Inspection Reports for
Bonnevie Residence And Care
555 A McLaughlin Avenue, San Jose, CA 95116, CA, 95116
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
9 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
125% worse than California average
California average: 4 deficiencies/year
Deficiencies per year
24
18
12
6
0
Occupancy
Latest occupancy rate
67% occupied
Based on a August 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Plan of Correction
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 19, 2025
Visit Reason
Licensing Program Analyst Manuel Monter conducted a Plan of Correction (POC) case management visit to clear deficiencies cited on August 13, 2025, during an annual inspection visit. The visit also included amending the previous report to add an additional deficiency that was erroneously not cited during the previous visit.
Findings
The facility had been cited a Type A deficiency related to Personal Rights of Residents on August 13, 2025, with a POC due date of August 14, 2025. The plan of corrections was received by the due date, and all deficiencies were cleared during this visit. No deficiencies were cited during the current visit.
Deficiencies (1)
Personal Rights of Residents in All Facilities (a)(1)
Report Facts
Capacity: 6
Census: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Facility Administrator met during the inspection and involved in review of report |
| Manuel Monter | Licensing Program Analyst | Conducted the Plan of Correction case management visit |
| Romeo Manzano | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Plan of Correction
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 19, 2025
Visit Reason
Licensing Program Analyst Manuel Monter conducted a Plan of Correction (POC) case management visit to clear deficiencies cited on August 13, 2025, during an annual inspection visit and to amend the previous report with additional information and an additional deficiency.
Findings
No deficiencies were cited during the visit. The previously cited Type A deficiency related to Personal Rights of Residents was cleared following receipt and approval of the plan of correction by the due date.
Deficiencies (1)
Type A deficiency related to Personal Rights of Residents in All Facilities (a)(1) cited on August 13, 2025, cleared by POC due date August 14, 2025.
Report Facts
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met with during inspection and named in report review |
| Manuel Monter | Licensing Program Analyst | Conducted the Plan of Correction case management visit |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 13, 2025
Visit Reason
Licensing Program Analyst Manuel Monter conducted a Plan of Correction (POC) case management visit to clear deficiencies cited on August 8, 2025, during an annual inspection visit and to amend the previous report with additional information and an additional deficiency.
Findings
The facility had previously cited deficiencies related to emergency drills, personal accommodations and services, and incidental medical and dental care, all of which were cleared during this visit. However, a new deficiency was cited due to a metal latch on the outside of the living room door posing immediate health, safety, and personal rights risks to residents.
Deficiencies (1)
Metal latch observed on the door exiting the living room, posing immediate health, safety, and personal rights risks to residents.
Report Facts
Capacity: 6
Census: 4
Deficiencies cited: 3
Plan of Correction due dates: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Facility administrator involved in findings and corrective actions |
| Manuel Monter | Licensing Program Analyst | Conducted the POC case management visit and authored the report |
| Romeo Manzano | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 13, 2025
Visit Reason
Licensing Program Analyst Manuel Monter conducted a Plan of Correction (POC) case management visit to clear deficiencies cited on August 8, 2025, during an annual inspection visit and to amend the previous report with an additional deficiency.
Findings
The facility was cited for a new deficiency involving a metal latch on the living room exit door that posed an immediate health, safety, and personal rights risk to residents. The latch was removed during the visit. Previous deficiencies cited on August 8, 2025, were cleared based on submitted plans of correction.
Deficiencies (1)
Metal latch observed on the door exiting the living room posing an immediate health, safety, and personal rights risk to residents.
Report Facts
Capacity: 6
Census: 4
Plan of Correction Due Date: Aug 14, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Facility administrator involved in removal of metal latch and discussion of deficiencies |
| Manuel Monter | Licensing Program Analyst | Conducted the Plan of Correction visit and authored the report |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 3
Date: Aug 8, 2025
Visit Reason
An unannounced annual inspection visit was conducted by Licensing Program Analyst Manuel Monter to evaluate compliance with licensing requirements at Bonnevie Residence and Care Facility.
Findings
The inspection found one Type A deficiency related to an obstructive metal latch on an exit door, which was removed during the visit. Two Type B deficiencies were cited: failure to conduct quarterly emergency drills with varied scenarios and incomplete centrally stored medication records for residents.
Deficiencies (3)
Presence of a 'hook & eye' metal latch outside the living room door obstructing an exit, posing an immediate health, safety, or personal rights risk.
Failure to conduct quarterly emergency drills for each shift with varied emergency scenarios and proper documentation.
Incomplete centrally stored medication records for residents, lacking multiple medications and fill dates for 2025.
Report Facts
Capacity: 6
Census: 4
Plan of Correction Due Date: Aug 9, 2025
Plan of Correction Due Date: Aug 15, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mercelo Garcia | Administrator | Met with Licensing Program Analyst during inspection and involved in deficiency corrections |
| Manuel Monter | Licensing Program Analyst | Conducted the inspection and authored the report |
| Romeo Manzano | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 3
Date: Aug 8, 2025
Visit Reason
The inspection was an unannounced annual inspection visit conducted to evaluate compliance with licensing requirements for Bonnevie Residence and Care Facility.
Findings
The inspection found a Type A deficiency related to an unsafe metal latch on an exit door posing an immediate risk, and two Type B deficiencies related to incomplete emergency drill documentation and incomplete centrally stored medication records for residents.
Deficiencies (3)
Presence of a 'hook & eye' metal latch outside the living room door obstructing an exit, posing an immediate health, safety or personal rights risk.
Failure to conduct and document quarterly emergency drills for each shift with varied emergency scenarios as required.
Incomplete centrally stored medication records for residents, lacking multiple medications and fill dates for 2025.
Report Facts
Facility capacity: 6
Resident census: 4
Plan of Correction Due Date: Aug 9, 2025
Plan of Correction Due Date: Aug 15, 2025
Number of staff reviewed: 3
Number of resident medication records reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mercelo Garcia | Administrator | Met during inspection and involved in removal of metal latch and plans of correction |
| Manuel Monter | Licensing Program Analyst | Conducted the inspection and authored the report |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 4, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of financial abuse of a resident at Bonnevie Residence and Care Facility.
Complaint Details
The complaint alleged financial abuse of a resident who gave $500 to a staff member to gamble at a casino. The investigation found the allegation substantiated based on interviews with the resident, staff, administrator, and family member, as well as review of bank and transaction statements.
Findings
The investigation substantiated that a resident loaned money to a staff member to gamble at a casino, which is prohibited. There was no written agreement regarding handling the resident's finances and loaning money, posing risks to persons in care. The staff returned the money the next day, but the facility failed to prevent this financial transaction.
Deficiencies (1)
Failure to have a written agreement regarding handling resident's finances and loaning money from residents, violating California Code of Regulations, Title 22, HSC 1569.269(29)(E).
Report Facts
Capacity: 6
Census: 4
Loan amount: 500
Plan of Correction Due Date: Aug 6, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Licensee/Administrator | Met during investigation and provided statements regarding staff and resident interactions |
| Simranjit Rai | Licensing Evaluator | Conducted the complaint investigation visit |
| Romeo Manzano | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 1
Date: Aug 4, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of financial abuse of a resident by staff at Bonnevie Residence and Care Facility.
Complaint Details
The complaint alleged financial abuse of a resident who gave $500 cash to a staff member to gamble at a casino. The investigation found the money was a loan repaid the next day. The resident felt pressured to give money and was told to buy food for others. The allegation was substantiated based on evidence including interviews and financial transaction reviews.
Findings
The investigation substantiated that a resident loaned money to a staff member without a written agreement outlining repayment terms, which is prohibited. The staff member accepted the loan and repaid it the next day. The facility lacked a written agreement regarding handling resident finances and loaning money, posing health, safety, and personal rights risks.
Deficiencies (1)
Failure to have a written agreement regarding handling resident's finances and loaning money from residents, violating HSC 1569.269(29)(E).
Report Facts
Capacity: 6
Census: 4
Deficiency count: 1
Plan of Correction Due Date: Aug 6, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Simranjit Rai | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation |
| Merclo Garcia | Licensee/Administrator | Facility administrator interviewed during investigation |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 0
Date: Apr 11, 2025
Visit Reason
The visit was an unannounced case management visit conducted to amend a previously created report that was issued in error on 04/09/2025.
Findings
No deficiencies were cited during the visit based on California Code of Regulation (CCR) Title 22. The Licensing Program Analyst conducted additional interviews with staff and residents and explained the report amendment to the Licensee/Administrator.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator/Director | Named as Licensee/Administrator during the visit and explanation of report amendment. |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced visit and interviews. |
| Romeo Manzano | Licensing Program Manager | Named in the report header. |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 0
Date: Apr 11, 2025
Visit Reason
The visit was an unannounced case management inspection conducted to amend a previously created report that was issued in error on 04/09/2025.
Findings
No deficiencies were cited during the visit based on California Code of Regulation (CCR) Title 22. The Licensing Program Analyst explained the correction to the Licensee/Administrator and conducted additional interviews with staff and residents.
Report Facts
Capacity: 6
Census: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator / Director | Licensee/Administrator present during the visit and involved in discussion about the amended report |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced visit and interviews |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Follow-Up
Census: 4
Capacity: 6
Deficiencies: 0
Date: Apr 9, 2025
Visit Reason
An unannounced case management visit was conducted to review Type A and Type B deficiencies cited on 10/31/2024 and to verify compliance with the fire clearance.
Findings
The facility was found to be in compliance with no deficiencies cited during this visit. The fire clearance was approved on 3/27/2025, resident and staff records were complete and updated, and the facility environment was safe and well maintained.
Report Facts
Non-perishable food supply: 7
Perishable food supply: 2
Water temperature: 119
Water temperature: 121
Resident records inspected: 2
Staff records inspected: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met with Licensing Program Analyst during inspection and discussed visit purpose |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced case management visit |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 0
Date: Apr 9, 2025
Visit Reason
An unannounced case management visit was conducted to follow up on Type A and Type B deficiencies cited on 10/31/2024 and to verify compliance with the fire clearance.
Findings
No deficiencies were cited during this visit. The facility was found to be in compliance with regulations including fire clearance, resident and staff records, and safety standards.
Report Facts
Food pantry non-perishable food supply: 7
Food pantry perishable food supply: 2
Water temperature: 119
Water temperature: 121
Fire clearance approval date: Mar 27, 2025
Disaster training date: Sep 21, 2024
Upcoming disaster training date: Apr 13, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met with Licensing Program Analyst during inspection and discussed visit purpose |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced case management visit |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 5
Capacity: 6
Deficiencies: 0
Date: Dec 19, 2024
Visit Reason
An unannounced case management visit was conducted to follow up on the Type A and Type B deficiencies cited on 10/31/2024.
Findings
No deficiencies were cited at this time. Observations included locked storage of sharps, toxic chemicals, and medications, appropriate hot water temperature, clean windows and screens, and adequate food supplies. Fire clearance is still pending further review.
Report Facts
Hot water temperature: 110.8
Staff observed: 4
Residents observed: 4
Perishable food supply: 2
Non-perishable food supply: 7
Administrator presence hours: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met with Licensing Program Analysts and discussed facility operations and deficiencies |
| Marcela Yanez | Licensing Program Analyst | Conducted inspection and provided letter of deficiency citations cleared |
| Simi Rai | Licensing Program Analyst | Conducted inspection and discussed administrator presence requirements |
Inspection Report
Follow-Up
Census: 5
Capacity: 6
Deficiencies: 0
Date: Dec 19, 2024
Visit Reason
Unannounced case management visit to follow up on previously cited Type A and Type B deficiencies from 10/31/2024.
Findings
No deficiencies were cited during this visit. Observations included secure storage of sharps, chemicals, and medications, appropriate hot water temperature, clean windows and screens, and adequate food supply. Fire clearance is still pending further review.
Report Facts
Staff observed: 4
Residents observed: 4
Hot water temperature: 110.8
Perishable food supply: 2
Non-perishable food supply: 7
Administrator presence hours: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met with Licensing Program Analysts during visit and discussed facility operations |
| Marcela Yanez | Licensing Program Analyst | Conducted the inspection visit and observations |
| Simi Rai | Licensing Program Analyst | Conducted the inspection visit and discussed facility supervision requirements |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 9
Date: Oct 31, 2024
Visit Reason
An unannounced Required 1 Year visit was conducted to evaluate compliance with licensing regulations and facility conditions.
Findings
The inspection found multiple deficiencies including excessively high hot water temperatures, unsecured toxic materials and medications, inadequate resident appraisals and service plans, insufficient food variety, facility maintenance issues, and improper medication storage and documentation. The facility was advised to update fire clearance and floor plans and submit plans of correction for all deficiencies.
Deficiencies (9)
Hot water temperatures in bathrooms measured above the allowed maximum of 120 degrees F.
Storage areas for poisons, firearms, and dangerous weapons were not locked, with toxic materials accessible to residents.
Residents did not have appraisals of needs and services plans in their files.
Centrally stored prescription medications for residents were not properly documented in the medication log.
Insufficient variety and quantity of nonperishable and perishable food supplies on premises.
Facility was not clean or in good repair: loose floorboard, cobwebs, holes in window screens, greasy kitchen appliances, stained carpets, and dusty furniture.
Medication belonging to a former hospice resident was not properly destroyed and was accessible.
Centrally stored medicines were not kept in a safe and locked place; medications accessible to residents.
Residents' unlocked closets contained OTC medications without proper physician orders or labels.
Report Facts
Hot water temperature: 145.7
Hot water temperature: 130.1
Hot water temperature: 141.1
Hot water temperature: 140.1
Census: 5
Total capacity: 6
Food cans observed: 20
Fire extinguisher last inspection: 6
Fire and Earthquake log last conducted: 7
Residents reviewed: 5
Residents medication logs missing entries: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Merclo Garcia | Administrator | Met during inspection; discussed deficiencies and plans of correction |
| Ramiro Custodio | Corporate Member and Administrator | Met during inspection; involved in facility management |
| Bienvenido Custodio | Signed the document on behalf of Merclo Garcia | |
| Marcela Yanez | Licensing Program Analyst | Conducted inspection and authored report |
| Romeo Manzano | Licensing Program Manager | Supervised inspection |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 9
Date: Oct 31, 2024
Visit Reason
The inspection was an unannounced required 1-year visit to evaluate compliance with licensing regulations and facility conditions.
Findings
The inspection identified multiple deficiencies including excessively high hot water temperatures, unlocked storage of toxic materials and medications, lack of resident appraisal and service plans, inadequate medication logs, insufficient food supplies, facility maintenance issues such as loose floorboards and unclean appliances, and improper destruction of medications for former residents. The facility was advised to submit plans of correction by specified due dates.
Deficiencies (9)
Hot water temperature in resident bathrooms measured above the allowed maximum (145.7°F, 130.1°F, 141.1°F).
Toxic materials such as car wax, cleaning supplies, lighter fluid, and garden fertilizer were accessible to residents in unlocked areas.
Residents did not have required appraisal needs and service plans in their files.
Medication logs for centrally stored prescription medications were incomplete; September 2024 refills for three residents were not documented.
Insufficient supplies of nonperishable and perishable foods were maintained on premises.
Facility was not clean or in good repair: loose floorboard, cobwebs, holes in window screens, greasy kitchen appliances, stained carpets, and dusty furniture.
Medication belonging to a former hospice resident was found unlocked and not properly destroyed.
Centrally stored medicines were found in an unlocked closet accessible to residents, posing immediate risk.
Residents' OTC medications were stored unlocked without proper physician orders or labels.
Report Facts
Hot water temperature: 145.7
Hot water temperature: 130.1
Hot water temperature: 141.1
Census: 5
Total capacity: 6
Food cans observed: 20
Fire extinguisher last inspection date: 202306
Fire and Earthquake drill last conducted: Jul 15, 2024
Number of residents without appraisal needs and service plans: 5
Number of residents with undocumented medication refills: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Facility administrator named in relation to findings and plans of correction |
| Merclo Garcia | President/Administrator | Newly elected president/administrator involved in facility oversight and discussions of findings |
| Bienvenido Custodio | Facility representative who signed the report and discussed deficiencies | |
| Marcela Yanez | Licensing Program Analyst | Conducted inspection and signed report |
| Romeo Manzano | Licensing Program Manager | Supervised inspection and signed report |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 0
Date: Sep 26, 2024
Visit Reason
The visit was an unannounced case management inspection triggered by an incident report received on 2024-09-17 regarding the unknown death of a resident.
Complaint Details
The visit was complaint-related due to an incident involving the unknown death of a resident. The coroner's office clarified that the death report was a mistake and not a coroner's report.
Findings
The licensing evaluator conducted interviews and follow-up regarding the death report, which was later clarified as not a coroner's report. Due to lack of information, the case management remains open for further investigation.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Interviewed during the case management visit regarding the incident. |
| Mita Partoza | Licensing Program Analyst | Conducted the unannounced case management inspection. |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 0
Date: Sep 26, 2024
Visit Reason
Unannounced case management visit was conducted due to an incident involving the reported unknown death of a resident on 09/17/2024.
Complaint Details
Investigation was triggered by a complaint regarding an unknown death of a resident. The death report was found to be mistaken and not confirmed by the coroner's office.
Findings
The investigation revealed that the reported death was a mistake and not a coroner's report. The case management remains open for further investigation due to lack of information.
Report Facts
Census: 4
Total Capacity: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator/Director | Met during the inspection and involved in follow-up on death report |
| Merclo Garcia | Met during the inspection | |
| Mita Partoza | Licensing Program Analyst | Conducted the unannounced case management visit |
| Romeo Manzano | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Census: 5
Capacity: 6
Deficiencies: 2
Date: Sep 15, 2024
Visit Reason
The visit was an unannounced case management and deficiency inspection conducted to address issues related to staff fingerprint/criminal background clearance and training compliance at the facility.
Findings
The inspection found that one staff member (S1) residing at the facility since July 1, 2024, did not have the required fingerprint/criminal background clearance and had not received required training for care and supervision of residents, resulting in cited deficiencies and a civil penalty.
Deficiencies (2)
Failure to obtain California criminal background clearance for staff member residing at the facility prior to working or residing, violating CCR 87355(e)(1).
Failure to provide initial and annual training to staff assisting residents, violating CCR 87411(c).
Report Facts
Civil penalty amount: 500
Staff count: 5
Plan of Correction due date: Sep 14, 2024
Plan of Correction due date: Sep 27, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator/Director | Licensee involved in the inspection and cited for deficiencies. |
| Merclo Garcia | Licensee | Met during inspection and participated in exit interview. |
| Maria Partoza | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Marcella Tarin | Licensing Program Analyst | Assisted in conducting the inspection. |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 2
Date: Sep 15, 2024
Visit Reason
The visit was an unannounced case management deficiency inspection conducted to address issues related to staff fingerprint/criminal background clearance and training compliance at the facility.
Complaint Details
The visit was complaint-related, focusing on the lack of fingerprint/criminal record clearance and training for staff member S1. The deficiency was substantiated and a civil penalty was assessed.
Findings
The inspection found that one staff member (S1) was residing and providing care at the facility without the required fingerprint and criminal background clearance, and that this staff member had not received the required training for care and supervision of residents. A civil penalty of $500 was assessed for these deficiencies.
Deficiencies (2)
Failure to obtain California criminal background clearance for staff member residing and providing care at the facility.
Failure to provide initial and annual training to staff assisting residents with personal activities of daily living.
Report Facts
Civil penalty amount: 500
Staff count: 5
Plan of Correction due date: Type A deficiency due date 09/14/2024, Type B deficiency due date 09/27/2024.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator/Director | Licensee named in relation to deficiencies and interview. |
| Merclo Garcia | Licensee | Licensee met during inspection and exit interview. |
| Maria Partoza | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Marcella Tarin | Licensing Program Analyst | Participated in the inspection visit. |
Inspection Report
Census: 5
Capacity: 6
Deficiencies: 1
Date: Sep 13, 2024
Visit Reason
An unannounced case management deficiency visit was conducted to assess compliance with staff fingerprinting and training requirements at the facility.
Findings
The facility was found to have one staff member residing on-site without the required fingerprint and criminal background clearance and without proper training for care and supervision of residents. A civil penalty of $500 was assessed for this violation.
Deficiencies (1)
Staff member residing at the facility without fingerprint and criminal background clearance and without required training.
Report Facts
Civil penalty amount: 500
Staff count: 5
Days counted for penalty: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Met with Licensing Program Analysts during the inspection and discussed staff compliance. |
| Merclo Garcia | Administrator | Met with Licensing Program Analysts during the inspection and participated in exit interview. |
| Maria Partoza | Licensing Evaluator | Conducted the unannounced case management deficiency visit and signed the report. |
Inspection Report
Census: 5
Capacity: 6
Deficiencies: 1
Date: Sep 13, 2024
Visit Reason
An unannounced case management deficiency visit was conducted to assess compliance with staff fingerprint and criminal background clearance requirements.
Findings
The facility was found to have a staff member residing on-site without the required fingerprint and criminal background clearance, and this staff member had not received required training for care and supervision of residents. A civil penalty was assessed for this violation.
Deficiencies (1)
Staff member residing at the facility without fingerprint and criminal background clearance.
Report Facts
Civil penalty amount: 500
Staff count: 5
Facility capacity: 6
Resident census: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Met with inspectors and discussed staffing and compliance issues. |
| Merclo Garcia | Licensee | Met with inspectors and participated in exit interview. |
| Maria Partoza | Licensing Program Analyst | Conducted the inspection and issued the report. |
| Marcella Tarin | Licensing Program Analyst | Conducted the inspection. |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Date: Oct 7, 2022
Visit Reason
An unannounced Required 1 Year visit was conducted to evaluate the facility's compliance with regulations.
Findings
The Licensing Program Analyst toured the facility and observed adequate visitor screening, hygiene supplies, food supplies, and PPE. No deficiencies were cited during this inspection.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the unannounced Required 1 Year visit and evaluation. |
| Ramiro Custodio | Administrator | Facility administrator met with the Licensing Program Analyst during the visit. |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Date: Oct 7, 2022
Visit Reason
The inspection was an unannounced required 1-year visit to evaluate the facility's compliance with regulations.
Findings
The Licensing Program Analyst toured the facility and observed compliance with hygiene, food supply, and PPE requirements. No deficiencies were cited during this inspection.
Report Facts
Food supply: 2
Food supply: 7
PPE supply: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Met during inspection and reviewed report |
| David Marrufo | Licensing Program Analyst | Conducted the inspection |
| Sarah Yip | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Oct 22, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility was overcharging a resident.
Complaint Details
The complaint alleged that the facility was overcharging a resident. Interviews with residents and staff, as well as record reviews, showed no evidence to substantiate the allegation. The resident paid for damages at a reduced rate and was not forced to comply or make payment. The finding was unsubstantiated.
Findings
The investigation found the allegation to be unsubstantiated based on interviews with residents and staff, and a review of facility records showing no policy on property damage charges. The resident in question paid for damages at a reduced rate, and no deficiencies were cited during the visit.
Report Facts
Capacity: 6
Census: 6
Damage cost estimate: 7065
Damage payment: 6200
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anna Bui | Licensing Program Analyst | Conducted the complaint investigation visit |
| Ramiro Custodio | Administrator | Facility administrator met during the investigation and exit interview |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Oct 22, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility was overcharging a resident.
Complaint Details
The complaint alleged that the facility was overcharging a resident. Interviews with three residents and staff indicated that charges were consistent and damages were paid at a reduced rate. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Findings
Based on interviews with residents, staff, and review of facility records, the allegation was found to be unsubstantiated. No deficiencies were cited during the visit.
Report Facts
Damages cost estimate: 7065
Damages paid: 6200
Resident census: 6
Facility capacity: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anna Bui | Licensing Program Analyst | Conducted the complaint investigation visit |
| Ramiro Custodio | Administrator | Facility administrator involved in the investigation and exit interview |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Date: Oct 15, 2021
Visit Reason
An unannounced Annual Required 1 Year visit was conducted to evaluate the facility's compliance with licensing requirements.
Findings
No deficiencies were cited during the visit. An advisory note was issued recommending documentation of staff temperature checks and screening questions.
Report Facts
Medication supply duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Met with Licensing Program Analyst during the inspection and reviewed report and advisory note |
| Anna Bui | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Sarah Yip | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Date: Oct 15, 2021
Visit Reason
An unannounced annual required 1-year visit was conducted to evaluate the facility's compliance with licensing requirements.
Findings
No deficiencies were cited during the visit; however, an advisory note was issued recommending documentation of staff temperature checks and screening questions.
Report Facts
Facility capacity: 6
Resident census: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramiro Custodio | Administrator | Met with Licensing Program Analyst during the inspection and reviewed the report and advisory note |
| Anna Bui | Licensing Program Analyst | Conducted the inspection visit |
| Sarah Yip | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: May 11, 2021
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility was not operating at a comfortable temperature.
Complaint Details
The complaint alleged that the facility was not operating at a comfortable temperature. The allegation was investigated and found to be unfounded.
Findings
The investigation found that the facility's thermostat was set at 75 degrees Fahrenheit, within the acceptable range, and portable heaters were available. The heater had been broken but was repaired on 03/25/2021. Based on interviews and observations, the allegation was determined to be unfounded.
Report Facts
Facility capacity: 6
Census: 6
Thermostat temperature: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anna Bui | Licensing Program Analyst | Conducted the complaint investigation |
| Ramiro Custodio | Administrator | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: May 11, 2021
Visit Reason
The inspection visit was conducted as a complaint investigation regarding an allegation that the facility was not operating at a comfortable temperature.
Complaint Details
The complaint alleged that the facility was not operating at a comfortable temperature. The investigation included interviews with residents and staff, observation of the thermostat set at 75 degrees Fahrenheit, and confirmation that the heater was repaired. The allegation was found to be unfounded.
Findings
The investigation found that the facility's temperature was within the acceptable range, portable heaters were available, and the heater had been repaired. The allegation was determined to be unfounded.
Report Facts
Facility capacity: 6
Census: 6
Temperature: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anna Bui | Licensing Program Analyst | Conducted the complaint investigation visit |
| Sarah Yip | Licensing Program Manager | Reviewed the complaint investigation report |
| Ramiro Custodio | Administrator | Facility representative interviewed and acknowledged the report |
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