Inspection Report Summary
Most inspections found no deficiencies, with several complaint investigations determined to be unsubstantiated. The most recent report from May 13, 2025, was a complaint investigation triggered by incidents involving two residents’ falls and discovery of unknown medications; no deficiencies were cited. Earlier reports showed some isolated deficiencies related to medication documentation, resident personal rights violations such as locked grooming items, and record-keeping errors, but none posed immediate jeopardy or resulted in fines or license actions. The facility has addressed concerns over time, with the latest inspections showing improvement in compliance and resident safety. Minor issues like documentation and resident rights were the main themes among deficiencies, while most complaints were found unsubstantiated or resolved.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 171
Capacity: 216
Deficiencies: 0
May 13, 2025
Visit Reason
The inspection was an unannounced Case Management - Incident visit triggered by a reported incident involving two residents who had unwitnessed falls and the discovery of unknown medications without valid prescriptions in their apartment.
Findings
The facility reported multiple falls for two residents since their admission, including a fall resulting in a closed fracture of the right hip. The facility found alcohol and unknown medications in the residents' room, communicated with police, and issued a 30-day eviction notice due to safety concerns. No deficiencies were cited during the visit.
Complaint Details
The visit was complaint-related due to an incident reported on April 25, 2025, involving unwitnessed falls of two residents and the presence of unknown medications without valid prescriptions. The facility has been in communication with the Foster City Police Department regarding the medications. The complaint was investigated and no deficiencies were cited.
Report Facts
Number of falls for resident #1: 6
Number of falls for resident #2: 6
Eviction notice timeframe: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met during inspection and provided information about residents and incident |
| Murial Han | Licensing Program Analyst | Conducted the unannounced inspection visit |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 144
Capacity: 216
Deficiencies: 2
Dec 10, 2024
Visit Reason
The inspection was an unannounced annual inspection conducted to evaluate compliance with licensing regulations and assess the facility's operations and safety.
Findings
The inspection found deficiencies related to the medication destruction process documentation lacking the administrator's signature and personal grooming items not being in residents' possession in the memory care unit. The facility was otherwise compliant with safety measures such as fire safety, medication security, and food provisions.
Deficiencies (2)
| Description |
|---|
| Facility was not able to provide documentation to prove that the administrator was one of the participants for the Medication Destruction Process. |
| Handsoap bottles for rooms 209B and 218B were not in residents' own possession as they were left unattended in shared bathrooms. |
Report Facts
POC Due Date: Dec 18, 2024
POC Due Date: Dec 11, 2024
Fire extinguisher last serviced: Nov 24, 2024
Hot water temperature range: 106-118
Facility floors: 6
Resident files reviewed: 5
Staff files reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the annual inspection and authored the report |
| Seema Chand | Community Business Director | Met with Licensing Program Analyst during inspection and discussed findings |
| Freddie Fullon | Administrator | Named in medication destruction process deficiency |
| April Cowan | Licensing Program Manager | Supervisor overseeing the inspection process |
Inspection Report
Follow-Up
Census: 169
Capacity: 216
Deficiencies: 0
Sep 12, 2024
Visit Reason
An unannounced Case Management visit was conducted to follow up on an incident reported by the facility involving a resident's concern about a caregiver's unprofessional behavior.
Findings
The facility investigated the incident, reported it to the Local Police Department and Ombudsman, and implemented new interventions to ensure the resident feels safe. During the visit, the resident stated that conditions have improved and caregivers are professional. No deficiencies were cited.
Complaint Details
The visit was triggered by a reported incident where a resident was afraid of a caregiver due to unprofessional behavior. The facility conducted an investigation and reported it to authorities. The resident confirmed improvement and safety measures in place.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and involved in addressing the incident. |
| Kari Jane | Assistant Administrator | Discussed the report with the Licensing Program Analyst. |
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
Inspection Report
Complaint Investigation
Census: 169
Capacity: 216
Deficiencies: 1
Sep 12, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2024-06-27 regarding staff not ensuring resident records contain correct information, charging residents for services not rendered, and failure to report incidents to appropriate parties.
Findings
The investigation substantiated that resident #1's date of birth was incorrect on the facesheet, posing a potential health risk. The allegations that staff charged a resident for services not rendered and failed to report an incident to appropriate parties were found to be unsubstantiated.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not ensure resident's records contained correct information. The allegations that staff charged resident for services not rendered and did not report an incident to appropriate parties were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Resident #1's date of birth is incorrect on the facesheet, which poses a potential health risk to residents in care. | Type B |
Report Facts
Capacity: 216
Census: 169
Deficiencies cited: 1
Plan of Correction Due Date: Sep 18, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Freddie Fullon | Administrator | Facility administrator met during the investigation and involved in findings |
| Kari Jane | Assistant Administrator | Reviewed the report findings |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 155
Capacity: 216
Deficiencies: 1
May 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not allow resident direct access to personal grooming and hygiene items, and that the licensee did not abide by the terms of the resident's admission agreement.
Findings
The investigation substantiated that the facility locked resident #1's grooming items such as toothpaste and toothbrush, which violated residents' personal rights to access their own possessions. Another complaint regarding inappropriate evaluation of resident service needs was unsubstantiated after review of care profiles and interviews. A privacy allegation was also unsubstantiated as the facility took corrective actions.
Complaint Details
The complaint investigation was substantiated for the allegation that staff locked resident #1's grooming and toileting items, violating the Admission Contract and residents' personal rights. The allegations that staff did not appropriately evaluate resident's service needs and did not ensure privacy were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility locked resident #1's toothbrush and toothpaste, posing a potential health risk and violating residents' personal rights to access their own possessions. | Type B |
Report Facts
Capacity: 216
Census: 155
Monthly rent increase: 1700
Plan of Correction due date: May 7, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and involved in findings discussion |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Cara Smith | Licensing Program Manager | Oversaw the complaint investigation process |
Inspection Report
Annual Inspection
Census: 146
Capacity: 216
Deficiencies: 0
Dec 26, 2023
Visit Reason
The visit was an annual unannounced inspection conducted by Licensing Program Analyst Murial Han to evaluate the facility's compliance with regulatory requirements.
Findings
The inspection found no deficiencies. The facility was toured, safety measures were verified, resident and staff records were reviewed and found complete, and all safety equipment and protocols were adequate.
Report Facts
Resident records reviewed: 5
Staff files reviewed: 5
Fire extinguisher last serviced: Aug 3, 2023
Perishable food supply: 2
Nonperishable food supply: 7
Hot water temperature range: 106-111
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during inspection and provided facility tour |
| Murial Han | Licensing Program Analyst | Conducted the annual inspection |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Deficiencies: 0
Dec 5, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility was not refunding a pre-admission fee.
Findings
The investigation found that the allegation was unfounded. The facility did not charge a pre-admission fee but referred to the payment as a New Resident Services Fee, which was credited and used to cover monthly rent according to the resident account summary and admission agreement.
Complaint Details
The complaint alleged that the facility was not refunding a $9,100 pre-admission fee paid to secure a room. The investigation determined the allegation to be unfounded as the fee was not charged and the payment was applied to monthly rent.
Report Facts
Pre-admission fee amount: 9100
Capacity: 216
Census: 148
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| John Calandra | Licensing Program Analyst | Conducted the complaint investigation |
| Seema Chand | Business Office Manager | Interviewed during investigation |
| Freddie Fullon | Administrator | Facility administrator named in report |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager overseeing investigation |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 216
Deficiencies: 0
Oct 6, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints received on 2023-04-25 regarding failure to provide comfortable temperature, facility disrepair, unsafe environment, and failure to issue a refund.
Findings
The investigation found the allegations of failure to provide comfortable temperature, facility disrepair, and unsafe environment to be unsubstantiated as the facility took steps to provide space heaters and repair heating units. The allegation of failure to issue a refund was found to be unfounded as a refund was confirmed to have been provided to the resident.
Complaint Details
The complaint investigation was unannounced and involved allegations that staff failed to provide comfortable temperature, the facility was in disrepair, staff failed to provide a safe and comfortable environment, and staff failed to issue a refund. The heating units were in disrepair from December 2022 to May 2023, but space heaters were provided and repairs were ongoing. Refund to Resident 1 was confirmed. The allegations were determined to be unsubstantiated or unfounded.
Report Facts
Facility capacity: 216
Census: 144
Complaint receipt date: Apr 25, 2023
Heating repair period: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and provided information about heating issues and refund |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Cara Smith | Licensing Program Manager | Reviewed the complaint investigation report |
Inspection Report
Census: 143
Capacity: 216
Deficiencies: 0
Sep 13, 2023
Visit Reason
The visit was a case management follow-up on an incident reported by the facility involving a resident who left the facility unassisted.
Findings
The investigation found that the resident exited the facility through the back elevator and returned within 15 minutes. The resident was not at risk for leaving unsupervised according to a recent physician's report. No deficiencies were cited during this visit.
Complaint Details
The visit was triggered by an incident report regarding resident #1 leaving the facility unassisted. The resident has dementia but was determined not to be at risk for unsupervised exit based on a physician's report dated May 10, 2023.
Report Facts
Capacity: 216
Census: 143
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and involved in verifying resident risk status |
| Murial Han | Licensing Program Analyst | Conducted the case management visit |
| Cara Smith | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 216
Deficiencies: 0
Aug 4, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-09-02 regarding multiple falls, failure to observe changes in a resident's condition, untimely medical attention, and prolonged bed rest of a resident.
Findings
The investigation found that although the resident had multiple falls, the facility sought timely medical attention and communicated with the resident's physician and responsible party. The allegation that staff left the resident in bed for long periods was unsubstantiated due to lack of evidence. Overall, the allegations were determined to be unsubstantiated.
Complaint Details
The complaint involved allegations that a resident had multiple falls, staff did not observe changes in the resident's condition, staff did not seek timely medical attention, and staff left the resident in bed for long periods. The investigation concluded these allegations were unsubstantiated.
Report Facts
Resident falls: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and provided information regarding allegations |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Cara Smith | Licensing Program Manager | Reviewed the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 216
Deficiencies: 1
Apr 4, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-11-09 regarding staff mismanagement of resident medication and failure to report an incident as required.
Findings
The investigation substantiated that on a day in June 2022, memory care residents did not receive medications in the morning due to med techs calling out with COVID symptoms. However, the allegation that staff did not report an incident was found to be unfounded. Staffing plans were in place and utilized during the COVID outbreak.
Complaint Details
The complaint alleging staff mismanaged resident medication was substantiated. The complaint alleging staff did not report an incident as required was unfounded.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to administer medications to memory care residents in the morning hours due to med techs calling out with COVID symptoms. | Type A |
Report Facts
Capacity: 216
Census: 145
Deficiencies cited: 1
Plan of Correction Due Date: Apr 5, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Freddie Fullon | Administrator | Facility administrator met with the investigator and was involved in the investigation |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Deficiencies: 0
Feb 17, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2022-11-16 concerning staff abandonment of a resident, failure to meet needs while COVID positive, not following admission agreement, unauthorized photographing of a resident, and sharing confidential information.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. The facility staff attempted to manage the resident's COVID isolation appropriately, followed admission agreement terms, and maintained confidentiality protocols. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint involved multiple allegations including staff abandonment of a resident during COVID isolation, failure to meet resident needs, breach of admission agreement, unauthorized photography, and sharing of confidential information. After review of documentation, interviews, and file examination, all allegations were found unsubstantiated.
Report Facts
Facility capacity: 216
Resident census: 148
Complaint receipt date: Nov 16, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director | Met during investigation and provided information regarding resident care and facility policies |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Census: 149
Capacity: 216
Deficiencies: 0
Feb 2, 2023
Visit Reason
The visit was conducted to deliver an immediate exclusion letter to exclude an employee of the facility.
Findings
An immediate exclusion letter was delivered and reviewed with the facility administrator. The report was discussed and a copy provided to the administrator.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and reviewed the exclusion letter. |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced visit and delivered the immediate exclusion letter. |
| Cara Smith | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 161
Capacity: 216
Deficiencies: 0
Dec 9, 2022
Visit Reason
The visit was an unannounced annual infection control inspection conducted to evaluate compliance with infection control practices and facility safety.
Findings
The facility was found to be clean, sanitary, and odorless with proper infection control practices observed, including entry procedures, daily monitoring logs, PPE supply, face coverings, containment strategies, staff training, and policies. No fire safety hazards or accessible bodies of water were observed, and chemicals and toxins were properly secured.
Report Facts
Laundry rooms: 5
Perishable food storage: 2
Non-perishable food storage: 7
Temperature range: 71
Temperature range: 74
PPE supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director | Met with Licensing Program Analyst and provided information during inspection |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Cara Smith | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 157
Capacity: 216
Deficiencies: 0
Nov 18, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility was providing inadequate food services to residents in care.
Findings
The investigation found that food is regularly provided to all residents, but one-on-one or hand-to-mouth feeding is not provided by staff in the memory care unit as outlined in the admission agreement. The allegation was determined to be unsubstantiated due to lack of evidence that the facility violated its policies.
Complaint Details
The complaint alleged inadequate food services to residents. The investigation included interviews with staff and review of policies. It was found that one-on-one feeding is not provided by the facility but must be arranged by the resident's responsible party. The allegation was unsubstantiated.
Report Facts
Facility capacity: 216
Resident census: 157
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Met with Licensing Program Analyst during investigation |
| Angel Bustos | Resident Services Director (RSD)/Nurse | Interviewed regarding food services and feeding in memory care unit |
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 160
Capacity: 216
Deficiencies: 0
Sep 28, 2022
Visit Reason
The visit was an unannounced case management follow-up on an incident reported on June 23, 2022, involving a resident who was absent without official leave (AWOL).
Findings
The facility attempted to ensure basic services were met for the resident who eloped, including assigning a private caregiver and notifying all required parties. No citations were issued at this time.
Complaint Details
The visit was triggered by a complaint regarding resident #1 being AWOL. The complaint was investigated and found that the facility took appropriate actions; no citations were issued.
Report Facts
Distance resident found from facility (miles): 3
Facility capacity: 216
Resident census: 160
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident. |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Jackie Jin | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Capacity: 216
Deficiencies: 0
Sep 27, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations of inadequate staffing resulting in lack of care for residents and mismanagement of residents' medications.
Findings
The investigation found staffing to be adequate and no evidence of medication mismanagement. There were no incident reports or staff reports supporting the allegations. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included inadequate staffing and medication mismanagement, but no evidence was found to prove or disprove these claims.
Report Facts
Facility capacity: 216
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation |
| Jackie Jin | Licensing Program Manager | Named as Licensing Program Manager in report |
| Freddie Fullon | Administrator | Facility administrator met during investigation |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 216
Deficiencies: 2
Mar 29, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including the facility refusing to accept a resident back after hospitalization and failure to communicate with the resident's authorized representative.
Findings
The investigation substantiated that the facility illegally evicted a resident by not performing a required reappraisal and eviction procedures after readmission with new health needs. It also substantiated failure to notify the resident's responsible party of hospitalization due to inaccurate contact information. Another allegation regarding a resident sustaining a fracture while in care was unsubstantiated due to lack of evidence and uncooperative staff.
Complaint Details
The complaint investigation was substantiated for allegations that the facility refused to accept a resident back after hospitalization without proper reappraisal and eviction procedures, and failed to notify the resident's authorized representative of the hospitalization. The allegation that the resident sustained a fracture while in care was unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to perform a reappraisal and issue a 30-day eviction notice after resident readmission with new health needs, violating eviction procedures. | Type A |
| Failure to maintain accurate resident contact information and notify the responsible party when the resident was transferred to the hospital. | Type B |
Report Facts
Facility capacity: 216
Census: 144
Deficiency count: 2
Plan of Correction Due Date: Apr 1, 2022
Plan of Correction Due Date: Apr 12, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Named in findings related to resident readmission and communication failures |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| Julio Montes | Licensing Program Manager | Oversaw the complaint investigation |
| Siobhan Surracao | Assistant Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 216
Deficiencies: 4
Mar 29, 2022
Visit Reason
An unannounced case management visit was conducted to follow-up on a complaint investigation regarding allegations of a resident sustaining a fracture while in care, the facility refusing to accept the resident back, and failure to report/provide information to the resident's family.
Findings
The investigation found that a caregiver failed to cooperate with the investigation, the administrator failed to provide requested camera footage, and the facility illegally evicted a resident without proper reappraisal. The facility also failed to update the resident's emergency card and ensure sufficient staff to meet resident needs, resulting in citations under multiple California Code of Regulations sections.
Complaint Details
Complaint #14-AS-20210913142555 involved allegations of a resident sustaining a fracture while in care, facility refusing to accept the resident back, and failure to report/provide information to the injured resident’s family. The complaint was substantiated with findings of illegal eviction, failure to cooperate with investigation, and failure to meet resident care requirements.
Severity Breakdown
Type B: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to ensure provisions for private interviews and examination of all records relating to the operation of the facility. | Type B |
| Failure to cooperate with investigation by caregiver and failure of administrator to provide requested camera footage. | Type B |
| Administrator failed to have qualifications and ability to conform to applicable laws, rules, and regulations. | Type B |
| Facility personnel insufficient in numbers and competence to meet resident needs, including failure to conduct reappraisal prior to readmitting resident with new health conditions. | Type B |
Report Facts
Plan of Correction Due Date: Apr 12, 2022
Complaint Number: 1413142555
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Named in relation to failure to provide camera footage and illegal eviction of resident |
| Murial Han | Licensing Program Analyst | Conducted the investigation and authored the report |
| Julio Montes | Licensing Program Manager | Supervisor overseeing the investigation |
| Siobhan Surracao | Assistant Administrator | Met with Licensing Program Analyst during visit |
Inspection Report
Plan of Correction
Census: 144
Capacity: 216
Deficiencies: 1
Mar 29, 2022
Visit Reason
An unannounced plan of correction (POC) visit was conducted to verify and confirm that the facility complied with a citation issued on 2022-03-08 regarding failure to provide medical records to the responsible party as requested.
Findings
The facility failed to submit proof that the plan of correction was completed and did not provide the requested medical records to the responsible party, resulting in reissuance of the citation and assessment of civil penalties.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The facility failed to provide R1's medical records as requested by the responsible party promptly and appropriately, posing potential health and safety risks to the resident in care. | Type B |
Report Facts
Civil penalty amount: 600
Civil penalty daily rate: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Administrator | Assisted with the inspection visit |
| Murial Han | Licensing Program Analyst | Conducted the unannounced plan of correction visit |
| Julio Montes | Licensing Program Manager | Supervisor overseeing the inspection |
| Siobhan Surracao | Assistant Administrator | Met with Licensing Program Analyst at the start of the visit |
Inspection Report
Complaint Investigation
Census: 146
Capacity: 216
Deficiencies: 1
Mar 8, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2021-12-22 regarding the facility's failure to provide documentation related to injuries to the responsible party and an allegation of questionable death due to physical abuse.
Findings
The investigation substantiated that the facility failed to provide requested medical records and documentation promptly and appropriately, violating residents' personal rights. However, the allegation of questionable death caused by physical abuse was found to be unfounded based on medical records and death certificate review.
Complaint Details
Complaint investigation was substantiated regarding failure to provide documentation related to injuries to the responsible party. The allegation of questionable death due to physical abuse was found to be unfounded.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to provide resident #1's medical records as requested by the responsible party promptly and appropriately, posing potential health and safety risks. | Type B |
Report Facts
Capacity: 216
Census: 146
Deficiency count: 1
Plan of Correction Due Date: Mar 22, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Julio Montes | Licensing Program Manager | Oversaw the complaint investigation |
| Freddie Fullon | Administrator | Facility administrator met during the investigation and discussed findings |
Inspection Report
Annual Inspection
Census: 148
Capacity: 216
Deficiencies: 0
Dec 7, 2021
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate compliance with licensing requirements and infection control practices.
Findings
The inspection found that COVID-19 signage was posted, infection control practices were reviewed, and most residents and all staff were observed wearing masks. The facility maintained appropriate storage of medications and toxins, sufficient food supplies, and adequate safety measures such as non-skid mats and first aid kits. Some recommendations were made to post hand-washing signs in shared bathrooms.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced annual inspection and authored the report. |
| Siobhan Surraco | Assistant Executive Director | Met with the Licensing Program Analyst during the inspection. |
| Seema Chand | Community Business Director | Joined the inspection shortly after it began and provided information about vaccination status. |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 216
Deficiencies: 1
Nov 22, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that the facility was not meeting a resident's dietary needs and that staff were not providing supervision per doctor's orders.
Findings
The allegation regarding unmet dietary needs was unsubstantiated due to lack of sufficient evidence. However, the allegation that staff failed to provide supervision during meals as ordered by the resident's Nurse Practitioner was substantiated, resulting in a deficiency citation.
Complaint Details
The complaint investigation was triggered by allegations received on 10/19/2021. One allegation regarding dietary needs was unsubstantiated. The other allegation regarding lack of supervision per doctor's orders was substantiated. Deficiencies were cited under California Code of Regulations, Title 22, Section 87611(e).
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to carry out Resident #1's Nurse Practitioner's order to provide supervision during meals due to a recent change in health condition, posing potential health and safety risks. | Type B |
Report Facts
Deficiencies cited: 1
Plan of Correction due date: Dec 6, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Julio Montes | Licensing Program Manager | Oversaw the complaint investigation |
| Angel Bustos | Resident Service Director | Facility staff member met during investigation and involved in findings |
| Freddie Fullon | Administrator | Facility administrator who was informed of findings |
Inspection Report
Complaint Investigation
Census: 130
Capacity: 216
Deficiencies: 0
Mar 30, 2021
Visit Reason
The inspection was conducted as an unannounced case management tele-inspection in response to a self-reported Unusual Incident Report dated March 26, 2021.
Findings
The Licensing Program Analyst interviewed the facility administrator and requested several documents related to the incident, including a staff written statement, employee handbook, resident's physician report, and police report. The resident involved was also asked to contact the analyst for confirmation.
Complaint Details
The visit was triggered by a self-reported unusual incident. No substantiation status or findings of deficiencies were stated in the report.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Garcia | Licensing Program Analyst | Conducted the unannounced case management tele-inspection. |
| Freddie Fullon | Executive Director/Administrator | Interviewed during the inspection and responsible for providing requested documents. |
| Brenda Chan | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 216
Deficiencies: 1
Mar 4, 2021
Visit Reason
An unannounced complaint investigation was conducted in response to allegations including lack of supervision resulting in a resident breaking their hip and multiple unexplained falls with injury while in care.
Findings
The investigation found the allegations of lack of supervision and multiple unexplained falls unsubstantiated due to sufficient staffing and lack of evidence. However, a separate allegation that tables in the facility posed a tripping hazard was substantiated based on evidence including surveillance video and staff interviews.
Complaint Details
The complaint investigation was unannounced and initiated based on allegations received on 09/20/2019. The allegations included lack of supervision resulting in a resident breaking their hip and multiple unexplained falls with injury. These were found unsubstantiated. A separate allegation regarding tripping hazards from tables was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| R1 was not accorded safe, healthful and comfortable furnishings and equipment. R1 unassisted by walker, tripped over a coffee table, which poses a potential Health, Safety or Personal Rights risk to residents in care. | Type B |
Report Facts
Capacity: 216
Census: 90
Plan of Correction Due Date: Mar 15, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bertha Raygoza | Licensing Program Analyst | Conducted the complaint investigation |
| Freddie Fullon | Administrator | Met with Licensing Program Analyst during investigation and was involved in findings review |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 115
Capacity: 216
Deficiencies: 0
Jan 20, 2021
Visit Reason
The visit was a Case Management tele-visit conducted to provide Technical Assistance to the facility regarding COVID-19.
Findings
There were no active COVID-19 cases at the time of the visit. A staff member, private duty aide, and a resident had tested positive earlier in the month but all cases were resolved. The facility had contacted the local public health department for mass testing and was conducting contact tracing.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Garcia | Licensing Program Analyst | Conducted the Case Management tele-visit and provided Technical Assistance. |
| Freddie Fullon | Executive Director/Administrator | Facility administrator who participated in the tele-visit and provided information about COVID-19 cases. |
| Paul Portem | Program Clinical Consultant, MSN, RN | Assisted in the tele-visit providing clinical consultation. |
Inspection Report
Census: 141
Capacity: 216
Deficiencies: 0
Nov 24, 2020
Visit Reason
An announced case management continuation visit was conducted remotely to provide Technical Assistance to the facility regarding COVID-19 protocols and safety measures.
Findings
The facility's COVID-19 protocol and screening area were reviewed, and staff were interviewed and observed demonstrating proper hand washing technique. Two staff members had tested positive for COVID-19, and mass testing was conducted for all staff and residents with results pending. Recommendations were made to improve screening area placement and staff mask handling.
Report Facts
Staff tested positive for COVID-19: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Met with Licensing Program Analyst during the visit and provided information about COVID-19 status |
| Brenda Chan | Licensing Program Manager | Participated in the Technical Assistance visit |
| Veronica Nazareth | Nurse | Department of Public Health nurse involved in the visit |
| Michael Garcia | Licensing Program Analyst | Conducted the announced case management continuation visit |
Inspection Report
Census: 141
Capacity: 216
Deficiencies: 0
Nov 20, 2020
Visit Reason
An announced case management visit was conducted remotely via video call to provide Technical Assistance regarding COVID-19 infection control, mitigation, and staffing plan.
Findings
The facility currently has two staff members who tested positive for COVID-19 and are isolating at home. The facility is coordinating with the Department of Public Health for mass testing scheduled on November 24 and 25, has conducted contact tracing and surveillance testing with negative results, and plans to continue weekly surveillance testing of 25% of staff after two rounds of negative tests.
Report Facts
COVID-19 positive staff: 2
Scheduled mass testing dates: Mass testing scheduled for November 24 and November 25, 2020
Surveillance testing frequency: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Freddie Fullon | Executive Director/Administrator | Participated in the case management visit and discussed COVID-19 plans |
| Michael Garcia | Licensing Program Analyst | Conducted the case management visit |
| Brenda Chan | Licensing Program Manager | Conducted the case management visit |
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