Most inspections found no deficiencies, including the two most recent visits on October 31, 2025, and May 13, 2025, which had no issues noted. Earlier reports showed some isolated deficiencies, primarily related to medication documentation in March 2025 and a failure to prevent a dementia resident from leaving unsupervised in June 2024. The facility addressed initial licensing concerns in early 2024 involving water temperature, ceiling repairs, and animal housing, with corrections verified in a follow-up visit. Several complaint investigations, including one in January 2025 about resident falls and care, were unsubstantiated. The overall trend shows improvement, with recent inspections free of deficiencies and no enforcement actions or fines listed in the available reports.
An unannounced health and safety case management visit was conducted to follow up on a fax received stating that the facility would be adding central air conditioning to the facility hallways.
Findings
The air conditioning installation was observed not to impede resident care or movement, with no health and safety concerns noted during the inspection.
Employees Mentioned
Name
Title
Context
Darlene Lindley
Administrator
Met with Licensing Program Analyst during the inspection and discussed the purpose of the visit.
Hanna Gough
Licensing Program Analyst
Conducted the unannounced health and safety case management visit.
The inspection was an unannounced case management visit to verify completion of renovations involving replacement of carpet with wood flooring in hallways and to ensure resident health and safety during the project.
Findings
No deficiencies were cited during the inspection. The facility completed the hallway flooring renovations as planned, maintaining resident safety by escorting residents as needed during the work.
Report Facts
Capacity: 210Census: 77
Employees Mentioned
Name
Title
Context
Darlene Lindley
Administrator
Met with Licensing Program Analyst during inspection and discussed renovation project
An unannounced inspection was conducted for the purposes of an annual inspection to evaluate compliance with licensing requirements.
Findings
The facility was observed to be clean, sanitary, and in good repair with all required furnishings and safety equipment operational. However, deficiencies were cited related to medication administration documentation not being properly maintained.
Deficiencies (1)
Description
Medications are not being documented when administered to residents, posing a potential health risk.
Report Facts
Plan of Correction Due Date: Mar 25, 2025
Employees Mentioned
Name
Title
Context
William Vanegas
Licensing Program Analyst
Conducted the inspection and cited deficiencies
Darlene Lindley
Administrator
Met during inspection and involved in exit interview and plan of correction
An unannounced complaint investigation was conducted to investigate allegations that staff did not meet the resident's needs, specifically concerning a resident (R1) who had multiple falls and was allegedly left alone and ignored regarding toileting needs.
Findings
The investigation found that the facility had a proper fall prevention plan in place which was updated after each fall incident involving R1. Interviews and document reviews did not corroborate the allegations, and the complaint was deemed unsubstantiated.
Complaint Details
The complaint alleged that R1 had three falls since July 2024, was often left alone, and staff ignored R1’s toileting needs. The investigation included interviews with staff, residents, and witnesses, and review of multiple incident reports and care plans. The falls were documented and addressed with updated fall prevention plans. The last fall was witnessed and assisted, indicating it could not have been prevented by the plan. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Falls: 3Census: 72Capacity: 210
Employees Mentioned
Name
Title
Context
Sean Haddad
Licensing Program Analyst
Conducted the complaint investigation
Armando J Lucero
Licensing Program Manager
Oversaw the complaint investigation
Darlene Lindley
Administrator
Interviewed during investigation and provided information about resident R1 and facility procedures
The inspection visit was an unannounced Case Management visit triggered by an incident report stating that a resident left the facility unassisted on 2024-06-05.
Findings
The inspection found that the facility did not comply with regulations regarding care of persons with dementia, as one dementia resident left the facility unsupervised. One deficiency was issued based on this finding.
Severity Breakdown
Type B: 1
Deficiencies (1)
Description
Severity
One dementia resident left the facility unsupervised, violating Section 87468, Personal Rights, as facility staff failed to redirect the resident attempting to leave.
Type B
Report Facts
Deficiencies cited: 1Plan of Correction Due Date: Jul 5, 2024
Employees Mentioned
Name
Title
Context
Dwayne L Mason
Licensing Program Analyst
Conducted the unannounced Case Management visit and issued the deficiency
Darlene Lindley
Administrator
Interviewed during the inspection regarding the incident
Lea Wine
Assistant Administrator
Interviewed during the inspection
Armando J Lucero
Licensing Program Manager
Supervisor and Licensing Evaluator overseeing the inspection
Inspection Report Original LicensingCensus: 36Capacity: 210Deficiencies: 0Feb 22, 2024
Visit Reason
The inspection was conducted as a pre-licensing visit to follow up on corrections identified during a prior visit on 2024-02-12 and to evaluate readiness for licensing as a Residential Care Facility for the Elderly (RCFE).
Findings
The facility was found to have ceased renovations in resident bedrooms, adjusted water temperatures to meet regulations, repaired ceiling tiles, and removed guinea pigs from a staff office, making it odor free. The facility was deemed ready to be licensed.
Inspection Report Original LicensingCensus: 38Capacity: 210Deficiencies: 3Feb 12, 2024
Visit Reason
The inspection was conducted as a pre-licensing visit to evaluate the facility's readiness to operate as a Residential Care Facility for the Elderly (RCFE) with a capacity of 210 residents.
Findings
The facility was found to have appropriate structure, furnishings, signal systems, fire safety equipment, and recreational materials. Some corrections were noted including water temperature adjustments, ceiling tile repairs, and proper housing for guinea pigs. A follow-up visit will be conducted to verify corrections.
Deficiencies (3)
Description
Water temperatures tested at 93.5 degrees F in resident bathrooms 247 and 248, requiring adjustment to meet regulation of 105 to 120 degrees F.
Ceiling tiles in the second story have been moved or are missing and a gap is visible in the ceiling exposing wood beams and covered by a thin clear plastic sheet.
Four guinea pigs are currently living in a staff office on the second story; two are in a designated cage, two are kept in a collapsible wagon intended for hauling.
Report Facts
Resident census: 38Total capacity: 210Fire extinguisher service date: Feb 17, 2024Fire clearance approval date: Jan 5, 2024Correction deadline: Feb 26, 2024
Employees Mentioned
Name
Title
Context
Young Park
Administrator
Met with Licensing Program Analyst during pre-licensing inspection
Darlene Lindley
Executive Director
Met with Licensing Program Analyst during pre-licensing inspection
Lea Wine
Assistant Administrator
Met with Licensing Program Analyst during pre-licensing inspection
Yung Lee
Corporate Member
Met with Licensing Program Analyst during pre-licensing inspection
Claudia Gutierrez
Licensing Program Analyst
Conducted the pre-licensing inspection
Armando J Lucero
Licensing Program Manager
Named in report header and signature
Inspection Report Original LicensingCapacity: 210Deficiencies: 0Dec 20, 2023
Visit Reason
The visit was an office type, unannounced original licensing evaluation conducted via phone call to complete Component II of the licensing process for the facility.
Findings
The applicant and administrator successfully completed Component II by phone call, confirming understanding of Title 22 regulations including facility operation, staff qualifications, program policies, and application document requirements.
Employees Mentioned
Name
Title
Context
Young Park
Administrator
Met with during the licensing evaluation and confirmed understanding of Title 22.
The visit was an office evaluation involving a phone call to complete Component II (COMP II) at the Centralized App Unit (CAB) to verify the applicant and administrator's understanding of Title 22 and related regulatory requirements.
Findings
The applicant and administrator successfully completed COMP II by phone, confirming understanding of facility operation, staff qualifications, program policies, and other regulatory areas. Technical assistance and document review were provided with no deficiencies or violations noted.
Employees Mentioned
Name
Title
Context
Maria Kaulen
Administrator
Named as facility administrator participating in COMP II
Darla Neeley
Licensing Program Manager
Named as Licensing Program Manager overseeing the evaluation
Gina Baldwin
Licensing Program Analyst
Named as Licensing Program Analyst conducting the evaluation
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