Inspection Report Summary
Most inspections over the past two years found no deficiencies, and several complaint investigations were unsubstantiated. The facility’s most recent report from July 1, 2025, cited one deficiency for improperly storing hazardous items, which posed an immediate health and safety risk. Earlier reports included some substantiated complaints related to resident care issues such as failure to follow doctor’s orders, improper handling causing injury, and inadequate hospice notifications, with one enforcement action involving a $500 fine in 2021. There was also a substantiated illegal eviction and some failures in reporting incidents and COVID-19 notifications, but these issues appear isolated rather than ongoing. Recent inspections show improvement with fewer deficiencies and no citations in the last several complaint investigations.
Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 176
Capacity: 225
Deficiencies: 1
Jul 1, 2025
Visit Reason
The inspection was a required annual inspection conducted to evaluate compliance with licensing requirements and ensure resident safety and care standards.
Findings
The facility was generally compliant with regulations, with residents observed in common areas and proper environmental conditions noted. However, a deficiency was cited for failure to properly store hazardous items, posing an immediate health and safety risk.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to properly store required locked items such as Enoxaparin Sodium Injections, Hydrogen Peroxide, scissors, disinfectant cleaners, and Acetaminophen tablets, posing an immediate health and safety risk to residents R1 and R2. | Type A |
Report Facts
Resident records reviewed: 7
Staff records reviewed: 5
Facility capacity: 225
Current census: 176
Fire extinguisher last serviced: Apr 5, 2025
Emergency Disaster Drill date: Jun 12, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez Camarillo | Executive Director | Met during inspection and named in exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted inspection and signed report |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
Inspection Report
Census: 161
Capacity: 225
Deficiencies: 0
Jun 6, 2025
Visit Reason
The visit was an unannounced case management inspection related to a Death Report, two SOC341 reports, and to discuss the outcomes of these incidents.
Findings
No deficiencies were cited during the visit. The report detailed discussions about residents involved in incidents including a physical altercation and a reported potential abuse incident, which was self-reported and resulted in staff termination.
Report Facts
Capacity: 225
Census: 161
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez Camarillo | Administrator/Director | Named as the facility administrator/director; noted as unavailable during the visit |
| Raquel Lozano | Business Office Manager | Met with Licensing Program Analyst during the visit and discussed resident issues |
| Ciara Flores | Memory Program Director | Met with Licensing Program Analyst during the visit and received a copy of the report |
| Lisha Holmes | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Complaint Investigation
Census: 173
Capacity: 225
Deficiencies: 0
Feb 10, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that facility staff were not providing residents with appropriate supervision, resulting in falls.
Findings
The investigation reviewed multiple resident records and staff schedules, confirming that while some falls were unwitnessed, they were documented and responded to appropriately. The facility appeared sufficiently staffed and had recent in-service training plans. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged inadequate resident supervision leading to falls. The investigation found no sufficient evidence to substantiate the allegation, resulting in an unsubstantiated finding.
Report Facts
Capacity: 225
Census: 173
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Raquel Lozano | Business Office Manager | Met with Licensing Program Analyst during the investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Carol Blackwell | Administrator | Facility Administrator named in the report |
Inspection Report
Complaint Investigation
Census: 186
Capacity: 225
Deficiencies: 0
Jan 15, 2025
Visit Reason
The visit was conducted as a case management for complaint 15-AS-20241007145119 received on 10/07/2024, and to discuss two reported elopements from the facility.
Findings
During the visit, the Licensing Program Analyst and Executive Director reviewed resident admission history and surveillance footage related to the complaint. Two elopement incidents were discussed, with staff intercepting residents promptly. No deficiencies were cited.
Complaint Details
Complaint 15-AS-20241007145119 was investigated with review of Safely You footage and resident histories. Two elopements were reported: one on 11/19/24 involving a resident exiting an alarmed back door and intercepted within 5 minutes, and another on 01/04/25 involving a resident exiting through the main entrance and intercepted at the bus stop within 2 minutes. Notifications were made to medical doctors and responsible parties. No deficiencies were cited.
Report Facts
Complaint number: 15
Census: 186
Total capacity: 225
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez Camarillo | Executive Director | Met with Licensing Program Analyst during visit and discussed findings |
| Lisha Holmes | Licensing Program Analyst | Conducted the case management visit and investigation |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 225
Deficiencies: 0
Dec 17, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations regarding resident care, including weight loss, failure to contact the resident's representative, non-adherence to the care plan, and delayed medical care.
Findings
The investigation found all allegations unsubstantiated after reviewing medical records, interviewing staff, residents, and family members, and examining documentation related to the resident's care and hospice visits.
Complaint Details
The complaint involved allegations that Resident (R1) lost significant weight, the facility failed to contact the resident's representative about health status, did not follow the resident's care plan, and delayed medical care. After investigation, including interviews and record reviews, the allegations were found unsubstantiated due to insufficient evidence to prove violations.
Report Facts
Weight lost by resident: 40
Facility capacity: 225
Resident census: 137
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Holzherr | Assistant Executive Director | Met with Licensing Program Analyst during the investigation. |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 225
Deficiencies: 0
Dec 17, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that staff were not responding to phone calls and were not effectively communicating with residents and their families regarding COVID-19 outbreaks at the facility.
Findings
The investigation found that the allegations were unsubstantiated based on interviews with staff, family members, and review of documentation showing proper communication and phone responsiveness. No deficiencies were cited.
Complaint Details
The complaint was unsubstantiated. Allegations included staff not responding to phone calls and ineffective communication about COVID-19 outbreaks. Interviews and document reviews showed the facility maintained phone coverage and communicated outbreak information to residents' families.
Report Facts
Capacity: 225
Census: 137
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Erik Holzherr | Assistant Executive Director | Met with Licensing Program Analyst during investigation |
| Michelle Moros | Administrator | Facility Administrator named in report |
Inspection Report
Complaint Investigation
Census: 186
Capacity: 225
Deficiencies: 4
Dec 12, 2024
Visit Reason
The inspection was an unannounced case management visit conducted to investigate complaint #15-AS-20240716140724 received on 07/16/2024 regarding issues with hospice care notification and pressure wound treatment for Resident #1.
Findings
The licensee failed to provide timely hospice care notifications and required reports to the Community Care Licensing Department, did not comply with the admission agreement terms regarding private personal assistance services, and failed to meet requirements for care of persons with dementia. These deficiencies posed potential health and safety risks to residents.
Complaint Details
Complaint #15-AS-20240716140724 was received on 07/16/2024 concerning failure to provide hospice care notifications and documentation for Resident #1, including issues related to stage 3 to 4 pressure wounds and deviations from hospice care plans.
Severity Breakdown
Type B: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to provide Resident #1's Initiation of Hospice notification and Physician’s Report (LIC602) to the Community Care Licensing Department within required timeframes. | Type B |
| Failure to report any deviation from Resident #1’s hospice care plan or interruption/discontinuation of hospice services as required. | Type B |
| Failure to comply with all applicable terms and conditions set forth in Resident #1's admission agreement. | Type B |
| Failure to conduct annual medical assessment and reassessment of dementia care needs for residents with dementia as required. | Type B |
Report Facts
Capacity: 225
Census: 186
Deficiencies cited: 4
Plan of Correction Due Date: Dec 19, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez Camarillo | Executive Director | Met with during inspection and involved in investigation |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and authored the report |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 186
Capacity: 225
Deficiencies: 1
Dec 12, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of illegal eviction received on 2024-07-16.
Findings
The investigation substantiated the allegation of illegal eviction, finding that the facility failed to seek joint determination before denying Resident #1's return after emergency treatment for a stage 3 to 4 pressure wound while under hospice care.
Complaint Details
The complaint investigation was substantiated regarding illegal eviction of Resident #1. The facility did not consult with the Community Care Licensing Department, the resident, the resident's Power of Attorney, hospice agency, physician, or licensee before denying the resident's return, posing a health and safety risk.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure joint determination before denying Resident #1's return to the facility after emergency treatment while under hospice care, violating CCR 87224(i). | Type A |
Report Facts
Capacity: 225
Census: 186
Deficiency count: 1
Plan of Correction Due Date: Dec 14, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez | Executive Director | Met during investigation and named in findings |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 184
Capacity: 225
Deficiencies: 1
Oct 8, 2024
Visit Reason
The visit was an unannounced case management inspection conducted to follow up on COVID-19 status reporting after a UIR report was presented to licensing.
Findings
The facility failed to comply with reporting requirements by not notifying the licensing agency of COVID-19 positive cases within 24 hours, resulting in a cited deficiency under Title 22 California Code of Regulations.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to notify the licensing agency of incidents within 24 hours which poses a potential health and safety risk to persons in care. | Type B |
Report Facts
Deficiency Plan of Correction Due Date: Oct 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez | Executive Director | Met with Licensing Program Analyst during the inspection and provided information about COVID-19 cases |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Complaint Investigation
Census: 182
Capacity: 225
Deficiencies: 0
Sep 26, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 2023-11-15 regarding neglect, unmet resident needs, mistreatment, and unsafe environment at the facility.
Findings
The investigation included interviews with residents and staff and review of relevant documents. The allegations were found to be unsubstantiated due to lack of preponderance of evidence. No deficiencies were cited during this visit.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included neglect during overnight shifts, staff not meeting resident needs, staff yelling and mistreating residents, and unsafe environment due to floor mopping procedures. Interviews and document reviews did not support these allegations.
Report Facts
Capacity: 225
Census: 182
Number of residents interviewed: 5
Number of staff interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Ciara Flores | Memory Care Coordinator | Met with Licensing Program Analyst and signed reports |
| Jesus Gonzalez | Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Census: 171
Capacity: 225
Deficiencies: 0
Aug 20, 2024
Visit Reason
The visit was an unannounced case management inspection related to the recent diagnoses and relocation of Resident #1 following a fall and subsequent hospitalization.
Findings
The inspection found no deficiencies. Discussions were held regarding the resident's health condition, relocation order requirements, and arrangements for removal of personal belongings to allow for unit renovations.
Report Facts
Capacity: 225
Census: 171
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez | Executive Director | Met with Licensing Program Analyst during inspection |
| Carol Blackwell | Director of Resident Care Services | Met with Licensing Program Analyst during inspection |
| Erik Holzherr | Assistant Executive Director | Met with Licensing Program Analyst during inspection and discussed resident relocation |
Inspection Report
Census: 171
Capacity: 225
Deficiencies: 0
Aug 20, 2024
Visit Reason
The visit was an unannounced case management inspection conducted to review an Unusual Incident/Injury Report (UIR) for Resident #1.
Findings
The Licensing Program Analyst interviewed facility staff regarding the resident's condition and confirmed that the UIR was sent to the licensing agency. No deficiencies were cited during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol Blackwell | Director of Resident Care Services | Interviewed regarding Resident #1's bowel movements and condition. |
| Erik Holzherr | Assistant Executive Director | Met with Licensing Program Analyst and received a copy of the report. |
| Lisha Holmes | Licensing Program Analyst | Conducted the unannounced case management visit. |
Inspection Report
Complaint Investigation
Census: 139
Capacity: 225
Deficiencies: 0
Aug 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff handled a resident in a rough manner and staff hit a resident.
Findings
The investigation found the complaint to be unfounded, meaning the allegations were false, could not have happened, or were without a reasonable basis. The facility reviewed relevant documents and met with the Executive Director, and the family decided to continue care with the private caregiver.
Complaint Details
The complaint was investigated and found to be unfounded.
Report Facts
Capacity: 225
Census: 139
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Jesus Gonzalez | Executive Director | Met with Licensing Program Analyst during the investigation |
Inspection Report
Annual Inspection
Census: 180
Capacity: 225
Deficiencies: 0
Jul 3, 2024
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate the facility's compliance with licensing regulations.
Findings
The facility was found to have approved fire clearance for 225 residents with various accommodations. Residents were observed in common areas, and safety features such as locked medication rooms, first aid kits, smoke/carbon monoxide detectors, and fire extinguishers were in place and maintained. Fire drills were conducted monthly with the last drill in June 2024. Records for residents and staff were reviewed, and no deficiencies or violations were explicitly noted in the report.
Report Facts
Resident records reviewed: 10
Staff records reviewed: 5
Fire extinguisher last serviced: May 16, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Holzherr | Assistant Executive Director | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Complaint Investigation
Census: 186
Capacity: 225
Deficiencies: 1
Feb 27, 2024
Visit Reason
An unannounced Case Management visit was conducted regarding an incident reported on 2024-02-14 involving Resident 1 who was observed walking back into the community unassisted, contrary to physician's report indicating the resident cannot leave unassisted.
Findings
The Licensee did not comply with the requirement to ensure an adequate number of direct care staff to support each resident's safety and health care needs, posing a potential health and safety risk to residents in care. A deficiency was cited under Title 22 California Code of Regulations.
Complaint Details
The visit was complaint-related due to an incident where Resident 1 was observed leaving the facility unassisted, which is against the physician's report. The complaint was substantiated by interviews and record review.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure an adequate number of direct care staff to support each resident’s safety and health care needs as identified in his/her current appraisal. | Type B |
Report Facts
Deficiencies cited: 1
Plan of Correction Due Date: Mar 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Gonzalez | Executive Director | Met with Licensing Program Analyst during the visit |
| Laura Hall | Licensing Program Analyst | Conducted the inspection visit |
| Harpreet Humpal | Licensing Program Manager | Supervisor and Licensing Program Manager named in report |
Inspection Report
Complaint Investigation
Census: 186
Capacity: 225
Deficiencies: 1
Nov 30, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 07/14/2022 regarding the facility's COVID mitigation procedures, staffing levels, staff qualifications, resident care, and cleanliness.
Findings
The investigation substantiated the allegation that the facility failed to follow adequate COVID mitigation procedures, specifically physical distancing in memory care dining. Other allegations including failure to provide COVID-positive notifications, inadequate staffing, unqualified staff, resident neglect, and cleanliness were found unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was substantiated for failure to follow adequate COVID mitigation procedures. Other allegations including failure to provide COVID-positive notifications, inadequate staffing levels, unqualified staff, resident neglect, and facility cleanliness were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Based on observation on 7/22/22, Licensee did not comply with the regulation cited above by not physically distancing residents in accordance to PIN 21-49-ASC and local public health guidance. AGPA and LPA observed 5 residents on wheelchairs in one round dining table in memory care which poses a potential health and safety risk to persons in care. | Type B |
Report Facts
Capacity: 225
Census: 186
Residents observed not physically distanced: 5
Plan of Correction Due Date: Dec 7, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizette Francisco | Associate Governmental Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Jesus Gonzalez | Executive Director | Met with the investigator during the visit |
| Michelle Moros | Administrator | Facility Administrator named in the report |
Inspection Report
Annual Inspection
Census: 184
Capacity: 225
Deficiencies: 0
Jul 20, 2023
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and facility safety standards.
Findings
The facility was found to be in compliance with no deficiencies cited. Safety equipment was operational, staff and resident records were complete, and the environment was safe, sanitary, and well-maintained.
Report Facts
Staff records reviewed: 5
Resident records reviewed: 5
Fire extinguisher service date: Apr 6, 2023
Hot water temperature: 111.2
Facility capacity: 225
Facility census: 184
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tamra Marie Tsanos | Executive Director | Met with Licensing Program Analyst and Associate Governmental Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 183
Capacity: 225
Deficiencies: 1
Mar 24, 2023
Visit Reason
The visit was an unannounced case management visit conducted to deliver findings related to a complaint investigation.
Findings
The facility was found deficient for failing to report an incident between two residents that occurred in December 2021, which is a violation of California Code of Regulations, Title 22.
Complaint Details
The visit was complaint-related and substantiated by the finding that the facility failed to submit an incident report to the licensing agency, posing a potential health and safety risk.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not report the incident between R1 and R2 that occurred in December 2021 as required by reporting regulations. | Type B |
Report Facts
Deficiency Plan of Correction Due Date: Apr 14, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the investigation |
| Tamra Marie Tsanos | Executive Director | Facility representative met during the visit |
| Rachel Kelly | Assistant Executive Director | Facility representative met during the visit |
Inspection Report
Complaint Investigation
Census: 183
Capacity: 225
Deficiencies: 0
Mar 24, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not prevent inappropriate behavior between residents.
Findings
The investigation included interviews with residents, staff, witnesses, and review of resident files. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff did not prevent inappropriate behavior between residents. The investigation found no sufficient evidence to substantiate the allegation, and the complaint was deemed unsubstantiated.
Report Facts
Capacity: 225
Census: 183
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Tamra Tsanos | Executive Director | Met with Licensing Program Analyst during investigation |
| Rachel Kelly | Assistant Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Capacity: 225
Deficiencies: 0
Jan 27, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that a resident sustained multiple falls at the facility and that facility staff were not meeting the resident's basic needs.
Findings
The investigation found no preponderance of evidence to prove the alleged violations occurred; therefore, the allegations were unsubstantiated.
Complaint Details
The complaint involved allegations of multiple falls sustained by a resident and failure of staff to meet the resident's basic needs. The investigation included interviews with staff and review of records, revealing the resident was a fall risk but resided in Independent Living and was later transferred to Assisted Living. The resident received hospice services and died on 12/29/20. The allegations were unsubstantiated.
Report Facts
Facility capacity: 225
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Tamra Tsanos | Executive Director | Met with Licensing Program Analyst during the investigation and received the report |
| Michelle Moros | Administrator | Facility Administrator named in the report |
Inspection Report
Complaint Investigation
Census: 184
Capacity: 225
Deficiencies: 4
Jan 19, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to multiple allegations received on 2022-04-07 regarding resident care issues including skin tears, infections, timely medical treatment, and medical record maintenance.
Findings
The investigation substantiated allegations that a resident sustained a skin tear due to improper handling, delayed medical treatment, and failure to maintain up-to-date medical records. Other allegations such as unexplained bruises, rash, incident reporting, admission agreement adherence, toileting needs, medication administration, and staffing levels were found unsubstantiated.
Complaint Details
Complaint investigation was substantiated for allegations related to skin tears, infection, delayed medical treatment, and improper maintenance of medical records. Other allegations including unexplained bruises, rash, incident reporting, admission agreement, toileting needs, medication administration, and staffing were unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Facility did not comply with proper transfer techniques resulting in a resident sustaining a skin tear, posing an immediate health and safety risk. | Type A |
| Facility failed to regularly observe residents for changes in condition. | Type B |
| Facility failed to immediately call 9-1-1 or take resident to medical facility after injury resulting in imminent health and safety risk. | Type B |
| Facility did not ensure annual medical assessment for resident with dementia was up to date. | Type B |
Report Facts
Civil penalty: 500
Capacity: 225
Census: 184
Plan of Correction Due Date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation and signed the report. |
| Rachel Kelly | Assistant Executive Director | Met with Licensing Program Analyst during the investigation and involved in discussions regarding findings. |
Inspection Report
Complaint Investigation
Census: 187
Capacity: 225
Deficiencies: 0
Apr 11, 2022
Visit Reason
The inspection was conducted as a health and safety check following receipt of a priority 2 complaint by the department.
Findings
The facility was toured and inspected including common areas, bathrooms, kitchen, and dining. No imminent health or safety concerns were found, and no deficiencies were cited during this visit.
Complaint Details
The visit was triggered by a priority 2 complaint. The complaint was investigated through a health and safety check, but no deficiencies were found or cited.
Report Facts
Water temperature: 106.4
Fire extinguisher last service date: Dec 13, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rachel Kelly | Assistant Executive Director | Met with during inspection |
| Zachary Striplin | Wellness Nurse | Met with during inspection |
| Leslie Ibo | Licensing Program Analyst | Conducted the inspection |
| L. Francisco | Licensing Program Analyst | Conducted the inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 225
Deficiencies: 0
Dec 28, 2021
Visit Reason
The visit was conducted as a case management incident in response to an incident report received on 2021-12-08 regarding a resident (R1) who was absent without leave (AWOL).
Findings
The Licensing Program Analyst and Manager conducted an unannounced visit, interviewed the Executive Director, toured the memory care unit, and found that R1 had left the facility but was located and returned unharmed. The facility implemented procedures to manage visitor influx. No deficiencies were cited during this visit.
Complaint Details
The visit was triggered by a complaint incident report of a resident absence without leave (AWOL) on 2021-12-08. The resident was found and returned unharmed. No deficiencies were cited.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Moros | Executive Director | Met with Licensing Program Analyst and Manager during the visit and interviewed regarding the incident. |
| Lisha Holmes | Licensing Program Analyst | Conducted the visit and interview. |
| Yvonne Flores-Larios | Licensing Program Manager | Conducted the visit and interview. |
Inspection Report
Routine
Census: 186
Capacity: 225
Deficiencies: 0
Jul 21, 2021
Visit Reason
The visit was an unannounced Infection Control Inspection conducted as a required 1-year routine inspection.
Findings
The inspection found that the facility had proper infection control measures in place including screening, PPE usage, and sufficient food and PPE supplies. No deficiencies were cited during the visit.
Report Facts
PPE supply duration: 30
Food supply duration - perishable: 2
Food supply duration - non-perishable: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Moros | Administrator | Met with Licensing Program Analyst during inspection |
| Leslie Ibo | Licensing Program Analyst | Conducted the Infection Control Inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 191
Capacity: 225
Deficiencies: 1
Jul 16, 2021
Visit Reason
An unannounced complaint investigation was conducted based on allegations received on 04/20/2020 regarding staff not following doctor's orders and other care concerns at Belmont Village Albany.
Findings
The investigation substantiated that staff did not follow doctor's orders related to providing a protein drink twice a day to a resident, posing a potential health and safety risk. Other allegations regarding resident weight loss, incontinence care, care plan adherence, and provision of care plan copies were found unsubstantiated.
Complaint Details
Complaint investigation was substantiated for failure to follow doctor's orders regarding protein drink administration. Other allegations about resident weight loss, incontinence care, care plan adherence, and provision of care plan copies were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. Facility did not comply with this requirement by not following doctor's orders. | Type B |
Report Facts
Resident weight lost: 15
Deficiency POC due date: Jul 30, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Rachel Kelly | Senior Administrative Specialist | Met with Licensing Program Analyst during investigation |
| Merryn Oliveira | Director Memory Care Program | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 191
Capacity: 225
Deficiencies: 2
Jul 16, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff caused injury to a resident and took the resident's belongings.
Findings
The investigation found that resident R1 sustained severe bruising due to improper handling during transfers by staff, despite prior discussions about R1's propensity to bruise easily. Additionally, an Amazon Echo Dot device with audio capability was removed from R1's room, violating the facility's admission agreement. The allegations were substantiated and a $500 immediate civil penalty was assessed.
Complaint Details
The complaint investigation was substantiated. The allegations included staff causing injury to a resident and taking the resident's belongings. The investigation included interviews, document reviews, and found evidence supporting the allegations.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to provide safe, healthful and comfortable accommodations resulting in R1 sustaining severe bruising due to improper handling during transfer. | Type A |
| Facility failed to respect personal rights of residents by removing R1's device which posed a potential health and safety risk. | Type B |
Report Facts
Civil penalty amount: 500
Capacity: 225
Census: 191
Plan of Correction Due Date: Jul 19, 2021
Plan of Correction Due Date: Jul 30, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and signed the report. |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Rachel Kelly | Senior Administrative Specialist | Met with Licensing Program Analyst during investigation. |
| Merryn Oliveira | Director Memory Care Program | Met with Licensing Program Analyst during investigation. |
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