Deficiencies (last 5 years)
Deficiencies (over 5 years)
6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
50% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
43% occupied
Based on a March 2026 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy over time
Inspection Report
Census: 18
Capacity: 42
Deficiencies: 3
Date: Mar 19, 2026
Visit Reason
The visit was an unannounced case management inspection conducted by Licensing Program Analyst A Gomez to assess compliance following a previous visit on 10/3/2025 where multiple deficiencies were observed including unclean conditions and insufficient staffing.
Findings
The inspection found deficiencies including visibly soiled surfaces with dried feces and blood, insufficient staffing to meet resident needs, and furniture in disrepair posing safety risks. Plans of correction were requested with a due date of 03/26/2026.
Deficiencies (3)
Facility did not disinfect visibly soiled surfaces in room 11, including dried feces and dried blood on wall next to bed, and floors were unsanitary.
Facility personnel numbers were insufficient to meet residents' needs; on 10/3/2025, 5 out of 23 residents required two-person assist but only three caregivers and one medtech were on shift.
Facility did not maintain furniture in a state of good repair; activities area sofas were ripping at seams and exposing nails, posing safety and personal rights risks.
Report Facts
Census: 18
Total Capacity: 42
Caregivers on shift: 3
Residents requiring two-person assist: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Administrator/Director | Named as facility administrator/director |
| Cecily Palma | Executive Director | Met with Licensing Program Analyst during inspection |
| Christine Montemayor | Resident Care Coordinator | Met with Licensing Program Analyst during inspection |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 22
Capacity: 42
Deficiencies: 1
Date: Oct 21, 2025
Visit Reason
The inspection was conducted as a case management visit related to complaint 15-AS-20250612143154 to follow up on requested documents and investigate compliance.
Complaint Details
The visit was complaint-related for complaint 15-AS-20250612143154. The facility refused to provide corrective actions/write-ups issued to staff, which was identified as a potential personal rights violation to residents in care.
Findings
The facility failed to provide requested corrective action documents (write-ups) to the licensing agency as required, which was cited as a deficiency posing a potential personal rights violation to residents in care.
Deficiencies (1)
Facility not providing requested documents as allowed; Inspection Authority of the Licensing Agency
Report Facts
Plan of Correction (POC) due date: Oct 24, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dimple Kamdar | Operations Specialist | Interviewed regarding refusal to provide corrective action documents |
| Alona Gomez | Licensing Program Analyst | Conducted the case management visit and inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 22
Capacity: 42
Deficiencies: 1
Date: Oct 21, 2025
Visit Reason
The inspection was conducted as a case management visit related to complaint 15-AS-20250612143154 to follow up on requested documents and compliance with licensing requirements.
Complaint Details
The visit was complaint-related for complaint number 15-AS-20250612143154. The deficiency was substantiated as the facility refused to provide corrective action documents as requested.
Findings
The facility was found deficient for refusing to provide requested corrective action documents/write-ups for staff, which poses a potential personal rights violation to residents in care.
Deficiencies (1)
Facility not providing requested documents as allowed; Inspection Authority of the Licensing Agency
Report Facts
Capacity: 42
Census: 22
Plan of Correction Due Date: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dimple Kamdar | Operations Specialist | Named in relation to refusal to provide corrective action documents |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection and authored the report |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 23
Capacity: 42
Deficiencies: 0
Date: Oct 3, 2025
Visit Reason
The visit was an unannounced case management inspection conducted in response to a self-reported incident alleging abuse and inadequate care by staff members, as well as failure of the Executive Director to escalate the incidents.
Complaint Details
The complaint involved allegations that staff members S1 and S2 were abusing residents, and that S2 and S3 were not providing adequate care. The Executive Director was suspended and then terminated for failure to escalate the alleged abuse incidents.
Findings
The inspection found allegations of staff abuse and inadequate care, termination of the Executive Director for failure to escalate incidents, dirty resident rooms and bathrooms, insufficient caregiver staffing for residents requiring two-person assist, and damaged furniture in common areas. The facility is actively seeking new maintenance and housekeeping staff and plans to hire more caregivers.
Report Facts
Caregivers on shift: 3
Residents requiring two-person assist: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hong Phuc Truong | Executive Director | Terminated for failure to escalate alleged incidents of abuse |
| Dimple Kamdar | Operations Specialist | Met with Licensing Program Analyst during inspection |
| Alona Gomez | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Complaint Investigation
Census: 23
Capacity: 42
Deficiencies: 0
Date: Oct 3, 2025
Visit Reason
The inspection visit was an unannounced case management visit conducted in response to a self-reported incident received on 2025-09-24 alleging abuse by staff members and inadequate care provided to residents.
Complaint Details
The visit was triggered by a complaint alleging abuse by staff members S1 and S2, and inadequate care by S2 and S3. The Executive Director was suspended and subsequently terminated for failure to escalate the abuse allegations.
Findings
The visit found allegations of abuse involving staff members S1 and S2, inadequate care by S2 and S3, and the termination of the Executive Director for failure to escalate the incidents. Observations included dirty resident rooms, unclean bathrooms with dry fecal matter, insufficient caregiver staffing, and damaged furniture in common areas.
Report Facts
Caregivers on shift: 3
Residents requiring two-person assist: 5
Facility capacity: 42
Resident census: 23
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hong Phuc Truong | Executive Director | Named in the report for suspension and termination due to failure to escalate abuse allegations |
| Dimple Kamdar | Operations Specialist | Met with Licensing Program Analyst during the visit and provided information about staffing and maintenance |
Inspection Report
Annual Inspection
Census: 21
Capacity: 42
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was an unannounced 1-Year Annual Required inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The inspection found no deficiencies. The facility was toured, records reviewed, and safety measures such as fire clearance, emergency plans, and medication storage were verified to be in compliance.
Report Facts
Residents records reviewed: 6
Staff records reviewed: 5
Fire extinguisher last serviced: Jan 9, 2025
Emergency disaster drill date: Mar 25, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during inspection and involved in facility tour |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection visit |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was conducted as a case management inspection resulting from an unusual incident report received on 2025-03-27 involving a resident found on the floor with a possible abuse allegation.
Complaint Details
The visit was triggered by a complaint regarding a resident (R1) found on the floor with a staff member allegedly stepping on them. The allegation was unsubstantiated as no injuries were found and the reporting staff indicated they may have seen the incident from a wrong angle.
Findings
The investigation found no visible injuries to the resident and no deficiencies were cited. The incident was reported by staff who may have misinterpreted the event, and the resident was unable to recall the incident.
Report Facts
Capacity: 42
Census: 21
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with during inspection and involved in incident discussion |
| Alona Gomez | Licensing Program Analyst | Conducted the case management inspection |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was conducted as a case management inspection following an unusual incident report received on 2025-03-27 regarding a resident found on the floor with a possible abuse allegation.
Complaint Details
The complaint involved a report that a staff member was seen stepping on a resident who was found on the floor. The allegation was not substantiated as there were no other witnesses, no injuries, and the reporting staff later indicated they may have seen the incident from a wrong angle.
Findings
The investigation found no visible injuries to the resident and no deficiencies were cited. The incident was reported by staff who may have misinterpreted the event, and the resident was unable to recall the incident.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with during the inspection and provided information regarding the incident. |
| Alona Gomez | Licensing Program Analyst | Conducted the case management visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Annual Inspection
Census: 21
Capacity: 42
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements.
Findings
The facility was found to be in compliance with no deficiencies cited. The inspection included a tour of the facility, review of resident and staff records, and verification of safety measures such as fire clearance, emergency plans, and medication storage.
Report Facts
Residents records reviewed: 6
Staff records reviewed: 5
Fire extinguisher last serviced: Jan 9, 2025
Emergency disaster drill completed: Mar 25, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during inspection |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Date: Jun 14, 2024
Visit Reason
The inspection was conducted as a case management visit resulting from an unusual incident report received on 2024-05-24 involving resident altercations.
Complaint Details
The visit was triggered by a complaint related to an incident on 2024-05-23 where R1 attempted to hit R2 and R3. The complaint was investigated, and no deficiencies were cited. R2 and R3 returned to baseline after hospitalization. R1 no longer resides at the facility.
Findings
The investigation found that resident R1 attempted to hit residents R2 and R3, resulting in R2 and R3 being hospitalized. R1 was provided 1:1 supervision and later discharged from the facility. No deficiencies were cited during the visit, and staff received additional training on dementia and aggressive behavior care.
Report Facts
Incident date: May 23, 2024
Incident report received date: May 24, 2024
Visit start time: 1400
Visit end time: 1526
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with during inspection and discussed incident and care plans |
| Alona Gomez | Licensing Program Analyst | Conducted the case management visit |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Date: Jun 14, 2024
Visit Reason
The visit was conducted as a case management follow-up resulting from an unusual incident report received on 2024-05-24 involving resident altercations.
Complaint Details
The complaint involved an incident on 2024-05-23 where R1 attempted to hit R2 and R3 with a cane. Police and 911 were notified, and R2 and R3 were hospitalized but have since returned to baseline. The facility provided additional staff training on dementia and aggressive behavior care.
Findings
The investigation found that resident R1 attempted to hit residents R2 and R3, resulting in R2 and R3 being sent to the hospital. R1 was provided 1:1 supervision after the incident and later discharged from the facility. No deficiencies were cited during the visit.
Report Facts
Incident report date: May 24, 2024
Incident date: May 23, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during the visit and provided information about the incident and resident care |
Inspection Report
Complaint Investigation
Census: 25
Capacity: 42
Deficiencies: 5
Date: May 14, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2023-12-22 regarding facility cleanliness, resident care plan adherence, adequate care and supervision, and reporting requirements.
Complaint Details
The complaint investigation was substantiated based on a preponderance of evidence for allegations related to facility cleanliness, care plan adherence, staffing shortages, and failure to follow reporting requirements. Other allegations were unsubstantiated.
Findings
The investigation substantiated several allegations including failure to maintain clean and sanitary conditions, failure to follow resident care plans (e.g., not applying compression socks as prescribed), inadequate staffing levels, and failure to follow reporting requirements. Other allegations such as ensuring residents receive meals, having a certified administrator, residents being kept in clean dry clothing, and proper medication dispensing were found unsubstantiated.
Deficiencies (5)
Facility was not kept clean and sanitary; vomit was left uncleaned on the floor.
Facility did not have adequate staffing to support residents' needs.
Facility failed to submit required written reports including date, nature of event, attending physician's name, findings, treatment, and disposition.
Facility staff were unaware of how and where to report incidents to licensing.
Facility was not following directions made by resident's doctor regarding care plans.
Report Facts
Capacity: 42
Census: 25
Plan of Correction Due Date: May 28, 2024
Deficiency Count: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jill Clancy-Czuleger | Licensing Evaluator | Conducted the complaint investigation and authored the report |
| Teresa Truong | Executive Director | Facility representative met during the inspection |
| Jasmine Seiffert | Administrator | Facility administrator mentioned in relation to staffing and certification status |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Date: Apr 25, 2024
Visit Reason
The visit was an unannounced Case Management inspection conducted in response to an unusual incident report received regarding a medication error involving resident R1 on 3/17/2024.
Complaint Details
The complaint involved a medication error where resident R1 was given 8 mg of Ativan instead of the prescribed 2 mg dose on 3/17/2024. The error was identified on 3/18/2024 and reported. The complaint was investigated and substantiated with corrective actions taken.
Findings
The inspection found that a medication error occurred where resident R1 was given the wrong dose of Ativan due to a change in milligrams per tablet that was not noticed by the Medtech. The Executive Director acknowledged the oversight, staff were retrained, and the Medtech was disciplined. No ill side effects were sustained by the resident and no deficiencies were cited during the visit.
Report Facts
Medication dosage error: 8
Facility capacity: 42
Resident census: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst and acknowledged medication error oversight |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection visit |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Date: Apr 25, 2024
Visit Reason
The visit was conducted as a Case Management visit in response to an unusual incident report received on 2024-03-21 regarding a medication error that occurred on 2024-03-17.
Complaint Details
The complaint involved a medication error where a resident was given 8 mg of Ativan instead of the prescribed 2 mg dose. The error was substantiated, corrective training was provided, and the responsible staff member was written up.
Findings
The investigation found that a resident was given the wrong dose of medication due to a change in milligrams per tablet that was not noticed by the Medtech. The Executive Director acknowledged the oversight, staff were retrained, and the Medtech was disciplined. No ill side effects were sustained by the resident and no deficiencies were cited during the visit.
Report Facts
Medication dosage error: 8
Medication dosage prescribed: 2
Facility capacity: 42
Resident census: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during visit and acknowledged medication error oversight |
| Alona Gomez | Licensing Program Analyst | Conducted the case management visit |
Inspection Report
Annual Inspection
Census: 21
Capacity: 42
Deficiencies: 2
Date: Apr 10, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The inspection found that the facility generally maintained adequate safety and comfort conditions, including adequate lighting, temperature control, and locked medication storage. However, two deficiencies were noted: hot water temperature in one resident room exceeded the allowed maximum, and the facility lacked updated documentation of emergency disaster drills.
Deficiencies (2)
Hot water temperature in room 12 measured at 121.6 degrees F, exceeding the maximum allowed temperature.
No records of emergency disaster drills were found, indicating failure to maintain required documentation.
Report Facts
Hot water temperature: 121.6
Census: 21
Total capacity: 42
Plan of Correction Due Date: Apr 12, 2024
Plan of Correction Due Date: Apr 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during inspection and agreed to plans of correction |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection and signed the report |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 4
Date: Apr 10, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 2024-01-31 regarding resident hygiene, safeguarding of personal items, locked resident bedrooms, reporting requirements, and staffing adequacy.
Complaint Details
The complaint investigation was substantiated for allegations including inadequate resident hygiene, failure to safeguard personal items, locked resident rooms without keys, failure to follow reporting requirements, and insufficient staffing. Allegations regarding unexplained fractures, residents left soiled, and lack of activities were unsubstantiated.
Findings
The investigation substantiated that there was insufficient staffing to meet residents' hygiene and care needs, residents' personal items were not properly safeguarded, residents' rooms were locked without keys provided to most residents, and reporting requirements were not followed timely. Some allegations related to unexplained fractures, residents being left soiled, and lack of activities were unsubstantiated.
Deficiencies (4)
Residents' rooms were locked and most residents did not have a key, posing a potential health and safety risk.
Facility did not safeguard residents' cash, personal property, and valuables, posing a potential health and safety risk.
Inadequate staffing to meet residents' care and hygiene needs.
Failure to notify residents' responsible parties in a timely manner regarding changes in residents' conditions.
Report Facts
Capacity: 42
Census: 21
Deficiencies cited: 4
Plan of Correction Due Date: Apr 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Truong | Executive Director | Interviewed during investigation; acknowledged staffing shortages and issues with resident care and reporting |
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw complaint investigation report |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 1
Date: Apr 10, 2024
Visit Reason
Unannounced complaint investigation visit conducted in response to allegations that staff did not inform a resident's physician of a change in condition and did not ensure resident's medication supply was available at the facility.
Complaint Details
The complaint was substantiated based on the preponderance of evidence standard. Allegations included failure to notify physicians of resident condition changes and failure to ensure medication availability. The Health and Wellness director was found responsible and dismissed.
Findings
The investigation found that physicians were not notified in a timely manner as required and medication supply was mismanaged. The Health and Wellness director responsible for medication availability was not performing duties and was subsequently dismissed.
Deficiencies (1)
Failure to develop and implement a plan for incidental medical and dental care, including assistance in obtaining care and ensuring medication availability.
Report Facts
Facility capacity: 42
Census: 21
Deficiency count: 1
Plan of Correction due date: Apr 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Truong | Executive Director | Interviewed during investigation; confirmed issues with physician notification and medication management |
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 4
Date: Apr 10, 2024
Visit Reason
An unannounced complaint investigation was conducted based on a complaint received on 2024-01-31 regarding multiple allegations including inadequate resident hygiene, safeguarding of personal items, locked resident rooms, failure to follow reporting requirements, and insufficient staffing.
Complaint Details
The complaint investigation was substantiated for allegations related to inadequate hygiene, safeguarding of personal items, locked rooms, failure to follow reporting requirements, and insufficient staffing. Allegations regarding unexplained fractures, residents left soiled, and lack of activities were unsubstantiated.
Findings
The investigation substantiated several allegations including inadequate staffing leading to unmet hygiene and care needs, failure to notify responsible parties timely, residents' clothing being mixed up, and locked resident rooms without keys posing safety risks. However, allegations regarding unexplained fractures, residents being left soiled for extended periods, and lack of activities were found unsubstantiated due to insufficient evidence.
Deficiencies (4)
Residents' rooms are locked and most residents do not have a key, posing a potential health and safety risk.
Failure to safeguard residents' cash, personal property, and valuables.
Inadequate staffing to meet residents' care and hygiene needs.
Failure to regularly observe residents for changes in physical condition and notify responsible parties.
Report Facts
Capacity: 42
Census: 21
Deficiencies cited: 4
Plan of Correction Due Date: Apr 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Truong | Executive Director | Interviewed regarding staffing shortages, hygiene needs, reporting failures, and locked resident rooms |
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 42
Deficiencies: 1
Date: Apr 10, 2024
Visit Reason
An unannounced complaint investigation was conducted based on a complaint received on 2024-02-27 regarding staff not informing a resident's physician of a change in condition and not ensuring medication supply availability.
Complaint Details
The complaint was substantiated based on interviews and observations. The allegations included failure to notify physicians timely of resident condition changes and mismanagement of medication supply. The Health and Wellness Director was found responsible and was terminated.
Findings
The investigation substantiated that physicians were not notified timely of resident condition changes and medication supply was mismanaged. The Health and Wellness Director responsible for medication oversight was dismissed as a result.
Deficiencies (1)
Failure to develop a plan for incidental medical and dental care, including assistance in obtaining such care, as required by CCR 87465(a)(4).
Report Facts
Capacity: 42
Census: 21
Plan of Correction Due Date: Apr 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Truong | Executive Director | Interviewed during investigation; confirmed issues with physician notification and medication management |
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Annual Inspection
Census: 21
Capacity: 42
Deficiencies: 2
Date: Apr 10, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The inspection found that the facility had hot water temperature exceeding the allowed maximum and lacked documentation of emergency disaster drills. The facility was required to submit updated emergency disaster plans and complete disaster drills by specified due dates.
Deficiencies (2)
Hot water temperature in room 12 measured at 121.6 degrees F, exceeding the maximum allowed temperature.
No records of emergency disaster drills were found during file review.
Report Facts
POC Due Date: Apr 12, 2024
POC Due Date: Apr 19, 2024
Residents records reviewed: 5
Staff records reviewed: 5
Staff with current first aid training: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Hong Phuc Truong | Executive Director | Met with Licensing Program Analyst during inspection and agreed to plan of correction |
| Alona Gomez | Licensing Evaluator | Conducted the inspection and signed the report |
| Yvonne Flores-Larios | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 24
Capacity: 42
Deficiencies: 3
Date: Nov 27, 2023
Visit Reason
The inspection was an unannounced 1-Year Annual Required visit conducted to evaluate compliance with licensing regulations.
Findings
The inspection found deficiencies related to incomplete employee files, missing first aid training for required staff, and missing resident file documents including safeguards for property, consent form, and personal rights.
Deficiencies (3)
Resident file missing Safeguards for Property/Valuables, Consent Form, and Personal Rights.
All employee files were observed incomplete.
Required staff are missing first aid training.
Report Facts
Deficiencies cited: 3
POC Due Date: Dec 4, 2023
Facility Capacity: 42
Census: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jasmine Seiffert | Executive Director | Met with inspectors during the visit and responsible for plan of correction. |
| Yvonne Flores-Larios | Licensing Program Manager | Conducted the inspection and signed the report. |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Cheyenne Flores | Health and Wellness Director | Present during the facility tour. |
Inspection Report
Annual Inspection
Census: 24
Capacity: 42
Deficiencies: 3
Date: Nov 27, 2023
Visit Reason
The inspection was an unannounced 1-Year Annual Required visit conducted to evaluate compliance with licensing regulations at the facility.
Findings
The inspection found deficiencies related to incomplete employee files, missing safeguards and consent forms in a resident's file, and required staff missing first aid training. The facility had appropriate environmental conditions and emergency preparedness measures in place.
Deficiencies (3)
Resident file R4 was missing Safeguards for Property/Valuables, Consent Form, and Personal Rights.
All employee files reviewed were incomplete.
Required staff were missing first aid training.
Report Facts
Capacity: 42
Census: 24
POC Due Date: 12042023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jasmine Seiffert | Executive Director | Met with Licensing Program Analyst during inspection and named in report. |
| Glenda Bertucci | Administrator | Facility administrator named in report. |
| Alona Gomez | Licensing Program Analyst | Conducted the inspection. |
| Yvonne Flores-Larios | Licensing Program Manager / Supervisor | Supervised the inspection. |
| Cheyenne Flores | Health and Wellness Director | Present during facility tour. |
Inspection Report
Routine
Census: 26
Capacity: 42
Deficiencies: 0
Date: Jul 27, 2021
Visit Reason
The visit was an unannounced infection control inspection conducted as a required one-year routine check.
Findings
The inspection found the facility compliant with infection control standards, including proper PPE use, adequate food supply, and effective screening procedures. 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 |
|---|---|---|
| Glenda Bertucci | Executive Director | Met with Licensing Program Analysts during inspection |
| Lizette Francisco | Licensing Program Analyst | Conducted the infection control inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Routine
Census: 26
Capacity: 42
Deficiencies: 0
Date: Jul 27, 2021
Visit Reason
The visit was an unannounced infection control inspection conducted as a required one-year routine inspection.
Findings
The facility was found to have adequate infection control measures including proper PPE use, sufficient food supply, a central screening station with sign-in policy, and routine screening records. 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 |
|---|---|---|
| Glenda Bertucci | Executive Director | Met with Licensing Program Analysts during inspection |
| Lizette Francisco | Licensing Evaluator | Conducted the infection control inspection |
| Harpreet Humpal | Supervisor | Supervisor overseeing the inspection |
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