Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 35
Capacity: 45
Deficiencies: 0
Jul 24, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted by the Licensing Program Analyst to evaluate compliance with licensing requirements.
Findings
The facility was found to be clean, well-maintained, and in compliance with all applicable regulations. No deficiencies were cited during this inspection.
Report Facts
Temperature of water in resident bedroom: 118
Licensed capacity: 45
Census: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexis Alvarez | Designated Facility Administrator | Met with Licensing Program Analyst during inspection and accompanied on facility tour |
| Ellen Lindstrom | Licensing Program Analyst | Conducted the inspection |
| Jacqueline Hernandez | Administrator/Director | Named as facility administrator/director |
Inspection Report
Census: 36
Capacity: 45
Deficiencies: 0
Aug 29, 2024
Visit Reason
The visit was an unannounced case management inspection conducted by Licensing Program Analyst Maja Jensen to review resident records and assess changes in a resident's condition as part of a separate complaint investigation.
Findings
The review of resident records revealed that Resident 1 refused medications, toileting assistance, and grooming assistance on numerous occasions between May 4th and June 4th, indicating a change in condition that warrants a new medical assessment. Consultation was provided during the visit.
Complaint Details
The visit was related to a separate complaint investigation (complaint # 27-AS-20240607111426) involving Resident 1's refusal of medications and assistance.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maja Jensen | Licensing Program Analyst | Conducted the case management visit and reviewed resident records. |
| Jacqueline Hernandez | Executive Director | Met with the Licensing Program Analyst during the visit. |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Capacity: 45
Deficiencies: 3
Aug 19, 2024
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to allegations received on 2024-06-05 regarding staff neglect, failure to change dirty sheets, leaving a resident in dirty clothes, and not following the incontinence care plan.
Findings
The investigation substantiated that a resident was found with soiled bedding and clothing due to incontinence, and staff had difficulty following the incontinence care plan due to behavioral issues. Other allegations regarding malodorous rooms and improper cleaning were unsubstantiated based on interviews, inspections, and photographic evidence.
Complaint Details
The complaint investigation was substantiated based on evidence including interviews, photographs, and admissions by the Executive Director that a resident was found with soiled bedding and clothing due to incontinence. The facility staff had difficulty following the resident's incontinence care plan due to behavioral issues, which have since been addressed medically.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Personal Accommodations: Failure to provide clean linen including blankets, bedspreads, sheets, pillow cases, and mattress pads as evidenced by soiled bed sheets. | Type B |
| Basic services: Failure to provide personal assistance and care as needed, including dressing, as evidenced by resident wearing soiled clothing. | Type B |
| Managed Incontinence: Failure to ensure incontinent residents are kept clean and dry as evidenced by resident in soiled clothing and bedding. | Type B |
Report Facts
Capacity: 45
Deficiency count: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maja Jensen | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jacqueline Hernandez | Executive Director | Facility administrator who admitted to findings related to soiled bedding and clothing |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 37
Capacity: 45
Deficiencies: 0
Aug 6, 2024
Visit Reason
The inspection was an unannounced continuation of the annual inspection to evaluate compliance with licensing requirements and facility conditions.
Findings
The facility was found to be in substantial compliance with no deficiencies cited. The environment was safe, sanitary, and well maintained, with all staff and resident files complete and in compliance. Technical assistance was provided on various topics.
Report Facts
Staff files reviewed: 5
Resident files reviewed: 5
Fire extinguisher last serviced: 2024
Ansul system last serviced: 2024
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Hernandez | Executive Director | Met with Licensing Program Analyst during inspection |
| Maja Jensen | Licensing Program Analyst | Conducted the inspection and provided technical assistance |
| Lisa Rios | Licensing Program Manager | Named in report header and signature |
Inspection Report
Annual Inspection
Census: 37
Capacity: 45
Deficiencies: 0
Aug 5, 2024
Visit Reason
The inspection was an annual required unannounced visit to evaluate the facility's compliance.
Findings
The Licensing Program Analyst arrived to conduct the annual inspection and met with the administrative assistant. However, due to equipment issues, the visit was not completed and will be rescheduled.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Margarita Guizar | Administrative assistant | Met with Licensing Program Analyst during the inspection visit. |
Inspection Report
Annual Inspection
Census: 37
Capacity: 45
Deficiencies: 3
Aug 10, 2023
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing regulations and assess the facility's environment, resident accommodations, medication management, and overall operations.
Findings
The inspection found the facility generally clean and well-maintained with adequate resident activities and safety measures; however, deficiencies were cited related to storage of hazardous items accessible to residents, unsanitary kitchen conditions, and expired or unlabeled food items in the pantry and refrigerator.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Liquid hand soap and denture cleaning solution were accessible to residents in Memory Care areas, posing an immediate health and safety risk. | Type A |
| Crumbs, stains, and sticky surfaces were observed on appliances, shelves, cabinets, and floor in the facility kitchen, creating unsanitary conditions. | Type B |
| Uncovered, unlabeled, and/or expired food items including mayonnaise, salad dressing, baking soda, cocoa powder, and graham crackers were found in the pantry and refrigerator. | Type B |
Report Facts
Census: 37
Total Capacity: 45
Hot water temperature: 107.6
Fire extinguisher last inspection date: Apr 18, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Hernandez | Designated Facility Administrator | Met with Licensing Program Analyst during inspection and named in recertification and plan of correction |
| Kimberly Viarella | Licensing Program Analyst | Conducted the inspection and authored the report |
| Liza King | Licensing Program Manager | Supervisor of Licensing Program Analyst and named in report |
Inspection Report
Annual Inspection
Census: 33
Capacity: 45
Deficiencies: 0
Jul 21, 2022
Visit Reason
The inspection was an unannounced annual inspection conducted by the Licensing Program Analyst to evaluate the facility's compliance with regulations.
Findings
The facility was found to be in good condition with no deficiencies observed or cited. All safety equipment and protocols were verified as compliant, including fire extinguishers, smoke alarms, carbon monoxide detectors, and disaster drills. Staff vaccination and background clearance were confirmed.
Report Facts
Residents on hospice: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Hernandez | Administrator | Met during inspection and mentioned in certification expiration |
| Sarah Hurt | Licensing Program Analyst | Conducted the inspection visit |
| Stephenie Doub | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 33
Capacity: 45
Deficiencies: 1
Dec 30, 2021
Visit Reason
The visit was an unannounced follow-up to clear the Plan of Correction (POC) deficiencies cited during a prior visit on 02/01/2021.
Findings
The deficiencies initially cited on 02/01/2021 under section 87211(a)(2) have been cleared as of this visit on 12/30/2021.
Deficiencies (1)
| Description |
|---|
| Deficiency cited under section 87211(a)(2) cleared by this visit. |
Report Facts
Capacity: 45
Census: 33
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Named as Licensing Program Analyst involved in the visit |
| Stephenie Doub | Licensing Program Manager | Named as Licensing Program Manager overseeing the visit |
Inspection Report
Annual Inspection
Census: 36
Capacity: 45
Deficiencies: 0
Aug 9, 2021
Visit Reason
The inspection was an unannounced annual inspection visit conducted by Licensing Program Analyst Sarah Hurt to evaluate the facility's compliance with regulations.
Findings
The facility was found to be in good repair with clean bedrooms, adequate food supply, operational safety equipment, and no deficiencies observed or cited during the inspection.
Report Facts
Residents on hospice: 4
Water temperature: 107.7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Hernandez | Administrator | Met with Licensing Program Analyst during the inspection |
| Sarah Hurt | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Stephenie Doub | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 45
Deficiencies: 0
Jun 2, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-05-24 regarding inappropriate living accommodations and humiliation of a resident.
Findings
The investigation found no evidence supporting the allegations. The resident's living accommodations were appropriate, and the resident was treated with dignity and respect. Both allegations were deemed unfounded and the complaint was dismissed.
Complaint Details
The complaint included two allegations: 1) Facility has not provided appropriate living accommodations for resident, and 2) Resident is not free from humiliation. Both allegations were investigated and found to be unfounded.
Report Facts
Facility capacity: 45
Resident census: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Hurt | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Leticia Higares | Administrator | Facility administrator interviewed during investigation |
| Ruth Wallace | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Stephenie Doub | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 45
Deficiencies: 0
Apr 16, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations that the facility did not have planned activities for residents and did not hold Resident Council Meetings.
Findings
The investigation found that the facility did have planned activities following Community Care Licensing guidelines and COVID-19 Provider Information Notices, and did not hold Resident Council Meetings due to COVID-19 restrictions, both allegations were deemed unfounded.
Complaint Details
The complaint was investigated and found to be unfounded, meaning the allegations were false, could not have happened, or were without reasonable basis. The facility followed COVID-19 guidelines regarding activities and meetings.
Report Facts
Facility capacity: 45
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ruth Wallace | Licensing Program Analyst | Conducted the complaint investigation |
| Stephen Richardson | Licensing Program Manager | Named as Licensing Program Manager on report |
| Leticia Higares | Administrator | Facility Administrator mentioned in relation to investigation |
| Jacqueline Hernandez | Administrator Assistant | Met with Licensing Program Analyst via telephone during investigation |
Inspection Report
Census: 35
Capacity: 45
Deficiencies: 1
Feb 1, 2021
Visit Reason
The visit was a case management visit conducted via telephone due to COVID-19 precautionary measures, to conclude oversight related to positive COVID-19 staff cases and compliance with reporting requirements.
Findings
The facility failed to submit timely incident reports of positive COVID-19 staff cases to licensing, posing an immediate health and safety risk to residents. Two staff tested positive in mid-January 2021, but the department was not notified promptly and learned of the cases from Public Health.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The facility did not submit incident reports of positive Staff to licensing in a timely manner, posing an immediate health and safety risk to residents in care. | Type B |
Report Facts
Capacity: 45
Census: 35
Plan of Correction Due Date: Feb 15, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Leticia Higares | Administrator | Facility administrator involved in the exit interview and report receipt |
| Stephenie Doub | Licensing Program Manager | Supervisor overseeing the licensing evaluation |
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