Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jul 7, 2025
Visit Reason
The inspection was an unannounced annual inspection visit conducted to evaluate compliance with licensing requirements and ensure the safety and well-being of residents.
Findings
The facility was found to be in compliance with licensing requirements, with a clean and safe environment, current resident and staff files, and no citations issued. Some updated forms were requested to be submitted by 07/14/2025.
Report Facts
Resident files reviewed: 4
Staff files reviewed: 3
Staff present: 2
Residents on hospice: 1
Water temperature: 110
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Noralee Reyes | Administrator | Met with Licensing Program Analyst during inspection |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection |
| April Cowan | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 7
Capacity: 7
Deficiencies: 0
Apr 16, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that unqualified staff were administering medications to residents in care.
Findings
The investigation included interviews and document reviews. It was found that staff were trained by hospice to administer medications such as morphine, and the allegation could not be substantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that unqualified staff were administering medications to residents. The allegation was unsubstantiated after investigation.
Report Facts
Capacity: 7
Census: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Ante Buljan | Administrator | Met with Licensing Program Analyst during investigation |
| Nediljka Buljan | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Apr 16, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that unqualified staff were administering medications to residents in care.
Findings
The investigation found that staff were trained by hospice to administer medications such as morphine, and the specific allegation that a resident was given morphine was unsubstantiated. Overall, the allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that unqualified staff were administering medications to residents. The investigation concluded the allegations were unsubstantiated.
Report Facts
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Ante Buljan | Administrator | Met with Licensing Program Analyst during investigation |
| Nediljka Buljan | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 7
Capacity: 7
Deficiencies: 0
Oct 4, 2024
Visit Reason
An unannounced required 1-year inspection visit was conducted to evaluate compliance with licensing regulations and ensure resident safety and facility standards.
Findings
The facility was found to be clean, well-maintained, and in compliance with regulatory requirements. No citations were issued. Resident rooms, bathrooms, medications, and staff files were all current and in good order. Several updated forms were requested to be submitted by 10/11/2024.
Report Facts
Residents in care: 7
Licensed capacity: 7
Hospice residents: 3
Staff present: 4
Water temperature: 107
Administrator certificate expiration: Jan 10, 2025
Forms submission deadline: Oct 11, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ante Buljan | Administrator/Licensee | Met with Licensing Program Analyst during inspection and reviewed report |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit and authored the report |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Jul 3, 2024
Visit Reason
An unannounced annual inspection was conducted to evaluate the facility's compliance with regulatory requirements and ensure resident safety and well-being.
Findings
The facility was found to be clean, safe, and well-maintained with no citations issued. Resident and staff files were current, medications were properly stored and current, and safety equipment such as fire extinguishers and detectors were in place and inspected. Some updated forms were requested to be submitted by 07/10/2024.
Report Facts
Staff present: 2
Resident files reviewed: 2
Staff files reviewed: 2
Water temperature: 107
Fire extinguisher inspection date: Jun 28, 2023
Emergency drill date: Apr 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and authored the report |
| Noralee Reyes | Administrator | Facility administrator met with Licensing Program Analyst during inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jul 25, 2022
Visit Reason
The inspection was a required unannounced 1-year visit to evaluate the facility's compliance with regulations.
Findings
No deficiencies were observed in compliance with the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8. Infection control practices, medication storage, safety features, and staff clearances were all found to be adequate.
Report Facts
Residents present: 6
Staff present: 2
Capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ante Buljan | Administrator | Certified RCFE administrator overseeing facility operations |
| Noralee Reyes | Certified RCFE administrator | Met with licensing analyst and oversees facility operations |
| Audrey Jeung | Licensing Program Analyst | Conducted the facility tour and inspection |
| Julio Montes | Licensing Program Manager | Named in report header |
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