Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Apr 8, 2025
Visit Reason
The inspection was an unannounced required annual visit conducted by the Licensing Program Analyst to evaluate compliance with licensing requirements.
Findings
The facility was found to be generally in good condition with no obstructed exits, working smoke and carbon monoxide detectors, and proper storage of hazardous materials. However, deficiencies included the lack of emergency food and water supply, insufficient details in the disaster drill documentation, and the need for an updated floor plan with utility shut-off locations.
Deficiencies (4)
| Description |
|---|
| No supply of emergency food and water observed. |
| Disaster drill documentation lacks sufficient information; more details requested in Emergency and Disaster Plan. |
| Updated floor plan with location of utility shut-offs not provided; requested by Licensing. |
| Staff area with washer and dryer requires better cleaning and maintenance to avoid lint build-up. |
Report Facts
Capacity: 6
Census: 6
Fire and Emergency Drill Date: Mar 2, 2025
Fire Extinguisher Service Date: Feb 7, 2025
Temperature Setting: 73
Hot Water Temperature: 115
Form Submission Deadline: Apr 18, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Administrator/Director | Responded to assist with the inspection visit |
| Daiquiri Boyd | Licensing Program Analyst | Conducted the inspection visit |
| Ann Lorio | Staff member who assisted during the inspection | |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Mar 27, 2025
Visit Reason
The Licensing Program Analyst conducted an unannounced required annual visit to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean, well-maintained, and in compliance with safety standards including proper food storage, medication security, and functioning smoke and carbon monoxide detectors. No residents were on Hospice or Home Health, and staff had CPR/First Aid training. Updated forms were requested to update the facility file.
Report Facts
Facility capacity: 6
Resident census: 6
Hot water temperature: 109
Fire extinguisher service date: Feb 7, 2025
Last fire drill date: Mar 2, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daiquiri Boyd | Licensing Program Analyst | Conducted the inspection visit |
| Johanna Lorio | Caregiver/Assistant | Assisted with the inspection visit |
| Phillip Gonzales | Owner | Offered assistance with the inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Apr 27, 2024
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with licensing regulations.
Findings
The facility was found to be generally clean, safe, and well-maintained with proper food storage, functioning safety equipment, and adequate staff training. However, a deficiency was cited for incomplete staff training related to dementia care and other required topics.
Deficiencies (1)
| Description |
|---|
| Licensee did not have complete training for staff, which poses/posed a potential health, safety or personal rights risk to persons in care. |
Report Facts
Plan of Correction Due Date: May 24, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Administrator | Met with Licensing Program Analyst during inspection and assisted with the visit |
| Shawna Doucette | Licensing Program Analyst | Conducted the inspection and signed the report |
| Sergiy Pidgirny | Licensing Program Manager | Named as supervisor and licensing program manager |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Apr 15, 2024
Visit Reason
The visit was an unannounced required annual inspection conducted by the Licensing Program Analyst to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean, well-maintained, and in compliance with safety and health standards. Resident rooms, kitchen, and outdoor areas were inspected and found satisfactory. Safety equipment such as smoke and carbon monoxide detectors and fire extinguishers were operational and up to date.
Report Facts
Facility capacity: 6
Resident census: 5
Hot water temperature: 115.4
Fire extinguisher service date: Feb 5, 2024
Last fire drill date: Feb 2, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Licensee/Administrator | Responded to the facility to assist with the visit |
| Ann Lorio | Staff | Met with Licensing Program Analyst and participated in exit interview |
| Shawna Doucette | Licensing Program Analyst | Conducted the inspection visit |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Dec 14, 2023
Visit Reason
The visit was an unannounced required annual inspection conducted by the Licensing Program Analyst to evaluate the facility's compliance with licensing regulations.
Findings
The facility was found to be in good condition with clean and well-maintained resident rooms, proper food storage, functioning safety equipment, and no deficiencies cited during the inspection.
Report Facts
Fire extinguisher service date: Feb 6, 2023
Emergency disaster drill date: Dec 10, 2023
Hot water temperature: 118.6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Licensee/Administrator | Granted entry and approved staff to complete the annual visit |
| Constancia Dampitan | Staff | Completed the annual visit and received a copy of the report |
| Miriam Flores | Licensing Program Analyst | Conducted the unannounced required annual visit |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Nov 28, 2023
Visit Reason
The visit was an unannounced required annual inspection conducted by the Licensing Program Analyst to evaluate compliance with licensing regulations.
Findings
The facility was generally found to be clean, safe, and well-maintained with proper food storage, functioning smoke and carbon monoxide detectors, and up-to-date fire extinguisher service and drills. However, a deficiency was cited regarding non-compliance with postural support bed rail requirements for six residents, posing potential health and safety risks.
Deficiencies (1)
| Description |
|---|
| A bed rail that extends from the head half the length of the bed and used only for assistance with mobility was not compliant in 6 residents, posing potential health, safety, or personal rights risks. |
Report Facts
Residents affected: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Licensee / Administrator | Present during the annual inspection and named in the deficiency plan of correction |
| Miriam Flores | Licensing Program Analyst | Conducted the inspection and signed the report |
| Sergiy Pidgirny | Licensing Program Manager | Named as supervisor in the report |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Aug 25, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2022-08-19 alleging that staff do not have required training.
Findings
The Licensing Program Analyst observed that 5 of 7 staff files reviewed did not have the required training, substantiating the allegation. A health and safety check was completed on residents, and residents were observed visiting family outside and in common areas.
Complaint Details
The complaint alleging staff do not have required training was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 5 of 7 staff files reviewed did not have the required training, posing a potential health and safety/personal rights risk to residents in care. | Type B |
Report Facts
Staff files lacking required training: 5
Total staff files reviewed: 7
Facility census: 6
Facility capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Garza | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Marilen Gonzales | Administrator | Facility administrator present during the investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 2
Aug 10, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 2021-11-01 regarding staff training and unsafe positioning of a resident in a wheelchair.
Findings
The investigation substantiated the allegations that staff were not properly trained and a resident was left in an unsafe wheelchair position. Four of four staff files were incomplete, and a photo showed a resident's wheelchair leaning back with front wheels in the air, posing a health and safety risk.
Complaint Details
Complaint was substantiated based on record reviews and observations. Allegations included staff not properly trained and unsafe positioning of a resident in a wheelchair.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Incomplete training records for 4 of 4 personnel files, posing a potential health and safety or personal rights risk to residents. | Type B |
| Failure to provide on-the-job training or related experience to staff, evidenced by unsafe positioning of resident in wheelchair. | Type B |
Report Facts
Capacity: 6
Census: 6
Deficiencies cited: 2
Plan of Correction Due Date: Aug 19, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Garza | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Marilen Gonzales | Administrator | Facility administrator met during investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Aug 10, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations including resident developing a pressure injury, staff yelling at resident, and failure to assist resident with transfers and toileting needs.
Findings
Investigation found that the resident had pressure injuries prior to admission and staff did not yell at residents. Staff assisted residents appropriately and all care needs were met. All allegations were unsubstantiated and no deficiencies were cited.
Complaint Details
Complaint was unsubstantiated. Allegations included resident developing a pressure injury while in care, staff yelling at resident, staff not assisting with transfers, and staff not assisting with toileting needs. Investigation included interviews and record reviews confirming allegations were unsubstantiated.
Report Facts
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Garza | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Marilen Gonzales | Administrator | Facility administrator met with Licensing Program Analyst during investigation |
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 1
Aug 10, 2022
Visit Reason
The visit was a case management follow-up to a previous visit made on 11/04/2021, to complete a health and safety check on residents in care.
Findings
The Licensing Program Analyst observed the facility front door secured with a pin at the bottom, posing an immediate health and safety or personal rights risk to residents. A deficiency was cited related to fire safety regulations. During the previous visit, residents were observed unsupervised while staff were smoking outside, which posed a potential risk, but no duplicate citation was issued during this visit.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Front door secured with a pin at the bottom, posing an immediate health and safety or personal rights risk to residents in care. | Type A |
Report Facts
Capacity: 6
Census: 6
Plan of Correction Due Date: Aug 11, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Garza | Licensing Program Analyst | Conducted the inspection and cited deficiency |
| Marilen Gonzales | Administrator | Facility administrator present during inspection |
Inspection Report
Routine
Census: 6
Capacity: 6
Deficiencies: 0
Apr 25, 2022
Visit Reason
The inspection was an unannounced required infection control inspection conducted as part of the 1-year routine visit.
Findings
The infection control practices were found to be in compliance based on observations, documentation review, and interviews with the administrator and staff. The facility had appropriate signage, symptom screening, PPE plans, and hand hygiene supplies, though a 30-day supply of PPE was not observed on site but was available at a different location.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Administrator | Administrator interviewed and involved in infection control inspection. |
| Mary Garza | Licensing Program Analyst | Conducted the infection control inspection. |
| Johanna Lorio | Direct Care Staff | Greeted Licensing Program Analyst and participated in COVID pre-screening. |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Mar 28, 2022
Visit Reason
The visit was an unannounced required 1-year infection control inspection conducted to assess compliance with COVID-19 infection control procedures.
Findings
The Licensing Program Analyst observed compliance with required infection control practices including symptom screening, PPE usage, hand hygiene, and visitation protocols. No deficiencies were noted related to infection control.
Report Facts
Residents with 30-day supply of medications: 2
Facility capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Administrator | Administrator contacted and interviewed during inspection |
| Mary Garza | Licensing Program Analyst | Conducted the infection control inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Jun 21, 2021
Visit Reason
The visit was an unannounced required 1-year infection control inspection conducted to evaluate compliance with infection control practices and other regulatory requirements.
Findings
The facility was found not in compliance with required infection control practices, resulting in a technical advisory and citation. Multiple deficiencies were identified including un-fingerprinted staff working in the facility, residents' door locks taped preventing access, a resident's room lacking a bed, and disabled auditory alarms on exit doors posing safety risks.
Severity Breakdown
Type A: 2
Type B: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Staff was observed working in the facility without fingerprint clearance or association to the facility, posing an immediate health, safety, or personal rights risk. | Type A |
| Residents' door locks were taped preventing residents from accessing them, posing an immediate health, safety, or personal rights risk. | Type A |
| Resident's room lacked a bed and only had a couch, posing a potential health, safety, or personal rights risk. | Type B |
| Front entry door, back sliding door, and garage door entry had auditory alarms turned off, posing a potential health, safety, or personal rights risk. | Type B |
Report Facts
Civil penalty: 100
Capacity: 6
Census: 6
Plan of Correction Due Date: Jun 22, 2021
Plan of Correction Due Date: Jun 28, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilen Gonzales | Administrator | Interviewed during inspection and involved in plans of correction. |
| Mary Garza | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the inspection. |
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