Inspection Reports for Belmont Village Senior Living Sunnyvale
1039 E El Camino Real, Sunnyvale, CA 94087, United States, CA, 94087
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with the facility generally clean, well-maintained, and compliant in areas such as infection control, emergency preparedness, and resident accommodations. The most recent report from August 27, 2025, was a complaint investigation that found no evidence of physical abuse, and the allegation was unsubstantiated. Some earlier reports cited deficiencies related to medication documentation, staff training, timely incident reporting, and delays in arranging medical care, with one substantiated case of staff neglect in July 2024 that resulted in a $500 fine. Several complaint investigations were unsubstantiated, and the facility has shown improvement over time, with the latest inspections free of deficiencies. No license suspensions or large fines were listed in the available reports.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
2.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
45% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
74% occupied
Based on a August 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 111
Capacity: 150
Deficiencies: 0
Date: Aug 27, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation received on 2025-07-15 that a resident was physically abused while in care.
Complaint Details
The complaint alleged that a resident was physically abused while in care. The investigation included interviews with five staff members and five residents, review of incident reports, internal investigations, medical and hospice records, and law enforcement findings. The allegation was found to be unsubstantiated and unfounded due to inconsistent statements, absence of injuries, and corroborating interviews.
Findings
After interviews with staff and residents, review of records, and law enforcement investigation, there was insufficient evidence to support the allegation of physical abuse. No injuries were observed, the staff member involved resigned, and the allegation was determined to be unfounded.
Report Facts
Staff interviewed: 5
Residents interviewed: 5
Complaint allegations: 1
Montreal Cognitive Assessment score: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Manzo | Executive Director | Met with Licensing Program Analyst during investigation and named in report |
| Kiran Jain | Licensing Program Analyst | Conducted the complaint investigation |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 111
Capacity: 150
Deficiencies: 0
Date: May 27, 2025
Visit Reason
The inspection visit was conducted as a Case Management – Incident inspection regarding a self-reported SOC 341 for a financial abuse incident involving a resident writing checks to a staff member.
Complaint Details
The complaint involved financial abuse where a resident wrote checks to a staff member. The staff member was terminated after evidence showed endorsement and cashing of six checks. Partial repayment was made. The resident confirmed voluntary action and no coercion.
Findings
The investigation found that six checks totaling $6,850 were cashed by the staff member, who was subsequently terminated. The staff member returned $5,000 but lacked funds to return the remaining $1,850. The resident stated they wrote the checks voluntarily and no deficiencies were cited during the visit.
Report Facts
Total amount cashed: 6850
Amount returned: 5000
Amount not returned: 1850
Number of cashed checks: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Manzo | Executive Director | Met with Licensing Program Analyst and involved in investigation and report |
| Kiran Jain | Licensing Program Analyst | Conducted the inspection visit and investigation |
| Radhika Singh | Administrator/Director | Named as facility administrator/director on report |
Inspection Report
Annual Inspection
Census: 100
Capacity: 150
Deficiencies: 0
Date: Apr 17, 2025
Visit Reason
The inspection was a Required 1-Year Annual inspection conducted unannounced to assess compliance with licensing requirements.
Findings
The facility was found to be clean, well-maintained, and compliant with all inspected areas including resident rooms, kitchen, medication storage, and emergency equipment. No deficiencies were cited during the visit.
Report Facts
Resident rooms inspected: 10
Staff personnel records reviewed: 6
Resident records reviewed: 5
Emergency drills frequency: 1
Hot water temperature range: 114.4-119.5
Food supply duration: 2
Food supply duration: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Manzo | Executive Director | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Kiran Jain | Licensing Program Analyst | Conducted the inspection |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 111
Capacity: 150
Deficiencies: 1
Date: Aug 1, 2024
Visit Reason
The visit was conducted as a case management - incident visit to address incident reports and death reports that were submitted late to the Department from April 1, 2024 to July 25, 2024.
Findings
The facility submitted 15 late incident reports and 4 late death reports to the Department, all reported more than 7 days after the occurrence date. A deficiency was cited for failure to submit reports within the required timeframe, posing a potential health, safety, and personal rights risk to persons in care.
Deficiencies (1)
Failure to report incidents and death reports to the Department within 7 days of occurrence as required by California Code of Regulations, Title 22.
Report Facts
Late incident reports: 15
Late death reports: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dana Malengo | Director of Resident Care Services | Met with Licensing Program Analyst during the visit and discussed incident report submissions |
| Lola Bullock | Administrator/Director | Executive Director responsible for submitting incident and death reports |
Inspection Report
Complaint Investigation
Census: 114
Capacity: 150
Deficiencies: 2
Date: Jul 3, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following allegations that staff neglect led to hospitalization of a resident and that staff did not seek medical attention for the resident in a timely manner.
Complaint Details
The complaint was substantiated regarding staff neglect leading to hospitalization and failure to seek timely medical attention. Other allegations about feeding, sanitation, and notification of responsible party were unsubstantiated.
Findings
The Department substantiated the allegations that staff neglect led to the hospitalization of resident R1 due to failure to follow protocol regarding change of condition and failure to report it. An immediate civil penalty of $500 was assessed. Additional allegations regarding failure to ensure resident was fed, maintain clean conditions, and notify responsible party of change in condition were found unsubstantiated.
Deficiencies (2)
Facility did not provide care and supervision for resident R1, failed to report and act on R1's change of condition, leading to hospitalization.
Facility did not assist or arrange medical care appropriately for resident R1's change of condition, posing immediate health and safety risk.
Report Facts
Civil penalty amount: 500
Capacity: 150
Census: 114
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met during investigation and named in findings regarding failure to follow protocol. |
| Steve Chang | Licensing Program Analyst | Conducted unannounced investigation visit. |
| Manuel Monter | Licensing Program Analyst | Conducted unannounced investigation visit. |
| Chihhsien Chang | Licensing Program Analyst | Conducted complaint investigation and signed report. |
Inspection Report
Annual Inspection
Census: 120
Capacity: 150
Deficiencies: 3
Date: Apr 26, 2024
Visit Reason
The inspection was an unannounced required 1-year annual inspection conducted by the Licensing Program Analyst to evaluate compliance with regulations at Belmont Village Sunnyvale facility.
Findings
The facility was generally well maintained with clean living areas, proper safety equipment, and adequate resident accommodations. However, deficiencies were cited related to incomplete documentation of centrally stored PRN medications, incomplete staff health screenings, and insufficient annual training hours for some staff members.
Deficiencies (3)
Five residents' PRN medications were not properly documented in the centrally stored medication record.
One staff member's health screening and TB result were not available for review.
Two staff members did not have at least 20 hours of annual training including dementia care, postural supports, restricted health conditions, and hospice care.
Report Facts
Residents' files reviewed: 11
Staff files reviewed: 6
PRN medication documentation deficiencies: 5
Staff health screening deficiencies: 1
Staff training deficiencies: 2
Plan of Correction Due Date: May 3, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met with Licensing Program Analyst during inspection and advised regarding deficiencies. |
| Christine Dolores | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Sarah Yip | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 0
Date: Apr 15, 2024
Visit Reason
The visit was an unannounced Case Management - Incident inspection triggered by an incident report received on 2024-04-12 regarding a resident with a black and swollen left eye from an incident occurring on 2024-04-02.
Complaint Details
The complaint involved a resident found with a black eye and head lacerations after a fall. The resident stated no abuse or hitting occurred. The facility responded by updating care plans and adding safety measures. No substantiation of abuse was noted.
Findings
The resident was found with injuries consistent with a fall and was sent to the hospital, then discharged back to the facility. The facility updated the resident's care plan immediately and implemented additional safety measures including a bed alarm and staff escort. No abuse was reported by the resident. No citations were issued during this visit.
Report Facts
Capacity: 150
Census: 121
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met with Licensing Program Analyst during inspection and provided information about the incident and facility response |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit |
Inspection Report
Monitoring
Census: 121
Capacity: 150
Deficiencies: 0
Date: Apr 15, 2024
Visit Reason
The visit was conducted to ensure the facility is adhering to the Compliance Plan submitted after a Non-Compliance Conference held on 07/25/2023. This case management inspection is part of a series conducted every 3 months for 2 years.
Findings
The Licensing Program Analyst reviewed the facility's plans, policies, staff training records, and protocols related to prior deficiencies, resident appraisals, fall risk identification, medication administration, and care plans. The facility was toured and discussions were held with the Executive Director regarding compliance and staff responsibilities.
Report Facts
Inspection frequency: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met with Licensing Program Analyst during inspection and discussed compliance |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management - Legal/Non-compliance inspection |
| Romeo Manzano | Licensing Program Manager | Named in report header |
| Chihhsien Chang | Licensing Program Analyst | Named in report header |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 1
Date: Mar 26, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations including staff not assisting a resident with obtaining medical care and the facility signal system not being maintained operable.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not assist a resident with obtaining medical care, specifically that 911 was not called promptly after a resident fell. The allegation regarding the facility signal system was determined to be unfounded.
Findings
The allegation that staff did not assist a resident with obtaining medical care was substantiated due to delayed 911 call after a resident's fall. The allegation regarding the facility signal system not being maintained operable was found to be unfounded based on records and interviews.
Deficiencies (1)
Incidental Medical and Dental Care: The licensee failed to arrange or assist in arranging medical care for a resident who fell during an outing, delaying the 911 call which posed an immediate health, safety, and personal rights risk.
Report Facts
Capacity: 150
Census: 121
Deficiencies cited: 1
Assistance call attempts: 15
Response time range (minutes): 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Grace Donato | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lola Bullock | Administrator | Facility administrator met during the investigation |
| Jackie Jin | Licensing Program Manager | Named in report as Licensing Program Manager |
| Joshua Lambengco | Director of Resident Services | Interviewed regarding signal system response times |
Inspection Report
Census: 123
Capacity: 150
Deficiencies: 0
Date: Jan 3, 2024
Visit Reason
The visit was conducted to ensure the facility is adhering to the Compliance Plan submitted after a Non-Compliance Conference held on 07/25/2023. This case management inspection is part of a series to be conducted every 3 months for 2 years.
Findings
The Licensing Program Analyst reviewed plans, policies, and staff training records related to prior deficiencies, resident appraisals/reappraisals, fall risk identification and safety plans, residents' needs and service plans, medication administration, and staff responsibilities. The facility was toured including various units and common areas, and discussions were held with the Executive Director regarding compliance and staff training.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met with Licensing Program Analyst during inspection and discussed compliance and facility protocols. |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management - Legal/Non-compliance inspection. |
| Romeo Manzano | Licensing Program Manager | Named in report header. |
Inspection Report
Enforcement
Census: 119
Capacity: 150
Deficiencies: 1
Date: Jul 25, 2023
Visit Reason
The Noncompliance Conference meeting was conducted to discuss serious violations that occurred at the facility on 03/18/2022 and 03/19/2022, which resulted in a resident sustaining a fracture and missed medications. The substantiated complaint findings were delivered on 12/20/2022.
Complaint Details
The visit was related to substantiated complaint findings regarding a resident who sustained a fracture and missed medications in March and April 2022.
Findings
Deficiencies cited on 12/20/2022 for violations of Title 22 California Code of Regulations were amended. Additional civil penalties of $10,000 may be assessed pending review. A 2-year monitoring plan including more frequent licensing inspections was established.
Deficiencies (1)
Care of Persons with Dementia amended to Reappraisal and Additional Personal Rights of Residents in Privately Operated Facilities
Report Facts
Civil penalties amount: 10000
Monitoring plan duration: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Facility Administrator | Present at Noncompliance Conference meeting |
| Vivien Helbling | San Bruno Adult and Senior Care Regional Manager | Present at Noncompliance Conference meeting |
| Romeo Manzano | Licensing Program Manager | Present at Noncompliance Conference meeting and named in report |
| Steve Chang | Licensing Program Analyst | Present at Noncompliance Conference meeting and named in report |
| Douglas Armstrong | Senior VP of Regulatory Affairs and Quality | Present at Noncompliance Conference meeting |
| Sharlene Gephart | Regional V. P. of Resident Care Service | Present at Noncompliance Conference meeting |
| Ann Wood | V. P. of Operation | Present at Noncompliance Conference meeting |
Inspection Report
Annual Inspection
Census: 129
Capacity: 150
Deficiencies: 2
Date: Apr 25, 2023
Visit Reason
The inspection was an unannounced annual required one year inspection conducted to evaluate compliance with regulatory standards at Belmont Village Sunnyvale facility.
Findings
The inspection found that emergency systems and supplies were generally in place and functioning, but deficiencies were cited including outdated physician reports for residents with dementia and expired first aid certifications for staff. A Technical Advisory note was also issued.
Deficiencies (2)
Five out of six residents with dementia did not have a physician's report updated annually, posing a potential safety risk.
Two out of five reviewed staff did not have current First Aid Certifications, posing a potential safety risk.
Report Facts
Residents with dementia lacking updated physician reports: 5
Staff without current First Aid Certifications: 2
Residents census: 129
Facility capacity: 150
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Administrator | Met with Licensing Program Analysts during inspection and involved in securing scissors found in memory care unit |
| David Marrufo | Licensing Program Analyst | Conducted inspection and authored report |
| Sarah Yip | Licensing Program Manager | Supervisor of inspection and report |
Inspection Report
Complaint Investigation
Census: 119
Capacity: 150
Deficiencies: 2
Date: Dec 20, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations including a resident sustaining a fracture while in care, a resident not receiving medication, and a motion detector being in disrepair.
Complaint Details
The complaint investigation was substantiated for allegations that a resident sustained a fracture while in care and did not receive medication as ordered. The allegation regarding a motion detector in disrepair was unsubstantiated. An immediate civil penalty of $500 was assessed, with an additional $10,000 penalty pending review.
Findings
The investigation substantiated that a resident sustained a fracture due to inadequate reassessment and care plan updates after falls, and that medications were missed without explanation. An immediate civil penalty was assessed. The allegation regarding the motion detector was found unsubstantiated after testing and interviews confirmed the system was functioning and monitored by a third party.
Deficiencies (2)
Failure to update the resident's pre-admission appraisal and care plan after a fall, posing immediate risk to resident health.
Failure to provide care, supervision, and services meeting the resident's individual needs, resulting in a third fall and hip fracture.
Report Facts
Civil penalty immediate assessment: 500
Civil penalty pending: 10000
Missed medication days: 19
Resident census: 119
Facility capacity: 150
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Joshua Lambengco | Director of Resident Care | Met with Licensing Program Analyst during investigation and exit interview |
| Lola Bullock | Executive Director | Interviewed regarding motion detector system and fall procedures |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 125
Capacity: 150
Deficiencies: 0
Date: Apr 6, 2022
Visit Reason
An unannounced annual inspection was conducted as a required one-year visit to evaluate the facility's compliance with regulations.
Findings
The facility was found to be clean, well maintained, and compliant with all observed requirements including infection control, emergency preparedness, and safety measures. No deficiencies were cited during the visit.
Report Facts
Water temperature: 118.4
PPE supply: 30
Food supply: 2
Food supply: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Administrator | Facility Administrator met during inspection and report review |
| Ryker Heberle | Licensing Program Analyst | Conducted the inspection |
| Sarah Yip | Licensing Program Manager | Named in report header |
Inspection Report
Census: 121
Capacity: 150
Deficiencies: 0
Date: Jul 1, 2021
Visit Reason
The visit was conducted to gather additional information following a death report received on 06/30/2021 regarding a resident who passed away on 06/27/2021.
Findings
The resident was found unresponsive and pronounced dead by paramedics; staff reported no signs of suicidal ideation prior to the incident. No deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Radhika Singh | Executive Director | Met with Licensing Program Analyst during the case management visit. |
| Yatfai Eric Ng | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Sarah Yip | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 110
Capacity: 150
Deficiencies: 0
Date: May 21, 2021
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 10/20/2020 regarding allegations of resident dehydration and lack of dignity in staff relationships.
Complaint Details
The complaint involved allegations that a resident was severely dehydrated and not accorded dignity in relationships with staff. The allegations were found to be unfounded based on interviews and records review.
Findings
The investigation found the allegations to be unfounded after interviews with staff, the alleged victim, and relatives, as well as review of medical notes. The resident was in independent living and consciously chose not to eat or drink due to psychological issues, not due to facility neglect.
Report Facts
Capacity: 150
Census: 110
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yatfai Eric Ng | Licensing Program Analyst | Conducted the complaint investigation and subsequent visit |
| Sante Dhakal | Director of Residence Care Services | Met with Licensing Program Analyst during investigation |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Monitoring
Census: 115
Capacity: 150
Deficiencies: 1
Date: Apr 2, 2021
Visit Reason
An unannounced tele-Case Management visit was conducted related to COVID-19 surveillance testing compliance following concerns that the facility was not testing all staff as required.
Findings
The facility was found to be testing only staff who did not receive COVID-19 vaccination, which was not in compliance with Department guidance requiring 25% surveillance testing of all staff weekly. A deficiency was cited for failure to comply with this requirement, posing an immediate risk to resident health.
Deficiencies (1)
Licensee/administrator failed to comply and cooperate with technical assistance recommendations provided by local public health and CCL on 25% surveillance testing of staff regardless of vaccination status weekly, posing an immediate risk to resident health.
Report Facts
Capacity: 150
Census: 115
Surveillance testing percentage: 25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Executive Director | Met virtually during the inspection and reviewed the report |
| Yatfai Eric Ng | Licensing Program Analyst | Conducted the unannounced tele-Case Management COVID-19 visit and authored the report |
| Sarah Yip | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 120
Capacity: 150
Deficiencies: 0
Date: Dec 8, 2020
Visit Reason
Due to the COVID-19 pandemic, Licensing Program Analysts and a Nurse Evaluator conducted a Case Management - Other tele-visit via FaceTime to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility.
Findings
The virtual tour observed staff wearing masks, availability of hand sanitizing stations, COVID-19 signage, and infection control practices including PPE use. One recommendation was made to place a covered trash bin inside an isolation room for PPE disposal, which was immediately addressed. No deficiencies were cited during the tour.
Report Facts
Maximum staff capacity in break areas: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lola Bullock | Assistant Executive Director | Met with Licensing Program Analysts and Nurse Evaluator during the virtual tour and infection control discussion. |
| Kathleen Weiss | Nurse Evaluator II | Participated in the Case Management tele-visit to provide technical assistance. |
| Yatfai Eric Ng | Licensing Program Analyst | Participated in the Case Management tele-visit and virtual tour. |
| Jackie Jin | Licensing Program Analyst | Participated in the Case Management tele-visit and virtual tour. |
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