Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 2
Apr 7, 2025
Visit Reason
Licensing Program Analyst Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection.
Findings
The facility was generally compliant with required standards including resident and staff records, food storage, and medication administration. However, deficiencies were cited for missing documentation of quarterly fire and earthquake drills and for three fire extinguishers lacking service tags or proof of service.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| No proof of quarterly Fire and Earthquake drills documentation on file. | Type B |
| Three fire extinguishers mounted throughout the facility without serviced tags or receipts as proof of service. | Type A |
Report Facts
Fire extinguishers without service tags: 3
Facility capacity: 6
Current census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debbie Palacios | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Malcolm E White | Administrator/Director | Facility administrator named in the report. |
| Sunny Rosete | Caregiver | Met with Licensing Program Analyst during inspection. |
| Tricia Danielson | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Apr 18, 2024
Visit Reason
The visit was conducted for a Pre-Licensing inspection of the facility to evaluate compliance with regulatory requirements prior to licensing.
Findings
The facility was found to be in compliance with all applicable regulations with no Title 22, Division 6 violations observed or cited. The physical plant, medication storage, safety equipment, bedrooms, kitchen, bathrooms, records, administration, activities, and dementia care provisions met regulatory standards.
Report Facts
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Malcolm E White | Administrator | Met with Licensing Program Analyst during the Pre-Licensing inspection |
| Venus Mixson | Licensing Program Analyst | Conducted the Pre-Licensing inspection |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Mar 4, 2024
Visit Reason
The visit was an initial licensing evaluation conducted virtually to assess the applicant/administrator's understanding of community care facility licensing laws and readiness for operation.
Findings
The applicant/administrator demonstrated understanding of licensing laws, facility operation, admission policies, staffing requirements, emergency preparedness, complaints reporting, and pre-licensing readiness during the virtual interview.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Malcolm E White | Licensee/Administrator | Participated in the initial licensing evaluation and interview. |
| Darla Neeley | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Diamond Law | Licensing Program Analyst | Named as Licensing Program Analyst on the report. |
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