Inspection Report Summary
The facility’s most recent inspection on July 16, 2025, found no deficiencies, continuing a pattern of clean reports from the past year. Earlier complaint investigations revealed some substantiated issues, primarily involving failure to notify responsible parties about residents’ condition changes and inconsistent assistance with basic care tasks like dressing and toileting. A serious medication administration error in October 2023 led to a medical emergency and was addressed by staff termination, but no fines or enforcement actions were noted beyond that event. The facility also faced a major incident in early 2023 where improper storage of hazardous materials caused serious injury and deaths, resulting in multiple citations, staff exclusions, and a civil penalty. Since then, the facility has shown improvement with no recent deficiencies, and most complaint investigations have been unsubstantiated.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
4.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
20% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
52% occupied
Based on a July 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Census: 91
Capacity: 175
Deficiencies: 0
Jul 16, 2025
Visit Reason
The visit was an unannounced case management - legal/non-compliance inspection conducted in response to a Stipulation/Waiver/Order dated 11/29/2023.
Findings
The Licensing Program Analyst observed appropriate signage in food areas, proper posting of the stipulation, maintenance of cleaning and hazardous materials policies, and documentation of resident acknowledgements and staff training. No deficiencies were cited during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management - legal/non-compliance visit and observed compliance. |
| Thomas Kirk Brooks | Administrator | Met with Licensing Program Analyst and acknowledged conditions of Stipulation. |
Inspection Report
Annual Inspection
Census: 91
Capacity: 175
Deficiencies: 0
Jun 18, 2025
Visit Reason
An unannounced annual inspection visit was conducted to evaluate the facility's compliance with licensing requirements.
Findings
The inspection found the facility to be in good condition with no deficiencies cited. Resident rooms, common areas, and safety equipment were all observed to be well maintained, and records for residents and staff were complete and up to date.
Report Facts
Resident records reviewed: 6
Staff records reviewed: 6
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thomas Kirk Brooks | Administrator | Met with Licensing Program Analyst during inspection |
| Grace Donato | Licensing Program Analyst | Conducted the inspection visit |
| April Cowan | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 0
Apr 11, 2025
Visit Reason
The visit was an unannounced case management - incident investigation conducted due to a report of a possible physical injury that occurred on 2025-04-09 involving resident R1 and staff S1.
Findings
The Licensing Program Analyst collected pertinent documents and information regarding the incident involving R1 and S1. The report was reviewed with the Life Guidance Director Lavendar Halafau, and a copy was provided during the visit.
Complaint Details
The complaint involved a possible physical injury to resident R1 during servicing by staff S1 on 2025-04-09. The investigation was conducted on 2025-04-11.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavendar Halafau | Life Guidance Director | Met with Licensing Program Analyst during the incident investigation visit. |
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management - incident investigation visit. |
| Thomas Kirk Brooks | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Census: 78
Capacity: 175
Deficiencies: 0
Mar 28, 2025
Visit Reason
Unannounced case management - legal/non-compliance visit conducted in response to and as per Stipulation/Waiver/Order dated 11/29/2023.
Findings
The visit confirmed documentation of administrator training on hazardous materials handling, emergency planning, staffing levels, and communication with emergency services. Documentation was also provided for staff training on responding to resident ingestion of hazardous materials and written acknowledgements from residents regarding receipt of stipulation and amended accusation. No deficiencies were cited.
Report Facts
Administrator training hours: 40
Staff trained: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Paula Spanek | Resident Services Director | Met during inspection and acknowledged conditions of Stipulation. |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit. |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager. |
| Thomas Kirk Brooks | Administrator/Director | Facility administrator mentioned in relation to training documentation. |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 175
Deficiencies: 0
Mar 28, 2025
Visit Reason
An unannounced complaint investigation visit was conducted regarding allegations of unlawful eviction, failure to conduct resident reassessment, failure to provide services as per admission agreement, and medication error.
Findings
The investigation found that the eviction notice was valid and complied with licensing requirements, reassessments were conducted appropriately, the admission agreement contained necessary information and conditions, and medications were administered as prescribed. The complaint was determined to be unfounded and dismissed.
Complaint Details
The complaint alleged unlawful eviction, failure to conduct reassessment of resident, failure to provide services in admission agreement, and medication error. The complaint was found to be unfounded and dismissed.
Report Facts
Capacity: 175
Census: 78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Paula Spanek | Resident Services Director | Met with Licensing Program Analyst during investigation |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager |
| Thomas Kirk Brooks | Administrator | Facility Administrator |
Inspection Report
Census: 72
Capacity: 175
Deficiencies: 0
Dec 20, 2024
Visit Reason
An unannounced case management - legal/non-compliance visit was conducted in response to and as per Stipulation/Waiver/Order dated 11/29/2023.
Findings
The Licensing Program Analyst observed secure storage and proper labeling of cleaning compounds and poisons, appropriate signage regarding food and beverage containers, adequate staffing in the memory care unit, and posting of the Stipulation/Waiver/Order. No deficiencies were cited.
Report Facts
Staffing: 5
Staffing: 1
Residents: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
| Angie Serraon | Activities Director | Met with Licensing Program Analyst during inspection |
| Thomas Kirk Brooks | Administrator | Facility administrator mentioned as not present during visit |
| Lavander Halafu | Life Guidance Director | Provided staffing ratios in memory care unit |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 175
Deficiencies: 1
Oct 18, 2024
Visit Reason
This was an unannounced complaint investigation visit triggered by a complaint received on 10/26/2023 regarding staff not answering the facility phone.
Findings
The allegation that staff did not answer the facility phone on 10/12/2023 from 11:30 pm for 2-3 hours was substantiated based on witness information and evidence of unanswered calls. The facility failed to ensure telephone communications were responded to promptly, posing a potential health, safety, or personal rights risk to clients.
Complaint Details
The complaint was substantiated. The allegation was that staff did not answer the facility phone starting at 11:30 pm on 10/12/2023 for 2-3 hours. Evidence of unanswered calls was provided and reported to resident services director. Overnight staff were questioned but it is unknown if the overnight nurse was interviewed.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Residents in all residential care facilities for the elderly shall have all of the personal right to have communications to the licensee from their representatives answered promptly and appropriately. This requirement was not met, as the client's relative was not able to reach facility by phone on 10/12/23, which posed a potential health, safety or personal rights risk to clients in care. Licensee failed to ensure that telephone communications were responded to promptly. | Type B |
Report Facts
Capacity: 175
Census: 78
Plan of Correction Due Date: Oct 25, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager |
| Jennifer Duenas | Administrator | Facility administrator named in report |
| Kirk Brooks | Met with during investigation |
Inspection Report
Census: 76
Capacity: 175
Deficiencies: 0
Sep 17, 2024
Visit Reason
The visit was a Case Management - Legal/Non-compliance inspection conducted in response to a Stipulation/Waiver/Order dated 11/29/2023.
Findings
The administrator received documented training on hazardous materials handling, emergency planning, staffing levels, and communication with emergency services. Staff training on responding to residents ingesting hazardous materials was documented for quarters 1 and 2. Written acknowledgements from residents regarding receipt of the Stipulation and amended accusation were maintained. No deficiencies were cited.
Report Facts
Administrator training hours: 40
Staff trained: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thomas Kirk Brooks | Administrator/Director | Acknowledged conditions of Stipulation and additional staff training and reporting requirements |
| Audrey Jeung | Licensing Program Analyst | Observed and documented findings during the inspection |
| April Cowan | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 175
Deficiencies: 0
Sep 17, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not meet residents' hygiene and medical needs.
Findings
Based on review of facility records and interviews with staff and witnesses, the allegations were determined to be unsubstantiated due to insufficient evidence. Although staff failed to apply prescribed antibacterial ointment on several days, it could not be definitively proven that this contributed to infection.
Complaint Details
The complaint alleged that staff did not meet residents' hygiene and medical needs. The investigation found these allegations unsubstantiated as there was not enough evidence to prove the alleged violations occurred.
Report Facts
Days ointment not applied: 14
Days ointment not applied: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| April Cowan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 75
Capacity: 175
Deficiencies: 0
Jun 19, 2024
Visit Reason
The inspection was a required unannounced 1-year annual inspection to evaluate compliance with RCFE California Code of Regulations, Title 22, Division 6, Chapter 8.
Findings
No deficiencies were observed during the inspection. The facility is operating in substantial compliance. Some updated forms and information were requested to be submitted by 07/03/2024.
Report Facts
Units in facility: 135
Memory care unit rooms: 30
Additional units on ground floor: 15
Units on 2nd floor: 45
Units on 3rd floor: 45
Hot water temperature: 105
Inspection start time: 945
Inspection end time: 1900
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kirk Brooks | Certified RCFE Administrator | Oversees facility operations |
| Audrey Jeung | Licensing Program Analyst | Conducted facility tour and inspection |
| April Cowan | Licensing Program Manager | Named as licensing program manager on report |
Inspection Report
Census: 75
Capacity: 175
Deficiencies: 0
Jun 19, 2024
Visit Reason
The visit was conducted as a Case Management - Legal/Non-compliance inspection in response to a Stipulation/Waiver/Order dated 11/29/2023.
Findings
The inspection found appropriate signage in food areas, posting of the Stipulation on the bulletin board, maintenance of cleaning and hazardous materials policies, written acknowledgements from residents regarding the Stipulation, and signed hazardous communication forms by staff. No deficiencies were cited.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kirk Brooks | Met with during the inspection and acknowledged conditions of the Stipulation. | |
| Nelson Rodrigues | Administrator/Director | Named as facility administrator/director. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager. |
| Audrey Jeung | Licensing Program Analyst | Conducted the inspection and signed the report. |
Inspection Report
Capacity: 175
Deficiencies: 0
Jan 26, 2024
Visit Reason
A collaborative virtual meeting was conducted by the San Bruno and Oakland CCLD Adult & Senior Care Regional Offices and CCLD Counsel with representatives of Atria Park of San Mateo and Atria Walnut Creek to review the Stipulation Agreements dated 11/29/2023 and discuss their status and implementation.
Findings
The meeting involved discussion of stipulations and their implementation status, with questions and clarifications addressed. No specific deficiencies or violations were detailed in the report.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Wiggins | Counsel, CCLD | Discussed stipulations and their status implementation during the meeting. |
| Cara Smith | Licensing Program Manager, CCLD, San Bruno ASC | Participant in the meeting and named as Licensing Program Manager. |
| Audrey Jeung | Licensing Program Analyst, CCLD, San Bruno ASC | Participant in the meeting and named as Licensing Program Analyst. |
| Kris Waluszko | Regional Vice President, Atria Senior Living | Participant in the meeting and facility administrator. |
| Kirk Brooks | National Operations Specialist, Atria Senior Living | Participant in the meeting. |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 0
Dec 5, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to allegations of staff neglect resulting in physical assault and injury to a resident, failure to prevent altercations, failure to observe mental status changes, and failure to report incidents to the licensing authority.
Findings
Investigation included review of video surveillance and interviews; staff intervened appropriately during the incident, assessments and service plans were completed, and the incident was reported to the licensing authority. The allegations were determined to be unfounded with no reasonable basis.
Complaint Details
Allegations included staff neglect causing physical assault and fracture, failure to prevent resident altercations, failure to observe mental status changes, and failure to report incidents to Community Care Licensing. The investigation found these allegations to be unfounded.
Report Facts
Complaint Control Number: 14
Investigation duration (hours and minutes): 1.75
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator / Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kirk Brooks | Met with during the investigation | |
| Jennifer Duenas | Administrator | Facility administrator named in the report |
| Cara Smith | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 0
Dec 4, 2023
Visit Reason
The visit was conducted in response to a Suspected Abuse Report submitted by the facility regarding client #1.
Findings
The licensing program analyst met with a national operations specialist who provided additional details of the incident observed on surveillance video. Additional information is to be obtained and no deficiency was cited.
Complaint Details
Visit was complaint-related due to a Suspected Abuse Report. No deficiency was cited and further information is pending.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Met with national operations specialist regarding the suspected abuse incident. |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Jennifer Duenas | Administrator | Facility administrator named in the report. |
Inspection Report
Census: 82
Capacity: 175
Deficiencies: 0
Dec 4, 2023
Visit Reason
The visit was conducted as a Case Management - Legal/Non-compliance inspection in response to a Stipulation/Waiver/Order dated 11/29/2023.
Findings
The inspection found secure storage and proper labeling of cleaning compounds and poisons, appropriate signage regarding food and beverage containers, and adequate staffing in the memory care unit. No deficiencies were cited.
Report Facts
Staffing: 4
Residents: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kirk Brooks | Met with during inspection and acknowledged conditions of Stipulation | |
| Jennifer Duenas | Administrator | Facility administrator named in report header |
| Cara Smith | Licensing Program Manager | Named in report |
| Audrey Jeung | Licensing Program Analyst | Conducted observations during inspection |
Inspection Report
Complaint Investigation
Capacity: 175
Deficiencies: 2
Oct 31, 2023
Visit Reason
The inspection was conducted as a complaint investigation regarding client #1, who was admitted on 2023-08-19, to evaluate alleged deficiencies in medication administration and resident care.
Findings
The investigation found that staff failed to provide medications to the resident for 24 hours, including insulin, resulting in a medical emergency and intensive care hospitalization. Additionally, the facility LVN did not respond appropriately to the resident's condition when vomiting was observed, posing an immediate health and safety risk.
Complaint Details
Complaint investigation was concluded and a report was delivered to the facility on 2023-10-10. The complaint involved failure to administer medications and inadequate response to resident's medical condition.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff did not provide medications to client #1 on 8/19/23 and 8/20/23, resulting in medical emergency and intensive care hospitalization. | Type A |
| Facility LVN did not respond appropriately when client was vomiting, posing an immediate health, safety or personal rights risk. | Type A |
Report Facts
Civil penalty: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Audrey Jeung | Licensing Program Analyst | Named as Licensing Program Analyst conducting the investigation. |
| Jennifer Duenas | Administrator | Facility administrator named in the report header. |
| Kris Waluszko | Met with during the inspection visit. |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 175
Deficiencies: 0
Oct 10, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints received on 2023-08-22 regarding inadequate food service, unmet showering needs, lack of prescription orders for medications, and improper resident assessments prior to admissions.
Findings
The investigation determined the allegations to be unsubstantiated or unfounded. Reviews of staff schedules, interviews, and documentation showed no sufficient evidence of violations. One incident of medication oversight causing a medical emergency was reported, and involved staff were terminated.
Complaint Details
The complaint investigation was unannounced and conducted by Evaluator Audrey Jeung. Allegations included inadequate food service, unmet showering needs, lack of prescription orders for medications, and improper assessments prior to admissions. The findings were unsubstantiated or unfounded. A medication administration error on 8/20/23 led to a medical emergency, reported to licensing, and resulted in termination of two staff members.
Report Facts
Capacity: 175
Census: 79
Assisted living residents assisted with bathing/showering: 39
Residents scheduled for morning showers: 26
Residents scheduled for afternoon/evening showers: 13
Medication frequency: 4
Date complaint received: Aug 22, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator | Conducted the complaint investigation |
| Jennifer Duenas | Administrator | Facility administrator named in report |
| Cara Smith | Licensing Program Manager | Named in report as licensing program manager |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 175
Deficiencies: 0
Oct 10, 2023
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2023-01-24 regarding allegations of inadequate resident care, physical abuse, and unwarranted charges at Atria Park of San Mateo.
Findings
The investigation found the allegations to be unsubstantiated or unfounded due to insufficient evidence. Staff were found to have provided hygiene, diapering, and hydration assistance, and no evidence of physical abuse or improper charges was found.
Complaint Details
The complaint included allegations that staff did not meet residents' hygiene, diapering, and hydration needs, failed to respond to requests for assistance, were inadequately trained, and that residents sustained unexplained injuries/bruising. Additional allegations included physical abuse and charging residents for services not provided. The investigation determined these allegations to be unsubstantiated or unfounded due to lack of evidence and unavailable witnesses.
Report Facts
Capacity: 175
Census: 79
Number of staff training records reviewed: 20
Inspection Report
Complaint Investigation
Census: 83
Capacity: 175
Deficiencies: 0
Sep 20, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-12-16 regarding staff supervision of a resident.
Findings
The allegation that staff did not properly supervise a resident was determined to be unsubstantiated based on review of facility and client records and staff interviews. Staffing was found appropriate for the memory care unit residents during the incident.
Complaint Details
The complaint alleged improper supervision of a resident. The investigation found insufficient evidence to prove the alleged violation occurred. The incident involved two memory care residents, with hourly status checks documented and no distress observed.
Report Facts
Capacity: 175
Census: 83
Memory care residents: 21
Caregivers: 2
Hourly status checks: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator | Conducted the complaint investigation |
| Jennifer Duenas | Administrator | Facility administrator mentioned in report header |
| Cara Smith | Licensing Program Manager | Named in report signature section |
Inspection Report
Complaint Investigation
Census: 81
Capacity: 175
Deficiencies: 0
Sep 6, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff does not ensure residents are transported to scheduled appointments in a timely manner.
Findings
The allegation was determined to be unsubstantiated based on review of client records, transportation schedules, and interviews with staff and clients. The facility employs a driver who transports residents on scheduled days, and no evidence was found that residents missed appointments due to untimely transportation.
Complaint Details
The complaint alleged that staff did not ensure timely transportation of residents to scheduled appointments. The investigation found no sufficient evidence to substantiate the allegation.
Report Facts
Capacity: 175
Census: 81
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with during investigation |
| Shanel Thitphaneth | Met with during investigation | |
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 81
Capacity: 175
Deficiencies: 0
Aug 31, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation of insufficient staffing to meet residents' needs received on 12/15/2022.
Findings
Based on review of staff schedules, surveillance video, and interviews, the allegation of insufficient staffing was determined to be unsubstantiated due to lack of sufficient evidence to prove the violation occurred.
Complaint Details
The complaint alleged insufficient staffing on the night of 12/7/22, claiming only one staff was working. Investigation found 4 staff assigned to assisted living and 2 to memory care overnight. Staff responded to resident calls multiple times with varying response times. Resident could not recall calls or 9-1-1 on that date. The allegation was unsubstantiated.
Report Facts
Capacity: 175
Census: 81
Staff assigned overnight: 6
Resident calls: 5
Response times (minutes): Array
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with during investigation |
| Shanel Thitp | Met with during investigation | |
| Audrey Jeung | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 81
Capacity: 175
Deficiencies: 1
Aug 31, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff failed to provide basic care services and other related complaints.
Findings
The investigation substantiated that staff failed to provide consistent dressing, undressing, and toileting assistance to a hospice resident, resulting in a deficiency citation. Other allegations related to failure to observe/report a coccyx sore, timely emergency response, and medication provision were found unsubstantiated.
Complaint Details
The complaint investigation was substantiated for failure to provide basic care services including dressing and toileting assistance. Other allegations about failure to observe/report coccyx sore, emergency call response, and medication provision were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff failed to provide consistent dressing, undressing and toileting assistance to client #1, failing to ensure appropriate level of care needed. | Type B |
Report Facts
Capacity: 175
Census: 81
Deficiencies cited: 1
Plan of Correction Due Date: Sep 14, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator / Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Cara Smith | Licensing Program Manager | Named in relation to licensing program management and report |
| Jennifer Duenas | Administrator | Facility administrator met during investigation |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 175
Deficiencies: 1
Aug 15, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that staff did not notify resident's responsible party of a change in condition and neglect resulting in a resident sustaining an unstageable pressure injury.
Findings
The investigation substantiated that staff failed to notify the resident's responsible party of a change in condition related to an unstageable heel wound, posing an immediate health and safety risk. However, the allegation of licensee neglect causing the pressure injury was unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was substantiated regarding failure to notify the responsible party of a resident's condition change. The allegation of neglect causing the pressure injury was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to notify resident's responsible party (POA) when hospice LVN observed unstageable wound, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 175
Census: 80
Plan of Correction Due Date: Aug 25, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with during investigation and named in report |
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 175
Deficiencies: 5
Apr 14, 2023
Visit Reason
The visit was conducted to follow up on a substantiated complaint alleging failure to observe residents’ personal rights, resulting in the death of two residents and serious bodily injuries to a third.
Findings
The investigation found that staff mistakenly served dishwashing detergent to residents, causing serious burns and resulting in the deaths of two residents and serious injury to a third. Multiple regulatory violations were cited related to personal rights, storage of hazardous materials, personnel competency, and administrator responsibilities. A civil penalty was assessed.
Complaint Details
The complaint was substantiated. It involved failure to observe residents’ personal rights leading to death of two residents and serious bodily injury to a third due to ingestion of dishwashing detergent mistakenly served by staff.
Deficiencies (5)
| Description |
|---|
| Violation of residents’ personal rights due to staff providing chemicals to residents causing serious injury and death. |
| Improper storage of disinfectants, cleaning solutions, and poisons accessible to clients. |
| Detergents and cleaning compounds not stored separately from food supplies. |
| Insufficient and/or incompetent personnel to meet resident needs. |
| Administrator failed to administer the facility in accordance with regulations and policies. |
Report Facts
Civil penalty amount: 39500
Civil penalty amount: 500
Facility capacity: 175
Resident census: 79
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mark Pagaduan | Engage Life Director | Met with Licensing Program Analysts during the inspection and received the report. |
| Jennifer Duenas | Administrator | Facility administrator absent during inspection; cited for failure to administer facility according to regulations. |
Inspection Report
Census: 79
Capacity: 175
Deficiencies: 0
Mar 21, 2023
Visit Reason
The visit was a Case Management - Other type of unannounced inspection to confirm receipt and acknowledgment of the Department's accusations for license revocation, administrator de-certification, and staff exclusions.
Findings
No deficiencies were cited during the visit. The licensing analyst confirmed that written notice of the accusations was given to residents, responsible parties, and the local Ombudsman program.
Report Facts
Staff exclusions: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Named in relation to license revocation and administrator de-certification |
| Shanel Thitphaneth | Resident Services Director | Met with licensing analyst to confirm receipt of accusations |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Audrey Jeung | Licensing Program Analyst | Conducted the visit and signed the report |
Inspection Report
Complaint Investigation
Capacity: 175
Deficiencies: 0
Feb 3, 2023
Visit Reason
An unannounced Case Management visit was conducted to deliver an amended report related to complaint number 14-AS-20220829165142, correcting immediate exclusion orders issued for residents S1, S2, S3, and S5.
Findings
The Licensing Program Analyst reviewed and discussed the amended report with the Resident Service Director, providing a copy of the report during the visit and electronically afterward.
Complaint Details
The visit was in reference to complaint number 14-AS-20220829165142 and involved correction of immediate exclusion orders for specific residents.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Murial Han | Licensing Program Analyst | Conducted the unannounced Case Management visit and reviewed the amended report. |
| Shanel Thitphaneth | Resident Service Director | Met with Licensing Program Analyst during the visit and received the amended report. |
| Jennifer Duenas | Administrator | Named as facility administrator. |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 175
Deficiencies: 5
Feb 2, 2023
Visit Reason
An unannounced complaint investigation visit was conducted due to a complaint received on 08/29/2022 alleging that three residents ingested poison while in care resulting in serious injury and/or death.
Findings
The investigation found that facility staff negligently left a pitcher of dishwashing detergent accessible to residents, which was served to three residents causing serious burns and resulting in the deaths of two residents. Immediate exclusion orders were issued for four staff members involved, and civil penalties were assessed.
Complaint Details
The complaint was substantiated. Three residents ingested dishwashing detergent resulting in serious bodily injuries and deaths of two residents. The investigation included interviews, review of records, video footage, medical and police reports. Immediate exclusion orders were issued for staff S1, S2, S3, and S5. A civil penalty of $500 was assessed immediately, with additional penalties pending review.
Severity Breakdown
Type A: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Facility staff left a pitcher of dishwashing detergent/chemicals on the kitchen counter unattended, unlocked and readily accessible in kitchen areas. | Type A |
| Facility failed to provide residents a safe environment, free from health and safety hazards when residents ingested chemicals causing serious injury. | Type A |
| Soaps, detergents, cleaning compounds or similar substances were not stored separately from food supplies, left unattended and accessible in food service area. | Type A |
| Facility personnel were not sufficient in numbers or competent to provide necessary services, as staff involved did not perform duties competently. | Type A |
| Facility administrator did not administer the facility according to regulations, resulting in serious violations. | Type A |
Report Facts
Capacity: 175
Census: 85
Immediate civil penalty: 500
Additional civil penalties: 10000
Additional civil penalties: 15000
Plan of Correction Due Date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with Licensing Program Analysts during investigation and discussed findings |
| Komal Charitra | Licensing Program Analyst | Conducted complaint investigation and signed report |
| Murial Han | Licensing Program Analyst | Conducted complaint investigation and signed report |
| Cara Smith | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 175
Deficiencies: 0
Jan 26, 2023
Visit Reason
Unannounced complaint investigation visit conducted in response to allegations received on 09/07/2022 regarding staff failing to observe and report changes in resident condition, failure to obtain medical intervention, and staff conduct issues.
Findings
The investigation found that the facility staff documented and reported changes in the resident's condition appropriately and communicated with the physician as required. Interviews with staff, residents, and responsible parties indicated no substantiated evidence of disrespectful or rough handling by staff. Therefore, all allegations were unsubstantiated.
Complaint Details
The complaint involved multiple allegations including failure to observe and report changes in resident condition, failure to obtain medical intervention, and staff being disrespectful and rough with clients. The investigation concluded these allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 175
Census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Executive Director | Met with Licensing Program Analyst during investigation |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 86
Capacity: 175
Deficiencies: 0
Jan 23, 2023
Visit Reason
The visit was a case management inspection to evaluate the facility's compliance with regulations related to client rights and safety, including inspection of door locking mechanisms and access to personal toiletries.
Findings
The licensing program analyst met with facility staff and inspected the locking mechanisms of doors in the Life Guidance unit. It was confirmed that clients have the right to access personal toiletries unless restricted by a physician's written order. No deficiencies were cited during this case management visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the inspection and met with facility staff. |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 175
Deficiencies: 1
Dec 14, 2022
Visit Reason
The inspection visit was conducted as a complaint investigation to evaluate deficiencies related to regulatory compliance.
Findings
During the complaint investigation, a deficiency was observed regarding the failure to maintain criminal record clearance for a former staff member, which posed an immediate health, safety, and personal rights risk.
Complaint Details
The visit was complaint-related, and the deficiency observed was substantiated as a failure to maintain required criminal record clearance for a staff member.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure criminal record clearance and association to the facility for former director of culinary services, Staff #4, employed from 12/29/21 until 11/21/22. | Type A |
Report Facts
Census: 87
Total Capacity: 175
Plan of Correction Due Date: Dec 15, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Facility administrator mentioned in report header |
| Cara Smith | Licensing Program Manager | Named as supervisor and licensing program manager |
| Audrey Jeung | Licensing Program Analyst | Licensing evaluator who observed the deficiency |
Inspection Report
Annual Inspection
Census: 87
Capacity: 175
Deficiencies: 1
Dec 14, 2022
Visit Reason
An unannounced annual required 1-year inspection focused on COVID infection control and general compliance was conducted.
Findings
The inspection found that infection control practices were generally followed, PPE supplies were adequate, and fire safety equipment was properly maintained. However, one staff member (S1) did not have a current criminal record clearance, which poses an immediate risk. A civil penalty of $300 was assessed.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with criminal record clearance requirements for one staff member (S1), whose clearance was pending and not approved as of the inspection date. | Type A |
Report Facts
Civil penalty amount: 300
Staff persons reviewed: 5
Water temperature: 108
Water temperature: 110
Staff work days: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and documented findings |
| Cara Smith | Licensing Program Manager | Supervisor overseeing the inspection |
| Kris Waluszko | Regional Vice President | Facility representative met during inspection |
| Jennifer Duenas | Administrator | Facility administrator mentioned in report |
Inspection Report
Census: 82
Capacity: 175
Deficiencies: 0
Dec 1, 2022
Visit Reason
The visit was a case management follow-up to deliver Facility Evaluation Reports and Complaint Investigation Reports that could not be delivered earlier due to technical difficulties.
Findings
No deficiencies were cited during this visit. An Order of Immediate Exclusion for staff #1 was given to the administrator pertaining to an incident on 11/15/22.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Received Order of Immediate Exclusion for staff #1 related to incident on 11/15/22. |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 0
Nov 30, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 07/27/2022 regarding a questionable death at the facility.
Findings
The investigation included interviews and record reviews related to a client who was hospitalized and later expired. The allegation of questionable death was determined to be unsubstantiated due to insufficient evidence to prove the alleged violation did or did not occur.
Complaint Details
The complaint involved an allegation of a questionable death. The investigation found no evidence of staff observing injuries or falls, and the death was ruled accidental by the Coroner's Report. The allegation was unsubstantiated.
Report Facts
Complaint received date: Jul 27, 2022
Investigation visit date: Nov 30, 2022
Facility census: 82
Facility capacity: 175
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Jennifer Duenas | Administrator | Met with investigator during complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 175
Deficiencies: 0
Nov 30, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 07/01/2021 alleging that staff did not groom a resident.
Findings
The investigation found that Monthly Assignment Reports documenting completion of grooming and other care tasks for the resident were not available for review. The allegation was determined to be unsubstantiated due to insufficient evidence to prove the violation occurred.
Complaint Details
The complaint was unsubstantiated based on information obtained from staff and facility records. Although the allegation may have occurred or be valid, there was not enough evidence to prove the alleged violation did or did not occur.
Report Facts
Facility capacity: 175
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| David Perryman | Administrator | Facility administrator named in report header |
| Jennifer Duenas | Met with during investigation | |
| Cara Smith | Licensing Program Manager | Named in report signature section |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 0
Nov 30, 2022
Visit Reason
This was an unannounced complaint investigation visit triggered by allegations received on 09/23/2022 regarding inappropriate staff behavior and misuse of resident funds.
Findings
The investigation included interviews with staff and review of staff files. The allegations were determined to be unfounded, meaning they could not have happened or lacked a reasonable basis.
Complaint Details
Allegations included staff having an inappropriate relationship with a resident and staff using resident funds to acquire property. The complaint was investigated and found to be unfounded.
Report Facts
Capacity: 175
Census: 82
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with during investigation |
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 175
Deficiencies: 1
Nov 30, 2022
Visit Reason
The visit was conducted in response to multiple incident reports dated 11/15/22, 11/18/22, 11/22/22, and 10/27/22 involving clients and staff at the facility.
Findings
A deficiency was cited related to failure to ensure that a caregiver (Staff #2) had the required criminal record clearance prior to working at the facility, posing an immediate health, safety, or personal rights risk to clients.
Complaint Details
The visit was complaint-related, triggered by incident reports involving multiple clients and staff. The deficiency cited was based on an incident report dated 10/27/22.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure Staff #2 had criminal record clearance prior to working as a caregiver for 5 days, violating Health and Safety Code Section 1569.17(b). | Type B |
Report Facts
Census: 82
Total Capacity: 175
Days worked without clearance: 5
Plan of Correction Due Date: Due date was 12/02/2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Met with Licensing Program Analyst during the visit |
| Audrey Jeung | Licensing Program Analyst | Conducted the investigation and participated in law enforcement interview |
| Cara Smith | Licensing Evaluator | Named as Licensing Evaluator and Program Manager on the report |
| Vivien Helbling | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 175
Deficiencies: 1
Oct 24, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-07-01 regarding allegations of inadequate resident care and facility conditions.
Findings
The investigation substantiated that staff failed to provide adequate bathing assistance to a resident as specified in the care plan. Other allegations including resident injury, bathroom cleanliness, laundry service, bed linen provision, and safeguarding of personal belongings were determined to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint included allegations that staff did not bathe the resident, resident sustained injury while in care, bathroom was not maintained clean and sanitary, staff did not provide basic laundry service or clean bed linen, and staff did not safeguard resident's personal belongings. The bathing allegation was substantiated; other allegations were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide personal assistance and care as needed, specifically staff did not assist client #1 with showers twice per week as required by the care plan. | Type B |
Report Facts
Capacity: 175
Census: 92
Number of showers missed: 5
Plan of Correction Due Date: Nov 7, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Perryman | Administrator | Facility administrator named in report header |
| Jennifer Duenas | Person met with during investigation | |
| Audrey Jeung | Licensing Program Analyst / Evaluator | Investigator who conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Manager overseeing the licensing program |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 175
Deficiencies: 0
Sep 15, 2022
Visit Reason
Unannounced complaint investigation visit conducted in response to allegations that a resident sustained multiple pressure injuries while in care and that staff did not ensure a resident was eating accordingly.
Findings
The investigation determined the allegations to be unsubstantiated after reviewing facility and medical records and interviewing staff and medical providers. The resident had pre-existing conditions and received appropriate care including wound treatment and dietary adjustments, but developed pressure ulcers and weight loss due to health conditions. There was insufficient evidence to prove the alleged violations occurred.
Complaint Details
The complaint was unsubstantiated based on investigation findings. The allegations involved pressure injuries and inadequate nutritional care, but evidence did not support violations.
Report Facts
Capacity: 175
Census: 94
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator | Conducted the complaint investigation |
| Jackie Jin | Licensing Program Manager | Named in report signature section |
| Cecilia Dauth | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 175
Deficiencies: 1
Sep 15, 2022
Visit Reason
The inspection was an unannounced complaint investigation triggered by a complaint received on 2022-08-05 regarding facility staff not following Covid-19 safety protocols.
Findings
The investigation substantiated the allegation that PPE including N95 respirators, gowns, gloves, and donning and doffing instructions were not properly maintained in isolation carts outside client apartments with COVID-positive residents, posing an immediate health, safety, and personal rights risk to clients.
Complaint Details
The complaint was substantiated based on investigation and observations made on 2022-08-12. The preponderance of evidence standard was met.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| COVID isolation rooms were not properly equipped with full PPE including donning and doffing instructions maintained outside of rooms for use by caregivers. | Type A |
Report Facts
Capacity: 175
Census: 94
Plan of Correction Due Date: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Jackie Jin | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Census: 101
Capacity: 175
Deficiencies: 0
Aug 31, 2022
Visit Reason
An unannounced Health and Welfare Check inspection was conducted to assess the facility's compliance with health and safety standards.
Findings
The Licensing Program Analyst and Investigator toured the facility and grounds, observed the kitchens, and found no citations were issued during this visit.
Report Facts
Residents in Assisted Living: 72
Residents in Life Guidance: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Executive Director | Met with Licensing Program Analyst and Investigator during the inspection |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Victoria McIntosh | Investigator | Conducted the inspection |
| Kris Waluszko | Regional Vice President | Met with Licensing Program Analyst and Investigator during the inspection |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 175
Deficiencies: 0
Jul 29, 2022
Visit Reason
The visit was conducted in response to an incident report of client elopement on 2022-06-07, involving a case management incident investigation.
Findings
An internal investigation was conducted by the resident services director, and retraining was provided to the receptionist on duty at the time of the incident. The Licensing Program Analyst requested copies of training records and written procedures for the front desk receptionist. No deficiencies were issued during this visit.
Complaint Details
The visit was triggered by a complaint related to a client elopement incident on 2022-06-07. The complaint was investigated, and no deficiencies were found or issued.
Report Facts
Capacity: 175
Census: 92
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Duenas | Administrator | Facility administrator named in the report header |
| Shanel Thitphaneth | Met with Licensing Program Analyst during the visit and provided information about the updated list of residents unable to leave unassisted | |
| Audrey Jeung | Licensing Program Analyst | Conducted the review of client file and investigation |
| Jackie Jin | Licensing Program Manager | Named in the report |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 175
Deficiencies: 0
Aug 19, 2021
Visit Reason
The visit was conducted in response to an incident report dated 08/14/2021 regarding the elopement of a resident. The licensing program analyst met with facility staff to obtain additional details and review procedures related to the incident.
Findings
The analyst reviewed the resident's file, observed the rooms involved, and assessed staff responsibilities related to the alarm response. The facility plans to implement new processes to prevent recurrence and submit an addendum to the incident report within five business days.
Complaint Details
Visit was triggered by an incident report of resident elopement dated 08/14/2021. No substantiation status explicitly stated.
Report Facts
Residents in memory care unit: 32
Caregivers present: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Conducted the investigation and met with facility staff |
Inspection Report
Census: 90
Capacity: 175
Deficiencies: 1
Aug 19, 2021
Visit Reason
The visit was a Case Management - Other type of unannounced inspection to evaluate facility compliance, including COVID-19 related requirements.
Findings
The facility lacked adequate COVID reminder signs for wearing face coverings and maintaining social distance, despite having an informational COVID sign in the entry foyer. It was strongly advised that the facility post individual reminder signs for face coverings, social distancing, and covering nose and mouth when coughing or sneezing.
Deficiencies (1)
| Description |
|---|
| No COVID reminder signs to wear face coverings and maintain social distance were posted, which was previously discussed during the annual inspection. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Licensing Program Analyst | Observed the lack of COVID reminder signs during the facility walk through. |
| Julio Montes | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 87
Capacity: 175
Deficiencies: 1
Jul 9, 2021
Visit Reason
The inspection was a required unannounced 1-year visit to evaluate compliance with regulations for the facility.
Findings
The facility was toured and infection control practices, safety, and environmental conditions were reviewed. A deficiency was cited related to criminal record clearances for two staff members who have client contact but whose clearances were not associated with the facility.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Two staff present during the visit have client contact and criminal record clearances are not associated with the facility, posing an immediate health, safety, or personal rights risk to persons in care. | Type A |
Report Facts
Census: 87
Total Capacity: 175
Plan of Correction Due Date: Jul 9, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| I.P. | Maintenance Director | Named in deficiency for lack of criminal record clearance transfer |
| K.E. | Agency LVN | Named in deficiency for lack of criminal record clearance transfer |
| David Perryman | Administrator | Facility administrator |
| Cecilia Dauth | Certified RCFE Administrator | Oversees facility operations |
| Audrey Jeung | Licensing Program Analyst | Conducted inspection and signed report |
| Julio Montes | Licensing Program Manager | Supervisor overseeing inspection |
Inspection Report
Complaint Investigation
Capacity: 175
Deficiencies: 0
Mar 29, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 12/14/2020 regarding staffing sufficiency, staff qualifications, resident assessment after falling, and treatment of residents with dignity and respect.
Findings
The investigation found that the facility had sufficient staff and qualified personnel as required by regulations. There was insufficient evidence to substantiate allegations related to improper resident assessment after a fall and failure to treat residents with dignity and respect. Overall, the allegations were unsubstantiated.
Complaint Details
The complaint included allegations that the facility lacked sufficient staff, staff were not qualified, a staff member did not properly assess a resident after falling, and a staff member did not treat a resident with dignity and respect. The investigation concluded all allegations were unsubstantiated due to lack of evidence or regulatory requirements not being violated.
Report Facts
Facility capacity: 175
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Perryman | Administrator | Named as facility administrator during investigation |
| Murial Han | Licensing Program Analyst | Conducted the complaint investigation |
| Brenda Chan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Capacity: 175
Deficiencies: 1
Mar 23, 2021
Visit Reason
The visit was an unannounced case management virtual visit conducted during the investigation of complaint 14-AS-20200520143002 regarding a resident who developed a stage 3 pressure wound, a prohibited health condition.
Findings
The licensee failed to request an exception to retain the resident and failed to provide a higher level of care despite communication from the home health nurse about the resident's worsening condition. The licensee did not ensure proper care by failing to follow wound care instructions and the Administrator did not fulfill qualifications and duties during the period of 04/18/20 through 04/24/20.
Complaint Details
Investigation of complaint 14-AS-20200520143002 found preponderance of evidence that the licensee failed to ensure proper care of the resident with a stage 3 pressure wound and failed to act on worsening condition communicated by the home health nurse.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The licensee failed to request an exception to retain the resident and failed to provide higher level of care. The home health nurse communicated the worsening of the resident's condition, but the licensee failed to act appropriately. Licensee failed to ensure proper care of R1's needs by failing to follow PCHH instructions on wound care. | Type A |
Report Facts
Facility capacity: 175
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cecilia Dauth | Administrator | Met during the visit and discussed report findings |
| David Perryman | Administrator | Named as facility administrator in report header |
| Bertha Raygoza | Licensing Program Analyst | Conducted the unannounced case management virtual visit |
| Brenda Chan | Licensing Program Manager | Supervisor named in report |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 175
Deficiencies: 1
Mar 23, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that a resident sustained a stage 4 pressure injury while in care.
Findings
The investigation found that the facility failed to provide necessary higher level care and 1:1 attention to a resident whose wound progressed from Stage 2 to Stage 4, resulting in serious injury. The allegation was substantiated based on medical records, staff and medical interviews.
Complaint Details
The complaint was substantiated. The allegation that a resident sustained a stage 4 pressure injury while in care was found valid based on the preponderance of evidence.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Personnel Requirements - Facility personnel were not sufficient in numbers or competent to meet resident needs, specifically failing to disclose and address resident wounds during 4/06/20 through 4/23/20. | Type A |
Report Facts
Civil penalty immediate assessment: 500
Civil penalty pending review: 10000
Census: 92
Total capacity: 175
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bertha Raygoza | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager. |
| Cecilia Dauth | Administrator | Met with Licensing Program Analyst during investigation and discussed report findings. |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 175
Deficiencies: 0
Mar 22, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2020-12-07 regarding the facility's compliance with the admission agreement.
Findings
The investigation found that the admission agreement for Resident 1 was tentative pending physician report and medical records, which revealed that Resident 1 required a higher level of care than the facility could provide. No payment was made for Resident 1's admission. The allegation was deemed unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that the facility did not comply with the admission agreement. The allegation was unsubstantiated after investigation.
Report Facts
Facility capacity: 175
Census: 92
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bertha Raygoza | Licensing Program Analyst | Conducted the complaint investigation visit |
| David Perryman | Administrator | Facility administrator discussed the report |
| Cecilia Dauth | Administrator | Met with Licensing Program Analyst during the visit and discussed the report |
| April Bennett | Staff In Charge | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 175
Deficiencies: 0
Mar 15, 2021
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff were not meeting residents' medical needs and not transporting residents to appointments.
Findings
The investigation found documentation and staff interviews supporting that medical appointments were attended and transportation was provided as alleged. Therefore, the allegations were deemed unsubstantiated.
Complaint Details
The complaint was unsubstantiated based on review of medical records, appointment schedules, transportation logs, and staff interviews indicating residents attended medical appointments and were transported as required.
Report Facts
Capacity: 175
Census: 92
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bertha Raygoza | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cecilia Dauth | Administrator | Met with Licensing Program Analyst during investigation |
Loading inspection reports...
