Inspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally good compliance with regulations. The most recent report from August 19, 2025, noted a minor deficiency involving missing valid health screening and TB test results in personnel files but no serious issues. Past deficiencies mainly involved personnel recordkeeping and staff training certificates, with no fines or enforcement actions listed in the available reports. A substantiated complaint in August 2023 found unqualified staff administering glucose testing, which posed a risk but was addressed. Overall, the facility’s record shows improvement in compliance with the latest inspection showing only minor isolated issues.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 69
Capacity: 75
Deficiencies: 1
Aug 19, 2025
Visit Reason
The inspection was an unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate compliance with licensing requirements.
Findings
The facility was found to have generally compliant infection control practices, operational requirements, physical plant safety, staffing, and resident rights. However, deficiencies were noted related to personnel records where the Executive Director and three staff members lacked valid health screening and TB test results in their files.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Executive Director, Staff #2, Staff #5, and Staff #6 files did not have valid Health Screening and TB test results, posing a potential health, safety, or personal rights risk to persons in care. | Type B |
Report Facts
Census: 69
Total Capacity: 75
Staff Count: 44
Fire Extinguishers: 17
Resident Rooms: 31
Resident Rooms: 34
Resident Medications Reviewed: 8
Residents Receiving Home Health Services: 4
Residents Receiving Hospice Care: 5
Residents Using Oxygen: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ken Patrick Padilla | Wellness Director | Met with Licensing Program Analyst during inspection and received exit interview |
| Daniel Konishi | Licensing Program Analyst | Conducted the inspection and authored the report |
| David Sicairos | Supervisor | Supervisor of the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 75
Deficiencies: 0
Feb 25, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that staff spoke inappropriately to a resident, failed to meet residents' incontinence needs, and did not assist residents when responding to call buttons.
Findings
The investigation included interviews with staff and residents, a facility tour, and record reviews. The allegations were found to be unsubstantiated due to lack of corroborating evidence from residents, staff, and police investigation. The staff member involved voluntarily resigned during the investigation.
Complaint Details
The complaint involved allegations that staff member S6 spoke inappropriately to resident R1, refused to provide incontinence care, and intentionally deactivated call light pendants without assisting residents. Interviews with residents and staff, as well as police investigation, did not corroborate these allegations. The allegations were determined to be unsubstantiated.
Report Facts
Capacity: 75
Census: 66
Staff interviewed: 6
Residents interviewed: 7
Suspension date: Feb 13, 2025
Resignation date: Feb 25, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Logan Harrison | Executive Director | Facility representative met during investigation |
| Ralph Balbin | Administrator | Facility administrator named in report header |
Inspection Report
Annual Inspection
Census: 67
Capacity: 75
Deficiencies: 1
Aug 6, 2024
Visit Reason
An unannounced required 1-year visit was conducted using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate compliance with licensing regulations.
Findings
The facility was found to be generally compliant with infection control, operational requirements, physical plant safety, staffing, resident rights, planned activities, food service, medical and dental care, resident records, and disaster preparedness. However, a deficiency was cited for personnel requirements due to five out of six staff files lacking valid/current First aid/CPR training certificates.
Deficiencies (1)
| Description |
|---|
| Five out of six staff files reviewed did not have a valid/current First aid/CPR training certificates on file, posing a potential health, safety or personal rights risk to residents. |
Report Facts
Residents under hospice care: 4
Staff members: 44
Staff files reviewed: 6
Staff without valid First aid/CPR training: 5
Fire extinguishers: 17
Hot water temperature tested rooms: 8
Licensed capacity: 75
Current census: 67
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Logan Harrison | Executive Director/Administrator | Met with Licensing Program Analyst and named in exit interview |
| Bennette Pena | Licensing Program Analyst | Conducted the inspection and authored the report |
| David Sicairos | Supervisor | Supervisor overseeing the licensing evaluation |
| Dedearie Villanueva | Staff scheduled for First aid/CPR training as part of Plan of Correction | |
| Tamaria Mcrae | Staff scheduled for First aid/CPR training as part of Plan of Correction | |
| Kathryn Sandoval | Staff scheduled for First aid/CPR training as part of Plan of Correction | |
| Carina Graham | Staff scheduled for First aid/CPR training as part of Plan of Correction | |
| Dylaney Edinger | Staff scheduled for First aid/CPR training as part of Plan of Correction |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 75
Deficiencies: 0
Nov 13, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility failed to adhere to the admission agreement.
Findings
The investigation found that the facility credited Resident #1 with 60% of the refundable community fee as per the admission agreement for a resident leaving within the second month of residency. Interviews with staff and residents supported that the facility was responsive and fair regarding fees and credits. There was insufficient evidence to substantiate the allegation, and it was determined to be unsubstantiated.
Complaint Details
The complaint alleged the facility failed to credit the correct amount of Resident #1's refundable community fee ($2,000), claiming an 80% credit was due but only 60% was provided. The investigation concluded the 60% credit was appropriate based on the timing of the resident's notice to vacate and admission agreement terms. The allegation was unsubstantiated due to lack of sufficient evidence.
Report Facts
Refundable community fee: 2000
Credit percentage given: 60
Credit percentage alleged due: 80
Facility capacity: 75
Resident census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Logan Harrison | Executive Director | Interviewed regarding admissions, discharge, refunds, and credit issues |
| Tena Herrera | Licensing Program Analyst | Conducted the complaint investigation visit |
| David Sicairos | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 75
Deficiencies: 0
Sep 26, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 09/18/2023 regarding staff not cleaning resident rooms, inadequate staffing, unqualified staff performing glucose testing, improper staff training, and failure to administer medication.
Findings
The investigation found no corroboration for any of the allegations after resident and staff interviews, facility tours, and record reviews. Staff were found to clean rooms regularly, adequately staff the facility, not perform glucose testing themselves, be properly trained, and administer medications appropriately. The allegations were determined to be unsubstantiated due to lack of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not cleaning resident rooms, inadequate staffing leading to neglect, unqualified staff performing glucose testing, improper staff training on injectable medication, and failure to administer injectable medication. All allegations were not corroborated by resident or staff interviews or record reviews.
Report Facts
Residents interviewed: 7
Staff interviewed: 6
Facility capacity: 75
Facility census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Logan Harrison | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 57
Capacity: 75
Deficiencies: 0
Sep 26, 2023
Visit Reason
The inspection was an unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate compliance with regulatory standards.
Findings
The facility was found to be in compliance with no deficiencies cited. Infection control practices, operational requirements, physical plant safety, staffing, personnel records, resident records, food service, and disaster preparedness were all reviewed and found satisfactory.
Report Facts
Staff members: 42
Resident files reviewed: 7
Resident medications reviewed: 6
Residents on Hospice: 5
Residents on Home Health: 8
Fire clearance capacity: 75
Non ambulatory residents allowed: 34
Bedridden residents allowed: 0
Perishables food supply: 2
Non-perishables food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the inspection and named in findings |
| Ashley Calderon | Licensing Program Analyst | Conducted the inspection and named in findings |
| Logan Harrison | Administrator | Met with during inspection and named in findings |
| Fernando Fierros | Supervisor | Named as supervisor on report |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 75
Deficiencies: 1
Aug 31, 2023
Visit Reason
The inspection was an unannounced follow-up complaint investigation conducted due to multiple allegations including improper staff training, presence of pests, residents' personal items posing hazards, and glucose testing being administered by unqualified personnel.
Findings
The investigation found the allegations of improper staff training, pest issues, and residents hoarding personal items to be unsubstantiated based on interviews and record reviews. However, the allegation that glucose testing was being administered by med techs instead of appropriately skilled professionals was substantiated, posing an immediate risk to residents.
Complaint Details
The complaint investigation was triggered by allegations received on 04/07/2022 regarding staff training, pest presence, hazards from residents' personal items, and improper glucose testing. The glucose testing allegation was substantiated; others were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Glucose testing was administered by unqualified med techs instead of appropriately skilled professionals, violating CCR 87628(a). | Type A |
Report Facts
Capacity: 75
Census: 51
Deficiencies cited: 1
Plan of Correction Due Date: Sep 1, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Logan Harrison | Administrator | Facility administrator met during investigation |
| Ralph Balbin | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 75
Deficiencies: 0
Aug 25, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 09/28/2022 concerning resident falls due to lack of supervision, delayed response to call buttons, and residents receiving cold meals.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with residents and staff indicated that falls were promptly assisted, call light requests were answered timely with an effective notification system, and food was generally served warm with procedures in place to maintain temperature.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included a resident sustaining a fall due to lack of supervision, staff not answering call buttons timely, and residents receiving cold meals. Interviews and document reviews did not corroborate these claims.
Report Facts
Facility capacity: 75
Resident census: 51
Call light response time: 3
Call light delay allegation: 30
Call light delay allegation: 42
Resident interviews: 8
Staff interviews: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Mia Nakamatzu | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Ralph Balbin | Administrator | Facility administrator at time of investigation |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 75
Deficiencies: 0
Mar 14, 2023
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 03/10/2023 regarding allegations that the facility failed to refill a resident's prescription and failed to inform the responsible party that the prescription was not filled.
Findings
The investigation included interviews with residents, staff, and review of records. All interviewed residents and staff denied the allegations, and medication records were found to be current and updated. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint involved two allegations: 1) Facility failed to refill a resident's prescription; 2) Facility failed to inform the responsible party that the prescription was not filled. Both allegations were investigated and found unsubstantiated.
Report Facts
Capacity: 75
Census: 51
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Wong | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Danny Vera | Executive Director | Facility representative who assisted with the visit and received the report |
| Mia Nakamatzu | Business Office Manager | Allowed entry to the facility and explained the reason for the visit |
Inspection Report
Annual Inspection
Census: 54
Capacity: 75
Deficiencies: 2
Feb 13, 2023
Visit Reason
The inspection was a Required - 1 Year unannounced visit to evaluate compliance with licensing regulations, focusing on infection control.
Findings
The facility was inspected for infection control practices including COVID-19 signage, visitor screening, and staff mask usage. Deficiencies were cited related to maintenance and water temperature issues.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Room #122 shower facet is loose which poses potential health, safety or personal rights risk to persons in care. | Type B |
| Bathroom in first floor closer to reception desk had water temperature at 120.02 degrees F. Shower water in room 125 measured 98.1 degrees F. Room 234 water measured 121.1 degrees F which poses an immediate health, safety or personal rights risk to persons in care. | Type A |
Report Facts
Capacity: 75
Census: 54
Hospice Waiver Residents: 10
Deficiencies cited: 2
POC Due Date: Feb 20, 2023
POC Due Date: Feb 15, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Conducted the inspection and authored the report |
| Danny Vera | Executive Director | Facility representative met during inspection and exit interview |
| Lisa Hicks | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Annual Inspection
Census: 62
Capacity: 75
Deficiencies: 4
Dec 9, 2021
Visit Reason
The inspection was a Required - 1 Year unannounced visit to evaluate compliance with Title 22 regulations, focusing on infection control, physical plant conditions, medication, and food supplies.
Findings
The facility was generally compliant with regulations, but several deficiencies were noted including hot water temperatures exceeding regulatory limits in multiple resident rooms, disrepair of a wooden fence, a wall near room #112 with a hole, and a kitchen drawer in room #105 that would not open or close properly.
Severity Breakdown
Type A: 1
Type B: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Hot water temperature in multiple rooms exceeded Title 22 limits, posing an immediate health and safety risk. | Type A |
| Wall near entrance of room #112 was in disrepair with a hole on the corner. | Type B |
| Kitchen top drawer next to the sink in room #105 was in disrepair and would not open or close properly. | Type B |
| Wooden fence by the east walkway was in disrepair with broken pieces and leaning forward, posing a potential health and safety risk. | Type B |
Report Facts
Residents present: 62
Licensed capacity: 75
Hospice waiver residents: 10
Hot water temperature: 124
Hot water temperature: 122.2
Hot water temperature: 124.9
Hot water temperature: 123.1
Hot water temperature: 123.1
Hot water temperature: 121.2
Hot water temperature: 98.5
Hot water temperature: 97.2
Hot water temperature: 68.1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joe Katrdzhyan | Licensing Evaluator | Conducted the inspection and signed the report |
| Wei Siew Ho | Supervisor | Supervised the inspection |
| Diana Marquez | Business Office Manager | Met with LPAs during the inspection |
| Danny Vera | Assistant Administrator | Assisted with the inspection visit |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 75
Deficiencies: 0
Aug 4, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to address allegations of resident mistreatment by staff and failure to safeguard a resident's personal property.
Findings
The investigation found insufficient evidence to substantiate the allegations of resident mistreatment and failure to safeguard personal property. The allegation of mistreatment was related to a dispute over reimbursement, and the facility had provided partial rent credit as a gesture of good faith. The property safeguarding allegation had been previously investigated and found unsubstantiated.
Complaint Details
The complaint investigation was triggered by allegations that a resident was mistreated by staff and that facility staff did not safeguard the resident's personal property. The allegations were found to be unsubstantiated based on interviews and prior investigations.
Report Facts
Capacity: 75
Census: 60
Rent credit amount: 350
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ralph Balbin | Former Executive Director | Named in allegation of resident mistreatment and interviewed by Licensing Program Analyst |
| Joe Katrdzhyan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Wei Siew Ho | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
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