Inspection Report Summary
Most inspections found no deficiencies, with several complaint investigations determined to be unsubstantiated. The most recent report from September 15, 2025, was clean with only two minor technical violations related to procedural matters. However, a serious deficiency was cited on August 5, 2025, after a complaint investigation found neglect and lack of supervision that led to resident injuries and posed an immediate health and safety risk; this was corrected by the following day’s Plan of Correction visit. Other issues noted over time involved minor documentation and personnel record deficiencies, as well as isolated environmental concerns like uncovered trash cans and missing handwashing posters. The facility appears to have improved since the serious incident in August 2025, with recent inspections showing no deficiencies.
Deficiencies per Year
4
3
2
1
0
High
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 134
Capacity: 183
Deficiencies: 0
Sep 15, 2025
Visit Reason
An unannounced annual inspection was conducted as a required one-year visit to evaluate compliance with licensing requirements.
Findings
No deficiencies were cited during the visit per California Code of Regulations Title 22. Two technical violations were issued related to procedural matters. The facility was found to have proper food storage, locked hazardous areas, functioning safety equipment, and adequate resident room and bathroom conditions, though water temperatures exceeded regulatory limits and the dining area was under remodeling without prior notification.
Report Facts
Water temperature measurements: 10
Resident records reviewed: 4
Medication records reviewed: 5
Staff records reviewed: 5
Technical violations issued: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met during inspection and involved in exit interview |
| Marcella Tarin | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Plan of Correction
Census: 95
Capacity: 183
Deficiencies: 0
Aug 6, 2025
Visit Reason
The visit was an unannounced Plan of Correction (POC) inspection conducted to verify correction of a previously cited Type A deficiency from a complaint investigation visit on 2025-08-05.
Findings
No deficiencies were cited during the POC visit. The facility provided a plan of correction with staff training and a Letter of Deficiencies Cleared was issued.
Complaint Details
The previous complaint investigation on 2025-08-05 resulted in a Type A deficiency citation related to complaint 26-AS-20240812112833, with a POC due date of 2025-08-06. The deficiency was cleared during this visit.
Report Facts
Deficiency citation: 1
Capacity: 183
Census: 95
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during the POC visit |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced POC visit |
Inspection Report
Complaint Investigation
Census: 95
Capacity: 183
Deficiencies: 1
Aug 5, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2024-08-12 regarding a physical altercation between two residents (R1 and R2) in the memory care unit.
Findings
The investigation found that neglect and lack of supervision by facility staff led to multiple incidents of physical altercations between residents R1 and R2, resulting in R1 sustaining head injuries and requiring hospital visits. The facility failed to provide necessary care and supervision to meet the residents' needs, posing an immediate health and safety risk.
Complaint Details
The complaint was substantiated. The allegation was neglect/lack of supervision resulting in resident-on-resident altercation. The Department found sufficient evidence that the facility neglected supervision duties, leading to injury of resident R1.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The facility did not provide the necessary care and supervision to resident R1 and R2 to meet their care needs, leading to R1's multiple falls and sustained head injury, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 183
Census: 95
Incidents: 3
Plan of Correction Due Date: Due date for plan of correction was 2025-08-06
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met during investigation and involved in providing information about the incidents |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit |
| Romeo Manzano | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 131
Capacity: 183
Deficiencies: 0
Jul 7, 2025
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following an allegation that staff did not prevent a resident from being harmed by another resident on 2024-06-04.
Findings
The investigation found that the allegation was unsubstantiated. The incident involved residents R1 and R2 in the memory care unit hallway, where R1 grabbed R2, R2 pushed R1, causing R1 to fall and be sent to the hospital. Staff responded promptly, and this was the first incident between the two residents.
Complaint Details
The complaint alleged that staff failed to prevent harm between residents. The investigation included interviews with residents, staff, and review of surveillance footage and physician reports. The allegation was found unsubstantiated due to insufficient evidence to prove the claim.
Report Facts
Facility capacity: 183
Census: 131
Complaint control number: 26-AS-20240607150519
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met during investigation and named in findings |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit |
| Chihhsien Chang | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Romeo Manzano | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 183
Deficiencies: 0
Oct 31, 2024
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 2024-05-21 alleging that the facts provided in a 30-day eviction notice for a resident were without foundation or merit.
Findings
The investigation found that the allegation was unfounded. The resident was accused of making threatening comments and causing a fire that activated the sprinkler system, resulting in water damage. Interviews, document reviews, and facility tours confirmed the events occurred as reported. The resident later moved out with family agreement. No citations were issued.
Complaint Details
The complaint alleged that the 30-day eviction notice issued to resident R1 was without foundation or merit. The investigation included interviews with staff and the resident, review of incident and fire reports, and facility inspection. The allegation was found to be unfounded.
Report Facts
Facility capacity: 183
Census: 93
Complaint received date: May 21, 2024
Incident dates: Apr 18, 2024
Incident dates: May 7, 2024
Eviction notice date: May 20, 2024
Resident move-out date: Jun 27, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during investigation and provided information |
Inspection Report
Complaint Investigation
Census: 136
Capacity: 183
Deficiencies: 0
Sep 18, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation received on 2023-05-15 that staff were not administering resident's medication per physician's order.
Findings
The investigation found that the facility did not receive the doctor's order for the medication before 2023-05-13 and started administering the medication to the resident on 2023-05-13. The allegation was determined to be unfounded with no citations noted.
Complaint Details
The complaint alleged that staff were not administering resident's medication per physician's order. After interviews with the Executive Director, Director of Resident Service, Executive Assistant, Medication Manager, resident, and family member, and review of medication records, the Department found the allegation to be unfounded.
Report Facts
Complaint received date: May 15, 2023
Medication administration start date: May 13, 2023
Medication not administered period: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met during investigation and named in findings |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit |
Inspection Report
Complaint Investigation
Census: 136
Capacity: 183
Deficiencies: 0
Sep 18, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation received on 07/11/2023 that staff did not adequately supervise a resident, resulting in the resident sustaining a fracture while in care.
Findings
Based on interviews, document reviews, and investigation, the allegation that staff failed to adequately supervise the resident resulting in a fracture was found to be unsubstantiated. The resident's fall was unwitnessed, and staff responded promptly by calling 911 and sending the resident to the hospital. No citations were issued.
Complaint Details
The complaint alleged inadequate supervision of a resident leading to a fracture. The investigation included interviews with staff and review of incident reports. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 183
Census: 136
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with during investigation and exit interview |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit |
Inspection Report
Annual Inspection
Census: 94
Capacity: 183
Deficiencies: 2
Sep 12, 2024
Visit Reason
An unannounced annual inspection visit was conducted as a required 1-year inspection to evaluate compliance with licensing regulations.
Findings
The inspection included review of resident and staff files, facility tour, and safety checks. Two deficiencies were cited related to personnel records missing health screening forms and inaccurate centrally stored medication forms. The facility had a recent faucet incident that was resolved the same day.
Deficiencies (2)
| Description |
|---|
| 2 out of 5 staff files were observed without health screen form which poses a potential health, safety or personal rights risk to persons in care. |
| 1 out of 5 resident files was observed with centrally stored medications form inaccurate and not maintained up to date which poses a potential health, safety or personal rights risk to persons in care. |
Report Facts
Staff files missing health screen form: 2
Resident files with inaccurate medication form: 1
Facility capacity: 183
Facility census: 94
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during inspection and named in plan of correction statements |
| Steve Chang | Licensing Program Analyst | Conducted the inspection visit |
| Chihhsien Chang | Licensing Evaluator | Named as licensing evaluator and analyst on report |
| Romeo Manzano | Licensing Program Manager | Named as supervisor and licensing program manager |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 183
Deficiencies: 0
May 30, 2024
Visit Reason
The visit was conducted as an unannounced case management inspection to open a complaint and gather additional information regarding an incident report involving a resident found unresponsive.
Findings
No deficiencies were cited during the visit. The Licensing Program Analysts interviewed staff and reviewed incident details including police and paramedic involvement, and requested the resident's physician report and service plan.
Complaint Details
The complaint investigation was triggered by an incident where resident R1 was found unresponsive in their bedroom. Staff called 911 and police and paramedics responded. Resident R1 was previously in hospice care and had graduated from hospice in January 2024. The complaint was not substantiated as no deficiencies were cited.
Report Facts
Facility capacity: 183
Resident census: 145
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yoliana Sanchez | Executive Assistant | Met with Licensing Program Analysts during the inspection and provided information related to the incident |
| Steve Chang | Licensing Program Analyst | Conducted the inspection |
| Manuel Monter | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Census: 138
Capacity: 183
Deficiencies: 0
May 10, 2024
Visit Reason
An unannounced case management-incident visit was conducted following an incident report of a fire alarm and sprinkler activation caused by a resident burning paper in the assisted living unit.
Findings
The fire was contained with no major damage except smoke and water damage to several rooms. All residents were safely evacuated with no injuries or hospitalizations reported. The facility took corrective actions including updating the resident's care plan and removing lighters.
Report Facts
Rooms affected: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analysts during the incident visit and provided information about the incident and follow-up actions. |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced case management-incident visit. |
| Manuel Monter | Licensing Program Analyst | Conducted the unannounced case management-incident visit. |
Inspection Report
Complaint Investigation
Census: 138
Capacity: 183
Deficiencies: 0
Nov 6, 2023
Visit Reason
An unannounced Case Management - Incident visit was conducted following the discovery of a resident found unresponsive on the floor of their bedroom and subsequently pronounced dead.
Findings
The investigation included interviews with staff, the administrator, and family members, and review of the resident's medical records. The resident was weak due to cancer and on 24-hour oxygen. No complaints were made by family members, and the case requires further investigation.
Complaint Details
This visit was triggered by an incident involving Resident 1 found unresponsive and deceased. Family members stated they had no complaints against the facility. The case is pending further investigation.
Report Facts
Census: 138
Total Capacity: 183
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 183
Deficiencies: 0
Nov 18, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 05/25/2021 that staff did not address a resident's change in level of care and did not provide adequate care and supervision to a resident.
Findings
The investigation found that the allegations were unfounded. The facility provided care and supervision to the resident during incidents in May 2021, and the Hospice Care team and responsible party were aware of the resident's declining health. No citations were issued during the investigation.
Complaint Details
The complaint alleged that staff did not address a resident's change in level of care and did not provide adequate care and supervision. The investigation included interviews with former and current Executive Directors and the Director of Memory Care, review of incident reports, care plans, and physician reports. The allegations were found to be unfounded.
Report Facts
Complaint Control Number: 26
Complaint Receipt Date: May 25, 2021
Incident Dates: May 19, 2021
Incident Dates: May 21, 2021
Care Plan Date: May 21, 2021
Physician Report Date: Nov 17, 2020
Care Conference Dates: May 21, 2021
Care Conference Dates: May 26, 2021
Care Conference Dates: May 28, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Jennell Revera | Former Executive Director | Interviewed during investigation and named as Administrator |
| Shantela Yadao | Executive Director | Interviewed during investigation and met with during visit |
| Maricel Ong | Director of Memory Care | Interviewed during investigation |
| Romeo Manzano | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 183
Deficiencies: 0
Nov 8, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on 07/13/2022 regarding a suspicious death at the facility.
Findings
The investigation found no evidence of neglect or lack of supervision related to the suspicious death. The resident was under hospice care with a terminal illness, and the death was determined to be due to heart and neurocognitive disorder. The allegations were found to be unfounded.
Complaint Details
Complaint of suspicious death received on 07/13/2022. Investigation included interviews with family members, executive director, and staff, as well as review of medical records and death report. Allegations were determined to be unfounded.
Report Facts
Complaint Control Number: 26
Complaint Control Number Full: 20220713121043
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Brandee Acosta | Memory Care Director | Interviewed during investigation |
| Veronica Chavez | Staff | Interviewed during investigation |
Inspection Report
Annual Inspection
Census: 90
Capacity: 183
Deficiencies: 2
Sep 13, 2022
Visit Reason
The inspection was a required unannounced one-year comprehensive inspection to evaluate compliance with licensing regulations.
Findings
The facility was inspected thoroughly including resident rooms, common areas, and safety equipment. Minor issues such as uncovered trash cans and missing handwashing posters were noted, with corrective actions planned within 3 days. No citations were issued.
Deficiencies (2)
| Description |
|---|
| Some trash cans were observed without covers; corrective action to cover all trash cans within 3 days. |
| Some sinks in restrooms lacked posters of washing hands for 20 seconds; corrective action to post within 3 days. |
Report Facts
Capacity: 183
Census: 90
Food supplies: 2
Food supplies: 7
Fire extinguisher service date: Sep 8, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analysts and involved in inspection and corrective action discussions |
| Steve Chang | Licensing Program Analyst | Conducted inspection and documented findings |
| Simi Rai | Licensing Program Analyst | Conducted inspection and documented findings |
Inspection Report
Follow-Up
Census: 90
Capacity: 183
Deficiencies: 0
Aug 24, 2022
Visit Reason
This visit is a follow-up case management visit conducted to follow up on the case management from 08/11/2022.
Findings
No deficiencies or citations were noted during this unannounced case management visit. Staff received training on resident rights and redirecting dementia residents with behaviors.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during the visit and provided training on resident rights. |
Inspection Report
Census: 89
Capacity: 183
Deficiencies: 0
Aug 11, 2022
Visit Reason
An unannounced Case Management visit was conducted to investigate an incident at the facility.
Findings
The Executive Director was interviewed and relevant documents were obtained. The facility plans to provide more staff training. No citations were issued during this investigation, and further investigation is needed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Interviewed regarding the incident during the Case Management visit. |
Inspection Report
Complaint Investigation
Census: 131
Capacity: 183
Deficiencies: 0
Sep 17, 2021
Visit Reason
The inspection was conducted as a complaint investigation following an allegation that staff threatened to hit a resident in care.
Findings
The investigation found the allegations to be unsubstantiated based on interviews, observations, and records reviewed. No deficiencies or citations were noted during the visit.
Complaint Details
The complaint alleged that staff threatened to hit the resident. Interviews with staff, the administrator, the resident's responsible party, and the resident were conducted. Video footage showed no evidence of abuse. The resident was unable to provide detailed information due to neurocognitive disorder. The allegation was reported to law enforcement but no injuries were reported.
Report Facts
Complaint Control Number: 26-AS-20210317094839
Number of staff interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the complaint investigation visit |
| Jennell Revera | Administrator | Facility administrator interviewed during investigation |
| Shantela Yadao | Executive Director | Met during the inspection visit and exit interview |
Inspection Report
Annual Inspection
Census: 85
Capacity: 183
Deficiencies: 0
Sep 15, 2021
Visit Reason
The inspection was a required unannounced 1-year visit to evaluate the facility's compliance with licensing regulations.
Findings
The Licensing Program Analyst toured the facility with the Executive Director, inspected multiple areas including resident rooms and common areas, and reviewed COVID-19 protocols. No citations were issued during this inspection.
Report Facts
Staff vaccination rate: 85
Resident vaccination rate: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantela Yadao | Executive Director | Met with Licensing Program Analyst during inspection and provided information on vaccination rates and facility operations |
| Steve Chang | Licensing Program Analyst | Conducted the inspection and toured the facility |
Inspection Report
Census: 130
Capacity: 183
Deficiencies: 0
Dec 8, 2020
Visit Reason
The visit was a Case Management - Other type conducted as a tele-visit due to COVID-19 preventive measures, to evaluate the facility's compliance with COVID-19 related protocols and general conditions.
Findings
The facility was virtually toured and found to have COVID-19 related posters, hand sanitizer, thermometer, and visitor sign-in logs appropriately placed. Some trash cans lacked lids, but the facility had ordered replacements. Social distancing was observed except in the Memory Care Unit dining room where tables and residents were less than 6 feet apart. Recommendations were given to address these issues. No deficiencies were cited during the tele-visit.
Report Facts
Residents in Memory Care Unit: 19
Residents in Assisted Living Unit: 111
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennell Revera | Executive Director | Met with Licensing Program Analysts during the tele-visit |
| Steve Chang | Licensing Program Analyst | Conducted tele-visit |
| Gladys Kuizon | Licensing Program Analyst | Conducted tele-visit |
| Elenteny Barbara | Program Clinical Consultant | Conducted tele-visit |
Inspection Report
Complaint Investigation
Census: 136
Capacity: 183
Deficiencies: 0
Nov 3, 2020
Visit Reason
Unannounced case management tele-visit to review an incident report about a resident fall.
Findings
The incident involved a resident who fell in their apartment resulting in a left arm fracture. The facility updated the resident's care plan, added a caregiver, and trained staff on fall risk interventions. No deficiencies were cited during the visit.
Complaint Details
Visit was complaint-related due to a resident fall incident. No deficiencies were cited, indicating no substantiated violations.
Report Facts
Capacity: 183
Census: 136
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennell Revera | Executive Director | Interviewed regarding the resident fall incident and facility interventions. |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced case management tele-visit. |
| Joanne Roadilla | Licensing Program Analyst | Conducted the unannounced case management tele-visit. |
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