the visit.
Complaint Details
The complaint involved an allegation by Resident 2 that Staff 5 hit Resident 1. The facility notified the Ombudsman but not the police. The internal investigation and interviews found no evidence to substantiate the allegation.
Report Facts
Incident report date: Jul 3, 2022
Incident date: Jul 2, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Zhou | Health and Services Director | Met with Licensing Program Analysts during the visit |
| James Sampair | Licensing Program Analyst | Conducted the case management visit |
| Emily Poon | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 85
Deficiencies: 0
Dec 30, 2021
Visit Reason
The visit was an unannounced case management inspection conducted regarding an incident report received on 12/28/2021 involving alleged abuse of a resident by staff.
Findings
The investigation found that Resident 1 reported abuse by Staff 5. Staff 5 was suspended immediately and terminated after the investigation. No deficiencies were cited during the visit.
Complaint Details
The complaint involved alleged abuse of Resident 1 by Staff 5. The facility notified law enforcement and the resident's responsible party. Staff 5 was suspended and terminated following the investigation.
Report Facts
Staff interviewed: 3
Incident report date: Dec 28, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Poon | General Manager | Met with Licensing Program Analyst during the visit. |
| Cathy Zhou | Health and Services Director | Met with Licensing Program Analyst during the visit. |
Inspection Report
Capacity: 85
Deficiencies: 0
May 7, 2021
Visit Reason
The visit was an office evaluation conducted via telephone call with the Community Care Licensing (CAB) analyst to complete Component II (COMP II) of the application process for a change of ownership (CHOW) of the facility.
Findings
The applicant and administrator successfully completed COMP II, confirming their understanding of Title 22 regulations including facility operation, staff qualifications, program policies, and application document requirements. The applicant was advised to submit required documentation to CAB.
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