Inspection Reports for Brookdale San Jose
1009 Blossom River Way, San Jose, CA 95123, United States, CA, 95123
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally good compliance with regulations. However, some deficiencies were cited in earlier reports, mainly related to resident record confidentiality, medical assessments, medication management, and staffing competence. The most serious issues included substantiated violations in December 2024 involving staff neglect and medication safety that posed immediate safety risks, as well as civil penalties issued in 2021 for failure to properly observe and report pressure injuries. The facility corrected a confidentiality deficiency by July 2025, and the most recent inspection on October 30, 2025, found no deficiencies, showing improvement over time. Minor issues such as documentation and environmental concerns appeared sporadically but did not persist in recent reports.
Deficiencies (last 7 years)
Deficiencies (over 7 years)
3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
25% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
63% occupied
Based on a October 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy over time
Inspection Report
Census: 97
Capacity: 153
Deficiencies: 0
Date: Oct 30, 2025
Visit Reason
The inspection was an announced pre-licensing visit for a change of ownership and case management, including inspection of the assisted living and memory care areas.
Findings
The facility was found to be well maintained with no deficiencies noted. Safety features such as delayed egress in memory care, locked medication carts, and proper signage were observed. Fire safety systems and food storage were inspected and found compliant.
Report Facts
Rooms in Assisted Living: 61
Rooms in Memory Care: 28
Food supply duration: 2
Food supply duration: 7
Freezer temperature: 0
Refrigerator temperature: 32
Food temperature log frequency: 5
Fire sprinkler system last inspection: Oct 13, 2025
Smoke alarm and CO detector last inspection: Aug 27, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director/Administrator | Met during inspection and participated in exit interview |
| Mita Partoza | Licensing Program Analyst | Conducted the announced pre-licensing visit |
| Maria Partoza | Licensing Program Analyst | Named as Licensing Program Analyst on report |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 91
Capacity: 153
Deficiencies: 0
Date: Jul 23, 2025
Visit Reason
The visit was conducted to follow up on a deficiency cited on 2025-03-14 related to unsecured personal resident records in an unlocked office room, following a complaint received on 2025-03-03.
Complaint Details
The visit was complaint-related, following a complaint received on 2025-03-03. The deficiency cited was for unsecured personal resident records. The follow-up visit found the deficiency corrected and no new deficiencies were cited.
Findings
During the visit, the licensing analyst observed that the financial department office door was locked and confirmed that it is always kept locked when unoccupied. No deficiencies were cited at this time as per California Code of Regulations Title 22.
Report Facts
Deficiency citation date: Mar 14, 2025
Complaint received date: Mar 3, 2025
Plan of Correction completion date: Mar 27, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the unannounced Case Management Visit and observed compliance |
| Sabrina Setz | Assisted Living Director | Met with Licensing Program Analyst during the visit and discussed findings |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 153
Deficiencies: 0
Date: May 2, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations that staff were not keeping the facility free of tripping hazards and that facility staffing was insufficient to meet residents' needs.
Complaint Details
Two complaints were investigated: 1) Staff not keeping the facility free of tripping hazards, which was found to be unfounded. 2) Facility staffing is insufficient to meet residents' needs, which was found to be unsubstantiated.
Findings
The investigation found no evidence of tripping hazards in the facility after interviews with residents, staff, and the Executive Director, as well as facility tours. Regarding staffing, while some residents and staff noted occasional short staffing, the majority stated staffing was sufficient to meet residents' needs. The department concluded the allegations of tripping hazards were unfounded and the staffing concerns were unsubstantiated.
Report Facts
Residents interviewed: 13
Staff interviewed: 10
Resident bedrooms toured: 9
Memory care bedrooms toured: 28
Pendant response time in room 244: 2
Pendant response time in room 231: 108
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews. |
| Marie Harris | Administrator | Interviewed regarding allegations and staffing. |
| Zeinab Donner | Executive Director | Interviewed regarding allegations and staffing. |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 153
Deficiencies: 0
Date: May 2, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not clean a resident's room.
Complaint Details
The complaint alleged that staff did not clean the resident's room. After investigation, including interviews with residents R1-R17, staff S1-S10, and executive directors, and facility tours, the allegation was found to be unfounded.
Findings
Based on interviews with residents, staff, and executive directors, as well as facility tours, the investigation found that resident rooms were cleaned weekly and maintained in a clean, safe, and sanitary condition. The allegation was determined to be unfounded.
Report Facts
Capacity: 153
Census: 96
Residents interviewed: 13
Staff interviewed: 10
Bedrooms toured: 9
Memory care bedrooms toured: 28
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Marie Harris | Executive Director | Interviewed regarding complaint and facility cleaning practices |
| Zeinab Donner | Executive Director | Interviewed regarding complaint and facility cleaning practices |
| Yatfai Eric Ng | Licensing Program Analyst | Conducted initial investigation on October 1, 2021 |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 153
Deficiencies: 0
Date: May 2, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff entered a resident's room without permission and went through the resident's personal belongings.
Complaint Details
The complaint alleged that staff entered a resident's room without permission and went through personal belongings. The allegation was investigated through interviews and record reviews and was found to be unfounded as the area was not under licensing jurisdiction.
Findings
The investigation found the allegation to be unfounded because the incident occurred in an independent living area not licensed by the Community Care Licensing Division. The staff member involved was suspended and then terminated by the facility following an internal investigation.
Report Facts
Complaint Control Number: 26
Complaint received date: Jan 6, 2022
Staff termination date: Jan 14, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Administrator | Interviewed regarding staff incident and disciplinary actions |
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during investigation |
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation |
| David Marrufo | Licensing Program Analyst | Conducted initial investigation and phone interview |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 153
Deficiencies: 0
Date: May 2, 2025
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to complaints alleging that the facility did not follow proper COVID-19 protocols and that there was insufficient staffing.
Complaint Details
Two complaints were investigated: one alleging failure to follow proper COVID-19 protocols, which was found to be unfounded, and another alleging insufficient staffing, which was found to be unsubstantiated.
Findings
The investigation found the allegations regarding improper COVID-19 protocols to be unfounded based on interviews and records review. The allegation of insufficient staffing was found to be unsubstantiated, with mixed resident and staff reports but no preponderance of evidence to prove the claim.
Report Facts
Residents interviewed: 13
Staff interviewed: 10
Pendant response time: 2
Pendant response time: 1.8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Zeinab Donner | Executive Director | Interviewed regarding infection control protocols and staffing |
| Marie Harris | Administrator | Named as facility administrator |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 153
Deficiencies: 0
Date: Apr 17, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 2025-04-09 alleging that facility staff yelled at a resident during breakfast on 2025-04-06.
Complaint Details
The complaint alleged that facility staff yelled at a resident during breakfast on 2025-04-06. The investigation found that staff member S1 was not working that day, and staff member S2 was also denied to have yelled at the resident. The resident was agitated and yelling at staff and another resident. The allegation was unsubstantiated.
Findings
After interviewing 8 staff members and 5 residents, and reviewing records, the allegation was found to be unsubstantiated. Staff and residents denied that staff yelled at the resident, and evidence showed the resident was agitated and yelling instead. No deficiencies were cited.
Report Facts
Staff interviewed: 8
Residents interviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christine Kabariti | Licensing Program Analyst | Conducted the complaint investigation |
| Banu Grewall | Health and Wellness Director | Met with Licensing Program Analyst during investigation |
| Sabrina Setz | Assisted Living Director | Met with Licensing Program Analyst during investigation |
| Ryan Golze | Administrator | Facility administrator named in report header |
| Jackie Jin | Licensing Program Manager | Named in report signature section |
Inspection Report
Follow-Up
Census: 99
Capacity: 153
Deficiencies: 0
Date: Apr 8, 2025
Visit Reason
Unannounced case management visit follow-up on the Type A deficiencies cited on 2025-03-14.
Findings
The Plan of Correction submitted on 2024-03-27 is currently being implemented. No deficiencies were cited at this time as per California Code of Regulations, Title 22.
Report Facts
Capacity: 153
Census: 99
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during the inspection and discussed the purpose of the visit. |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced case management visit follow-up. |
Inspection Report
Complaint Investigation
Capacity: 153
Deficiencies: 1
Date: Mar 20, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 04/21/2022 regarding residents' medical assessment forms not being updated annually and some residents lacking medical assessment forms.
Complaint Details
The complaint investigation was substantiated regarding residents' medical assessment forms not being updated annually and missing for some residents. Other allegations about care plans, staffing, resident left in soiled diaper, and resident not fed a meal were unsubstantiated.
Findings
The investigation substantiated that 3 out of 7 residents did not have a medical assessment on file, and 4 had updated assessments. A deficiency was cited for failure to maintain required medical assessments. Other allegations related to care plans, staffing sufficiency, resident left in soiled diaper, and resident not fed a meal were investigated and found unsubstantiated.
Deficiencies (1)
Failure to ensure 3 residents had a medical assessment on file, posing potential health, safety, and personal rights risks.
Report Facts
Residents without medical assessment: 3
Residents with updated medical assessment: 4
Resident records requested: 7
Resident records obtained: 6
Facility capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christine Kabariti | Licensing Program Analyst | Conducted the complaint investigation and delivered findings. |
| Jackie Jin | Licensing Program Manager | Named in the report as Licensing Program Manager overseeing the investigation. |
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during the investigation and reviewed the report. |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 153
Deficiencies: 1
Date: Mar 14, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-03-03 regarding staff not ensuring residents' personal information was kept confidential.
Complaint Details
The complaint alleged that staff did not ensure residents' personal information was kept confidential. The allegation was substantiated based on interviews and observations during the investigation.
Findings
The investigation found that the Financial Director's office door was unlocked with no staff present, and sensitive documents containing residents' personal information were accessible to unauthorized individuals. The allegation was substantiated and a citation was issued.
Deficiencies (1)
Failure to keep residents' records and personal information confidential as the Financial Director's office door was unlocked and sensitive documents were accessible to unauthorized individuals.
Report Facts
Capacity: 153
Census: 89
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Partoza | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Ryan Golze | Administrator | Named as facility administrator |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 153
Deficiencies: 0
Date: Mar 12, 2025
Visit Reason
The visit was a case management inspection regarding an incident that occurred on 2025-02-19.
Complaint Details
The visit was triggered by an incident reported on 2025-02-19. The Licensing Program Analyst determined that the incident requires further investigation. No citation was issued during this visit.
Findings
The Licensing Program Analyst discussed the incident report with the Executive Director and interviewed two staff witnesses. The incident requires further investigation, and no citation was issued during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director | Met with during the visit and discussed the incident report. |
| Maria Partoza | Licensing Program Analyst | Conducted the case management visit and investigation. |
Inspection Report
Annual Inspection
Census: 101
Capacity: 153
Deficiencies: 0
Date: Jan 30, 2025
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, reviewed medication and staff records, inspected food and emergency supplies, and verified fire alarm system inspection records. No deficiencies were cited during this inspection.
Report Facts
Water temperature range: 105
Water temperature range: 111
Number of resident living units toured: 7
Number of resident records reviewed: 7
Number of staff records reviewed: 7
Number of residents in census: 101
Facility capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during inspection |
| David Marrufo | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 153
Deficiencies: 2
Date: Dec 18, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2024-01-05 regarding resident care, medication management, staff supervision, and facility conditions at Brookdale San Jose.
Complaint Details
The complaint investigation was substantiated for allegations that staff failed to provide adequate care and supervision, including a staff member sitting on the phone for 1.5 hours during a resident visit, and medication safety violations. Other allegations such as foul odors and residents left in the same clothes for days were unsubstantiated.
Findings
The investigation found substantiated violations including staff neglecting resident care by sitting on the phone for extended periods, medication safety issues with pills found accessible to residents, and failure to provide adequate supervision. Other allegations such as foul odors and residents left in soiled clothes were unsubstantiated. Two Type A deficiencies were cited related to staffing competence and medication storage.
Deficiencies (2)
Facility personnel were not competent to provide necessary services, evidenced by staff S7 sitting in a corner on the phone instead of providing care, posing an immediate safety risk.
Centrally stored medications were not kept in a safe and locked place, as a pill was found accessible in a resident's living unit, posing an immediate safety risk.
Report Facts
Capacity: 153
Census: 98
Days between notice and rate increase: 73
Plan of Correction Due Date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the complaint investigation |
| Zeinab Donner | Executive Director | Facility representative met during investigation |
| Ryan Golze | Administrator | Facility administrator |
| S7 | Caregiver | Named in deficiency for failing to provide care and sitting on phone for 1.5 hours; discharged 12/08/2023 |
| S4 | Nurse | Reported destruction of pill found in resident's room and instructed staff on medication safety |
| S5 | Supervisor of Memory Care Unit | Reported pill found on floor and interviewed S7 regarding phone use |
Inspection Report
Census: 98
Capacity: 153
Deficiencies: 0
Date: Dec 18, 2024
Visit Reason
The visit was an unannounced Case Management visit conducted to amend a report that was delivered to the facility on 09/27/2024.
Findings
No deficiencies were cited at this time as per California Code of Regulations Title 22. The report was reviewed with the Executive Director and a copy was provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during the visit and reviewed the report. |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 153
Deficiencies: 0
Date: Sep 27, 2024
Visit Reason
The visit was conducted as a complaint investigation following a complaint received on 2024-09-20 alleging that the facility did not adhere to the smoking policy, resulting in infringement of residents' personal rights.
Complaint Details
The complaint alleged that the facility did not adhere to smoking policy, infringing on residents' personal rights. The complaint was investigated and found to be unfounded, meaning the allegation was false or without reasonable basis.
Findings
The investigation found that the facility had implemented the smoking policy and responded appropriately to the complaint. The complaint was determined to be unfounded, with no deficiencies cited during the visit.
Report Facts
Capacity: 153
Census: 85
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Partoza | Licensing Program Analyst | Conducted the complaint investigation |
| Zeinab Donner | Executive Director/Administrator | Interviewed during the investigation and involved in addressing the complaint |
| Ryan Golze | Administrator | Named as facility administrator |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Census: 69
Capacity: 153
Deficiencies: 0
Date: Jun 27, 2024
Visit Reason
The visit was conducted to deliver an immediate exclusion letter for a staff member (S1) and to explain the purpose of the letter to the Associate Executive Director.
Findings
No deficiencies were cited during this unannounced case management visit. The immediate exclusion letter was handed to the Associate Executive Director, who confirmed the excluded staff member is not currently working at the facility.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ash Sharma | Associate Executive Director | Met with Licensing Program Analyst during the visit and confirmed understanding of the immediate exclusion letter. |
| Christine Dolores | Licensing Program Analyst | Conducted the unannounced case management visit and delivered the immediate exclusion letter. |
Inspection Report
Complaint Investigation
Census: 211
Capacity: 153
Deficiencies: 0
Date: May 10, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation received on 2022-07-22 that facility staff did not seek medical attention for a resident in care.
Complaint Details
The complaint alleged that staff did not seek medical attention for resident R1's thyroid condition. The investigation included interviews with three staff members and review of physician reports, medication administration records, service plans, and residency agreement. The allegation was found to be unfounded.
Findings
The investigation found that the facility provided appropriate care and supervision to the resident, administered prescribed medications as ordered, and addressed the resident's health condition in service plans. The allegation was determined to be unfounded.
Report Facts
Complaint Control Number: 26-AS-20220722114741
Number of staff interviewed: 3
Resident R1 medication record dates: 09/01/2021 to 11/30/2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit |
| Ashwini Sharma | Associate Executive Director | Met with investigator during exit interview |
| Marie Harris | Administrator | Facility administrator named in report header |
Inspection Report
Annual Inspection
Census: 71
Capacity: 153
Deficiencies: 5
Date: Feb 9, 2024
Visit Reason
The visit was an unannounced annual continuation inspection conducted by the Licensing Program Analyst to evaluate compliance with regulatory requirements at the facility.
Findings
The inspection found multiple deficiencies including lack of updated medical assessments for residents with dementia, missing signed and dated appraisal/needs and services plans, expired and undocumented medications, missing TB test results, inadequate staff first aid/CPR certifications, and improper water temperature maintenance. Plans of correction were requested for all deficiencies.
Deficiencies (5)
Resident (R3) did not have a TB test and/or TB result prior to residing in the facility.
The 2nd floor water temperature was not maintained at least 105 degrees Fahrenheit.
At least one night shift staff member did not have an active first aid/CPR certification.
Two out of three residents diagnosed with dementia did not have an annual medical assessment.
Eight residents' appraisal/needs and services plans were missing signatures and dates; two residents' centrally stored medication records were not maintained.
Report Facts
Residents reviewed in memory care: 3
Residents reviewed in assisted living: 5
Staff files reviewed: 6
Residents missing signed appraisal/needs and services plans: 8
Residents without updated medical assessments: 2
Expired medication: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during inspection and reviewed report |
| Christine Dolores | Licensing Program Analyst | Conducted the inspection and authored the report |
| Sarah Yip | Licensing Program Manager | Supervisor of the inspection |
Inspection Report
Annual Inspection
Census: 71
Capacity: 153
Deficiencies: 3
Date: Jan 31, 2024
Visit Reason
The inspection was an unannounced required 1-year annual inspection of the assisted living facility.
Findings
The facility was generally well maintained with adequate lighting, clean kitchens, and updated emergency and infection control plans. Some expired emergency food items were noted, and an open trash can near PPE carts was advised to be replaced with a lidded trash bin. Six staff files were reviewed but 1st aid certification was not observed for six staff members during the visit.
Deficiencies (3)
Open trash can near PPE carts advised to be replaced with a lidded trash bin.
Multiple emergency food items were expired including cases of orange juice, apple juice, water bottles, lemon pudding, and boxes of cookies/crackers.
LPA did not observe 6 staff members' 1st aid certification during visit.
Report Facts
Resident apartments observed: 8
Staff files reviewed: 6
Kitchens observed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zeinab Donner | Executive Director | Met with Licensing Program Analyst during inspection and reviewed report |
| Christine Dolores | Licensing Program Analyst | Conducted the inspection and authored the report |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 153
Deficiencies: 0
Date: Jul 13, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate an allegation that the facility has a cockroach infestation.
Complaint Details
The complaint alleged a cockroach infestation at the facility. The investigation included interviews with residents, a private caregiver, the housekeeper, and the Assisted Living Director, as well as inspections of multiple facility areas. The complaint was found to be unfounded as no infestation was found in licensed areas.
Findings
The investigation found no evidence of cockroach infestation in the assisted living and memory care units. However, the independent living unit, which is not licensed by CCLD, had cockroaches. Therefore, the complaint was determined to be unfounded.
Report Facts
Facility capacity: 153
Resident census: 83
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the complaint investigation visit |
| Bruce Herman | Assisted Living Director | Interviewed during the investigation and participated in facility tour |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 153
Deficiencies: 0
Date: Jun 21, 2023
Visit Reason
An unannounced complaint investigation was conducted based on a complaint received on 2023-06-13 alleging that the facility does not have an evacuation plan.
Complaint Details
The complaint was unsubstantiated based on record review, interview, and observation. No deficiencies were cited per California Code of Regulations, Title 22.
Findings
The investigation found that evacuation maps were missing on some floors of the independent living section but were present in assisted living and memory care areas. The facility had an emergency disaster plan updated in 2023 but not visibly posted. Residents had complained about the small size of evacuation maps, and the facility had ordered larger maps. Staff received training on evacuation and fire drills, and residents were given a fire safety presentation. The allegation was unsubstantiated and no deficiencies were cited.
Report Facts
Facility capacity: 153
Census: 69
Complaint received date: Jun 13, 2023
Inspection visit date: Jun 21, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christine Dolores | Licensing Program Analyst | Conducted the complaint investigation |
| Ryan Golze | Executive Director | Met with Licensing Program Analyst during investigation |
| Audrey Bui | Assistant Executive Director | Met with Licensing Program Analyst during investigation |
| Arnulfo Cantu | Maintenance Director | Met with Licensing Program Analyst during investigation |
| Sarah Yip | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 77
Capacity: 153
Deficiencies: 0
Date: Jan 27, 2023
Visit Reason
An unannounced annual inspection focusing on infection control was conducted as a required one-year visit.
Findings
The facility was found to be clean and sanitary with no deficiencies cited. Infection control measures including PPE availability, N95 fit testing for staff, and COVID-19 related signage were observed. Fire exits were clear, medications were securely stored, and hygiene supplies were adequate.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ryan Golze | Executive Director | Met with Licensing Program Analysts during the inspection and reviewed the report. |
| Sabrina Setz | ClareBridge Program Manager | Met with Licensing Program Analysts during the inspection. |
| Arnulfo Cantu | Maintenance Director | Met with Licensing Program Analysts during the inspection. |
Inspection Report
Complaint Investigation
Capacity: 153
Deficiencies: 0
Date: Nov 8, 2022
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 06/28/2022 regarding a resident sustaining a fracture while in care.
Complaint Details
The complaint alleged that a resident sustained a fracture while in care. The investigation included interviews with facility staff, residents, hospice and hospital staff, and review of medical records. The allegation was found to be unsubstantiated due to lack of evidence.
Findings
The investigation found no evidence that the injury was caused intentionally by facility staff. Interviews and medical record reviews indicated the injury likely stemmed from the resident's pre-diagnosed medical conditions. The allegation was determined to be unsubstantiated.
Report Facts
Facility capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ryker Heberle | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Audrey Bui | Associate Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Marie Harris | Administrator | Named as facility administrator |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 153
Deficiencies: 0
Date: Nov 8, 2022
Visit Reason
The visit was conducted as a Case Management - Incident investigation following a reported incident on 11/02/2022 where a staff member yelled at a resident.
Complaint Details
The complaint involved a staff member yelling at a resident. The facility suspended the staff and initiated an investigation. Training plans were outlined to address the issue.
Findings
The facility had already started an investigation and suspended the suspect staff. The facility planned to provide staff training on challenging behavior intervention, behavior problem solving, and resident personal rights. No citations were noted during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Bui | Associated Executive Director | Met with Licensing Program Analyst during the visit and provided information about the incident and corrective actions. |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management visit and interviewed facility staff and residents. |
Inspection Report
Complaint Investigation
Capacity: 153
Deficiencies: 1
Date: Oct 3, 2022
Visit Reason
The visit was an unannounced case management - incident inspection to obtain additional information on incident reports regarding missed medications affecting 26 memory care residents.
Complaint Details
The visit was triggered by incident reports received by the Department regarding missed medications affecting 26 residents in memory care on 09/19/2022. The facility reported the incident on 09/20/2022, notified responsible parties and physicians, monitored residents for 48 hours with no adverse reactions, and provided staff training.
Findings
The facility failed to ensure an adequate number of medtechs and nurses on the morning of 09/19/2022, resulting in 26 memory care residents missing their AM medications. The facility provided staff training and developed a plan to prevent recurrence. A deficiency was cited per California Code of Regulations, Title 22.
Deficiencies (1)
Licensee did not ensure enough medtechs/nurses on 09/19/22 to support residents' health care needs, resulting in 26 memory care residents missing their AM medications, posing immediate health, safety, and personal rights risks.
Report Facts
Residents affected: 26
Facility capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anh Audrey Bui | Associate Executive Director | Met with Licensing Program Analyst during the visit and involved in incident response |
| Christine Dolores | Licensing Program Analyst | Conducted the case management - incident visit and authored the report |
| Sarah Yip | Licensing Program Manager | Supervisor and Licensing Program Manager named in the report |
Inspection Report
Routine
Census: 80
Capacity: 153
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
The purpose of this Technical Assistance Tele visit was to review the facility COVID-19 infection mitigation plan and conduct an inspection to ensure the plan is being carried out and to provide support and guidance to staff in mitigating the spread of the virus.
Findings
During the tele-visit inspection, the facility was toured and infection control measures were reviewed, including isolation rooms and PPE stations. Recommendations were provided to improve infection control practices, but no deficiencies were cited during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Administrator | Met with during inspection and discussed infection control measures |
| Steve Chang | Licensing Program Analyst | Conducted the inspection |
| Sarah Yip | Licensing Program Manager | Conducted the inspection |
| Vivien Helbling | Regional Manager | Conducted the inspection |
| Lori Kopplinger | Program Clinical Consultant | Conducted the inspection and discussed infection control measures |
| Romeo Manzano | Licensing Program Manager | Named in report as Licensing Program Manager |
| Chihhsien Chang | Licensing Program Analyst | Named in report as Licensing Program Analyst |
Inspection Report
Census: 80
Capacity: 153
Deficiencies: 0
Date: Apr 14, 2022
Visit Reason
The purpose of this Technical Assistance Tele visit was to review the facility COVID-19 infection mitigation plan and conduct an inspection to ensure the plan is being carried out and to provide support and guidance to staff in mitigating the spread of the virus.
Findings
The inspection found that the facility lacked COVID-19 signage at the main entrance, handwashing signage in restrooms, and donning and doffing PPE signage outside the isolation room. The facility administrator stated these would be posted later. No deficiencies were cited during the tele-visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Administrator | Met with during inspection and referenced regarding signage and infection control procedures. |
| Steve Chang | Licensing Program Analyst | Conducted Technical Assistance tele-inspection. |
| Sarah Yip | Licensing Program Manager | Conducted Technical Assistance tele-inspection. |
| Romeo Manzano | Licensing Program Manager | Named in report header and signature. |
| Chihhsien Chang | Licensing Program Analyst | Named in report header and signature. |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 153
Deficiencies: 0
Date: Oct 12, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that staff did not respond to residents' alerts in a timely manner and failed to properly assist residents while toileting.
Complaint Details
The complaint was unsubstantiated. Multiple residents and staff denied the allegations, and record review showed no over an hour response time as alleged. Previous similar complaints were also investigated with no substantiated findings.
Findings
The investigation found that the allegations were unsubstantiated based on interviews with residents and staff, and record reviews showing no evidence of delayed responses or unmet toileting needs.
Report Facts
Residents interviewed: 5
Staff interviewed: 10
Capacity: 153
Census: 68
Previous residents interviewed: 12
Previous staff interviewed: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yatfai Eric Ng | Licensing Program Analyst | Conducted the complaint investigation and subsequent visits |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during investigation |
| Michele Merritt | Administrator | Facility administrator named in the report |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Maria Kamara | Licensing Program Analyst | Conducted initial tele-investigation visit |
| Gladys Kuizon | Interviewed residents and staff during prior related complaint investigation | |
| Jackie Jin | Interviewed residents and staff during prior related complaint investigation |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 153
Deficiencies: 0
Date: Sep 30, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 06/10/2020 regarding a resident who suffered a fall resulting in fractures and sustained unexplained injuries while in care.
Complaint Details
The complaint involved allegations that a resident suffered a fall resulting in fractures and sustained unexplained injuries while in care. The investigation included interviews with staff, medical professionals, residents, family members, and review of medical and incident records. The findings were unsubstantiated for the fall allegation and unfounded for the unexplained injuries allegation.
Findings
Based on interviews with staff, medical professionals, residents, and review of records, the Department found the allegations unsubstantiated and unfounded. The investigation concluded there was insufficient evidence to prove the fall and injuries were preventable or caused by facility negligence.
Report Facts
Capacity: 153
Census: 67
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marybeth Donovan | Licensing Program Analyst | Conducted complaint investigation and delivered findings |
| Christine Dolores | Licensing Program Analyst | Assisted in complaint investigation and delivery of findings |
| Marielouise Harris | Executive Director | Met with investigators during complaint investigation |
| Michele Merritt | Administrator | Facility administrator named in report |
| Jackie Jin | Licensing Program Manager | Oversaw licensing program and signed report |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 153
Deficiencies: 1
Date: Jul 29, 2021
Visit Reason
The visit was a case management inspection conducted as a result of complaint investigation #26-AS-20210630151909 to review resident records and compliance with hospice care plan requirements.
Complaint Details
The visit was triggered by complaint investigation #26-AS-20210630151909. The deficiency cited relates to the failure to maintain a current hospice care plan for resident R1. Substantiation status is not explicitly stated.
Findings
The inspection found that resident R1's hospice care plan was not current and had ended on 05/12/2021, despite R1 still being under hospice care. A deficiency was cited for failure to maintain a current and complete hospice care plan.
Deficiencies (1)
Resident R1's hospice care plan was not current and ended on 05/12/2021, with no updated plan on file, posing a potential risk to health and safety.
Report Facts
Deficiency Type B: 1
Plan of Correction Due Date: Aug 6, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the case management visit and cited the deficiency. |
| Harriette Vega | Health and Wellness Director | Interviewed during the visit and involved in the exit interview. |
| Sarah Yip | Licensing Program Manager | Supervisor named in the report. |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 153
Deficiencies: 0
Date: Jul 29, 2021
Visit Reason
The inspection was conducted as a complaint investigation following a report received on 06/30/2021 alleging that facility staff refused to assist a resident who is unable to feed without assistance.
Complaint Details
The complaint alleged that facility staff did not assist a resident with feeding. The investigation included interviews with the resident, staff, and review of hospice care plans. The allegation was found unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation found the allegation unsubstantiated after interviews and record reviews. The resident was able to feed self at the time of investigation, staff reported no facility policy against assisting hospice residents with feeding, and some staff had assisted the resident. The facility has a policy that feeding assistance is provided in private apartments only, not in the communal dining room.
Report Facts
Facility capacity: 153
Resident census: 80
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harriette Vega | Health and Wellness Director | Met with Licensing Program Analyst during investigation |
| Marie Harris | Administrator | Named as facility administrator |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 89
Capacity: 153
Deficiencies: 0
Date: Jul 9, 2021
Visit Reason
An annual unannounced inspection was conducted as a required one-year visit to evaluate the facility's compliance with regulations.
Findings
No deficiencies were cited during the inspection. The facility was found to have COVID-19 mitigation measures in place, including PPE supplies, vaccination rates, and weekly staff testing.
Report Facts
COVID-19 vaccination rate: 70
PPE supply duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Executive Director | Met during inspection and mentioned as Administrator |
| Rizaldy Carreon | Assisted Living Director | Met during inspection |
| Gladys Kuizon | Licensing Program Analyst | Conducted the annual inspection |
| Sarah Yip | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 153
Deficiencies: 0
Date: Jun 25, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 03/30/2021 that the facility had insufficient staffing to meet resident needs and did not follow a resident's care plan.
Complaint Details
The complaint alleged insufficient staffing and failure to follow a resident's care plan regarding housekeeping and shower preferences. The investigation included interviews with residents, staff, and the Assisted Living Director, as well as review of staffing schedules and records. The findings were unsubstantiated.
Findings
The investigation found the allegations to be unsubstantiated based on interviews with residents, staff, and review of records. Most residents and staff reported sufficient staffing and no complaints about housekeeping or care plan adherence.
Report Facts
Resident interviews: 19
Residents reporting sufficient staffing: 15
Residents reporting staffing concerns: 4
Staff interviews: 12
Staff reporting adequate care: 11
Staff reporting need for additional caregivers: 1
Facility capacity: 153
Facility census: 79
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 153
Deficiencies: 0
Date: Jun 25, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following a complaint received on 04/06/2021 alleging that a facility staff made a sexually inappropriate hand gesture towards a resident.
Complaint Details
The complaint alleged that a facility staff member (S1) made a sexually inappropriate hand gesture towards resident R1. Interviews revealed R1 may have misinterpreted the gesture and no physical contact occurred. Staff member S1 was placed on administrative leave and later resigned. The San Jose Police Department report supported the unsubstantiated finding.
Findings
The investigation included interviews with residents and staff, review of police reports, and attempts to contact the accused staff member. The allegation was found to be unsubstantiated due to lack of sufficient evidence to prove the claim.
Report Facts
Capacity: 153
Census: 79
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Marie Harris | Executive Director | Interviewed during investigation and exit interview |
| Sarah Yip | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 153
Deficiencies: 2
Date: Jun 7, 2021
Visit Reason
The inspection was conducted due to a complaint alleging that the facility allows unqualified staff to dispense and administer medications, resulting in mismanagement of residents' medications.
Complaint Details
The complaint was received on 2021-02-08 alleging unqualified staff dispensing medications and mismanagement of residents' medications. The complaint was substantiated based on investigation findings including staff interviews, record reviews, and medication audits.
Findings
The investigation found that staff MedTechs who were not licensed professionals administered insulin injections to residents, and medication discrepancies were identified in 6 out of 7 residents' medication records. The allegations were substantiated and deficiencies were cited.
Deficiencies (2)
Staff MedTechs who were not licensed skilled professionals administered insulin injections to residents, posing an immediate risk to resident health and safety.
Medication audit revealed discrepancies such as extra medications in relation to recorded start date of administration in 6 of 7 resident medication records, posing an immediate risk to resident health and safety.
Report Facts
Residents with injectable medication administered by unqualified staff: 3
Residents' medication records with discrepancies: 6
Medication records reviewed: 7
Resident Care Associates interviewed: 4
MedTechs/nurses interviewed: 5
MedTechs/nurses who caught medication errors: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ryker Heberle | Licensing Program Analyst | Conducted complaint investigation and tele-visit |
| Gladys Kuizon | Licensing Program Manager | Conducted complaint investigation and tele-visit |
| Rizaldy Carreon | Assisted Living Director | Met with investigators during tele-visit |
| Marie Harris | Executive Director | Conducted internal audit and participated in exit interview |
| Harriette Vega | Health & Wellness Director | Conducted internal audit identifying medication errors |
| Sarah Yip | Licensing Program Manager | Named in report signature and oversight |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 153
Deficiencies: 2
Date: May 18, 2021
Visit Reason
Case Management visit to follow up on a substantiated complaint regarding neglect/lack of care and supervision related to a resident's pressure injury and failure to provide appropriate medical care.
Complaint Details
The complaint investigation was substantiated regarding neglect/lack of care and supervision. The resident developed pressure injuries that were not properly observed or reported by facility staff. An immediate civil penalty of $500 was issued on May 10, 2018, and an additional civil penalty of $9,500 was issued on May 18, 2021 for serious bodily injury.
Findings
The licensee failed to regularly observe and document changes in the resident's skin condition, did not report the pressure injury to the Department within seven days, and did not seek treatment for the resident's skin conditions, which developed into unstageable pressure injuries requiring medical intervention. A civil penalty was issued for serious bodily injury.
Deficiencies (2)
Failure to regularly observe resident for changes in physical functioning and failure to document and report pressure injury to physician.
Failure to report resident's pressure injury to the Department within seven days of discovery.
Report Facts
Civil penalty amount: 9500
Civil penalty amount: 500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marielouise Harris | Executive Director | Met with Licensing Program Analyst and Manager during Case Management visit. |
| Marybeth Donovan | Licensing Program Analyst | Conducted Case Management visit and signed report. |
| Jackie Jin | Licensing Program Manager | Oversaw Case Management visit and signed report. |
Inspection Report
Census: 89
Capacity: 153
Deficiencies: 0
Date: May 6, 2021
Visit Reason
The visit was a case management tele-visit conducted to review the facility's resident roster, staffing schedule, and program plans related to work shifts and medication policies as part of ongoing oversight.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst reviewed documents and discussed facility operations with the Executive Director and Health and Wellness Director. A medication audit was scheduled for the following week.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Executive Director | Met with Licensing Program Analyst during case management tele-visit |
| Harriette Vega | Health and Wellness Director | Met with Licensing Program Analyst during case management tele-visit |
| Gladys Kuizon | Licensing Program Analyst | Conducted the case management tele-visit |
| Sarah Yip | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 153
Deficiencies: 0
Date: Apr 14, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-01-14 regarding improper charges for services and inadequate food service for a resident.
Complaint Details
The complaint included two allegations: 1) Facility charged resident for services not agreed upon, and 2) Facility provides inadequate food service. Both allegations were investigated and found to be unfounded.
Findings
The investigation found that the facility did not charge the resident for two-person assist services beyond the agreed period and that food service allegations, including serving spoiled milk and inadequate portions, were unfounded based on interviews, record reviews, and observations.
Report Facts
Resident count during inspection: 84
Facility capacity: 153
Number of residents interviewed: 10
Number of staff interviewed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Marie Harris | Executive Director | Met with Licensing Program Analyst and involved in interviews regarding findings |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report |
| S1 | Financial Services Director | Interviewed regarding billing and charges for resident |
| S2 | Director of Dining Services | Interviewed regarding food service and milk delivery |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 153
Deficiencies: 0
Date: Apr 7, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations received on 01/25/2021 regarding rough handling of residents by a staff member and failure to remove trash and soiled linens from residents' rooms.
Complaint Details
The complaint alleged that a staff member handled residents roughly causing bruising and failed to remove trash and soiled linens from residents' rooms. After investigation, including interviews and virtual tours, the allegations were found to be unfounded.
Findings
The investigation included virtual tours of the facility, resident and staff interviews, and observations. No unsanitary conditions or evidence of rough handling were found. All interviewed residents and most staff denied the allegations. The complaint was determined to be unfounded.
Report Facts
Residents interviewed: 12
Staff interviewed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during investigation |
| Sarah Yip | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 153
Deficiencies: 0
Date: Apr 7, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 12/29/2020 regarding delayed assistance to residents and inadequate staff communication.
Complaint Details
The complaint alleged that residents did not receive timely assistance, staff did not assist with bathing and toileting needs, and staff communication was ineffective. The investigation concluded the allegations were unsubstantiated or unfounded, indicating insufficient evidence to prove the claims.
Findings
The investigation found the allegations unsubstantiated or unfounded based on resident and staff interviews, record reviews, and direct testing of pendant alarm response times. Staff generally responded within acceptable timeframes and assisted residents with toileting and bathing needs.
Report Facts
Capacity: 153
Census: 84
Staff response time: 15
Staff response time: 1
Staff response time: 7
Staff count: 3
Staff count: 1
Staff count: 2
Staff count: 1
Resident interviews: 11
Staff interviews: 9
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during investigation |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on report |
| Odette Colondres Torres | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 153
Deficiencies: 1
Date: Mar 26, 2021
Visit Reason
Unannounced investigation of a complaint alleging that facility staff failed to seek appropriate medical attention in a timely manner.
Complaint Details
The complaint was substantiated. The investigation found a 44-minute gap between the time a resident was noted to have stroke symptoms and the time 911 was called, posing an immediate health and safety risk.
Findings
The allegation was substantiated based on review of incident and dispatch reports showing a 44-minute delay between the observation of stroke symptoms in a resident and the 911 call. Staff interviews and resident statements were inconclusive or unable to verify the timing of the emergency call.
Deficiencies (1)
Failure to immediately telephone 911 when an injury or other circumstance resulted in an imminent threat to a resident’s health, specifically a 44-minute delay in calling 911 after stroke symptoms were noted.
Report Facts
Deficiency due date: Mar 29, 2021
Delay in minutes: 44
Census: 89
Total Capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yatfai Ng | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Sarah Yip | Licensing Program Manager | Oversaw the complaint investigation |
| Claudia Elias | Memory Care Director | Facility representative met during investigation and recipient of report |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 153
Deficiencies: 0
Date: Mar 25, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations received on November 6, 2020, regarding improper resident assessment and unauthorized charges and removal of personal property.
Complaint Details
The complaint investigation was triggered by allegations that facility staff did not properly assess a resident before adding 24-hour one-on-one caregiving services, that the resident was charged for services not agreed upon, and that staff removed the resident's personal property without permission. The first allegation was found to be unfounded, and the latter two were unsubstantiated.
Findings
The investigation found the allegation that the facility did not properly assess the resident prior to adding 24-hour one-on-one caregiving services to be unfounded. The allegations that the facility charged the resident for services not agreed upon and removed personal property without permission were found to be unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 153
Census: 75
Residents interviewed: 5
Staff interviewed: 7
Staff caregivers interviewed: 4
One-on-one caregiver service dates: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 153
Deficiencies: 1
Date: Mar 25, 2021
Visit Reason
The visit was a Case Management tele-visit to address deficiencies identified during a complaint investigation involving resident R1, specifically regarding the removal of personal property without permission.
Complaint Details
Complaint 26-AS-20201106171220 alleged that R1 had personal property removed from R1's room without permission. The deficiency cited relates to failure to inventory personal property upon admission.
Findings
The investigation revealed that resident R1 did not have an initial inventory of personal property upon admission as required by the facility's Theft and Loss Policy, and records did not show that R1 declined to inventory personal property. A deficiency was cited for this violation.
Deficiencies (1)
The initial personal property inventory was not completed by the licensee and resident upon admission, violating the facility's Theft and Loss Policy.
Report Facts
Deficiency Type: 1
Plan of Correction Due Date: Apr 2, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Executive Director | Met during the Case Management tele-visit |
| Gladys Kuizon | Licensing Program Analyst | Conducted the Case Management tele-visit and investigation |
| Sarah Yip | Licensing Program Manager | Supervisor named in the report |
Inspection Report
Census: 75
Capacity: 153
Deficiencies: 0
Date: Mar 10, 2021
Visit Reason
Licensing Program Analyst Gladys Kuizon conducted a Case Management - Legal/Non-compliance inspection visit to ensure that the facility is adhering to the Compliance Plan submitted after a Non-Compliance Conference held on 11/14/2018.
Findings
The facility's main kitchen, food storage, Assisted Living kitchens, pendant alert system, and Memory Care unit were inspected and found to be in compliance with the facility's compliance plan. Staff training records were reviewed and observed in compliance. The two-year quarterly case management visits imposed on the facility conclude with this visit.
Report Facts
Capacity: 153
Census: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the inspection visit |
| Marie Harris | Executive Director | Met with Licensing Program Analyst during the inspection |
| Rizaldy Carreon | Assisted Living Director | Present during the virtual meeting |
| Harriette Vega | Health and Wellness Director | Present during the virtual meeting |
Inspection Report
Complaint Investigation
Capacity: 153
Deficiencies: 0
Date: Feb 26, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation received on 2021-02-18 regarding inappropriate staff behavior towards a resident on 2020-10-18.
Complaint Details
The complaint alleged that facility staff spoke inappropriately to a resident. The investigation included interviews with staff and residents, review of medical records and police report, and found the allegation unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation found that although staff (S2) was witnessed cursing at a resident (R1) in Tagalog during a transfer, the resident did not understand, and there was insufficient evidence to substantiate the allegation. The allegation was determined to be unsubstantiated based on interviews, record reviews, and observations.
Report Facts
Facility capacity: 153
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation tele-visit and authored the report |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Rizaldy Carreon | Assisted Living Director | Met with Licensing Program Analyst during investigation |
| Odette Colondres Torres | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 153
Deficiencies: 0
Date: Feb 26, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on October 28, 2020, regarding staff not reporting an unusual incident and allegations of staff slapping a resident and leaving a resident in soiled clothing.
Complaint Details
The complaint involved allegations that facility staff did not report an unusual incident as required, staff slapped a resident, and staff left a resident in soiled clothing for an extended period. The investigation included interviews with staff and the resident's spouse, review of medical records and police reports, and concluded the allegations were unsubstantiated or unfounded.
Findings
The investigation found that the allegation of staff slapping a resident was unsubstantiated, with staff interviews and medical records reviewed. The allegation that staff did not report an unusual incident was found to be unfounded, meaning the allegation was false or without reasonable basis. The resident showed no visible signs of injury and the facility followed up with the resident's physician.
Report Facts
Facility capacity: 153
Census: 69
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Rizaldy Carreon | Assisted Living Director | Met with Licensing Program Analyst during tele-visit |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 153
Deficiencies: 1
Date: Feb 26, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that facility staff posted residents' confidential information in a public area.
Complaint Details
The complaint was substantiated based on observations, interviews, photo evidence, and review of records. The allegation was that confidential resident information was posted publicly, which was confirmed by the investigation.
Findings
The investigation found that a resident roster poster containing residents' names and other information was unintentionally left posted overnight in a public nurses' station area but was subsequently removed and secured in a locked office. No health information was identifiable from the poster. The allegation was substantiated and a deficiency was cited for failure to treat the register of residents as confidential.
Deficiencies (1)
Failure to treat the register of residents as confidential information pursuant to CCR 87508(c)(1), evidenced by a wall poster containing names of current residents posted in a nurses' station accessible to non-staff members.
Report Facts
Capacity: 153
Census: 69
Deficiency due date: Mar 5, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Rizaldy Carreon | Assisted Living Director | Interviewed during investigation and involved in findings |
| Sarah Yip | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 89
Capacity: 153
Deficiencies: 0
Date: Dec 23, 2020
Visit Reason
The visit was a Case Management - Other type of inspection conducted as a Technical Assistance tele-visit involving COVID-19 related observations and recommendations.
Findings
No deficiencies were cited during the visit. Several COVID-19 related recommendations were made to improve infection control practices, including posting hand-washing guides, promoting social distancing, ensuring covered trash bins, disinfecting common areas, and proper PPE donning and doffing procedures.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Harris | Executive Director | Present during the tele-visit and named in the report discussion. |
| Gladys Kuizon | Licensing Program Analyst | Conducted the Technical Assistance tele-visit. |
| Barbie Henson | Health Facilities Evaluator Nurse | Participated in the tele-visit and made recommendations. |
| Geraldine Veras | Health and Wellness Director | Present during the tele-visit. |
| Jeff Toomer | District Director of Operations | Provided information about the Special Isolation Unit. |
| Lori Fries | District Director of Clinical Services | Present during the tele-visit. |
| Jina Amstutz | District Compliance Specialist | Present during the tele-visit. |
Inspection Report
Census: 91
Capacity: 153
Deficiencies: 0
Date: Dec 22, 2020
Visit Reason
The visit was a Case Management tele-visit conducted to deliver an amended report to the facility and discuss it with the Executive Director.
Findings
The Licensing Program Analyst delivered an amended Case Management report originally issued on December 3, 2018, and discussed it with the Executive Director for review and signature.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Kuizon | Licensing Program Analyst | Conducted the Case Management tele-visit and delivered the amended report. |
| Marie Harris | Executive Director | Met with Licensing Program Analyst to review and sign the amended report. |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 90
Capacity: 153
Deficiencies: 0
Date: Nov 16, 2020
Visit Reason
The visit was a case management tele-visit conducted to review facility operations including COVID-19 screening procedures and infection control measures.
Findings
The facility was toured including Memory Care and Assisted Living areas, and COVID-19 safety protocols were observed. Staff were wearing PPE and communal dining was permitted under specific conditions. Several improvements were advised, and no deficiencies were cited during this visit.
Report Facts
Capacity: 153
Census: 90
Staff break room occupancy limit: 4
Elevator occupancy limit: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonette Edwards | Assisted Living Director | Present during tele-visit and facility tour |
| Geraldine Veras | Health & Wellness Director | Present during tele-visit and facility tour |
| Jeffrey Toomer | District Director of Operations | Present during tele-visit |
| Gladys Kuizon | Licensing Program Analyst | Conducted the case management tele-visit |
| Rebekah Bird-Wohlgemuth | Health Facilities Evaluator Nurse | Participated in tele-visit |
| Romeo Manzano | Licensing Program Manager | Present during tele-visit |
| Sarah Yip | Licensing Program Manager | Named in report |
Inspection Report
Census: 92
Capacity: 153
Deficiencies: 0
Date: Dec 3, 2018
Visit Reason
The visit was an unannounced Case Management visit to verify and confirm that the facility received the Immediate Exclusion Letter for employee S1 and that S1 is no longer present at the facility.
Findings
The Licensing Program Analyst verified through interview and observation that employee S1 is not present, employed, or residing at the facility. The licensee was advised to disassociate S1 from their roster, and an updated LIC 500 was received.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sean Fratellone | Acting Administrator | Met with Licensing Program Analyst during the visit and involved in verification of employee exclusion. |
| Christine Banglay | Health and Wellness Director | Met with Licensing Program Analyst during the visit and involved in verification of employee exclusion. |
| Gladys Kuizon | Licensing Program Analyst | Conducted the unannounced Case Management visit and verified employee exclusion. |
| Sarah Yip | Licensing Program Manager | Named as Licensing Program Manager on the report. |
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