Inspection Reports for
Carlton Senior Living San Jose

CA, 95136

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Deficiencies (last 7 years)

Deficiencies (over 7 years) 1.3 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

68% better than California average
California average: 4 deficiencies/year

Deficiencies per year

4 3 2 1 0
2020
2021
2022
2023
2024
2025
2026

Census

Latest occupancy rate 75% occupied

Based on a January 2026 inspection.

This facility has shown a steady increase in demand based on occupancy rates.

Occupancy over time

60 90 120 150 180 210 Nov 2020 Aug 2022 Nov 2022 Sep 2024 Aug 2025 Jan 2026 Jan 2026

Inspection Report

Complaint Investigation
Census: 137 Capacity: 183 Deficiencies: 0 Date: Jan 28, 2026

Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2026-01-23 regarding refund issues and communication with the responsible party about resident care.

Complaint Details
The complaint alleged the facility did not provide a refund to the resident and that staff were not communicating with the responsible party regarding the resident's care. The investigation concluded the allegations were unfounded.
Findings
The investigation found the allegations to be unfounded after reviewing documents, interviewing staff and the administrator, and observing the facility. The facility refunded the appropriate amount as per the deposit receipt terms, and staff communicated with the responsible party and emergency contact regarding the resident's condition and care.

Report Facts
Refund amount: 2500 Refund amount: 258 Capacity: 183 Census: 137

Employees mentioned
NameTitleContext
Marcela YanezLicensing EvaluatorConducted the complaint investigation visit
Shantela YadaoAdministratorFacility administrator met during investigation

Inspection Report

Census: 137 Capacity: 183 Deficiencies: 0 Date: Jan 23, 2026

Visit Reason
Licensing Program Analyst Manuel Monter conducted an unannounced case management visit to follow up on the facility's proposed memory care unit expansion.

Findings
No deficiencies were cited during the visit. The Licensing Program Analyst toured the memory care unit and the proposed expansion with the Director of Resident Services and reviewed the report with her.

Employees mentioned
NameTitleContext
Maricel OngDirector of Resident ServicesMet with during the visit and involved in discussion regarding the proposed memory care unit expansion.
Manuel MonterLicensing Program AnalystConducted the unannounced case management visit.
Romeo ManzanoLicensing Program ManagerNamed as Licensing Program Manager on the report.

Inspection Report

Complaint Investigation
Census: 94 Capacity: 183 Deficiencies: 0 Date: Jan 9, 2026

Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2025-06-26 regarding improper addressing of a resident's behaviors and failure to ensure an updated medical assessment after a change of condition.

Complaint Details
The complaint alleged that facility staff were not properly addressing a resident's behaviors and did not ensure the resident received an updated medical assessment after a change of condition. The investigation concluded the allegations were unfounded.
Findings
The investigation found the allegations to be unfounded after interviews and record reviews. The resident's behavioral changes were documented as occurring after hospitalization, and the facility staff worked with the resident's family and physician. No new medical orders were provided by the physician, and no deficiencies were cited.

Report Facts
Capacity: 183 Census: 94

Employees mentioned
NameTitleContext
Shantela YadaoAdministratorMet during the investigation and exit interview
Simranjit RaiLicensing Program AnalystConducted the complaint investigation

Inspection Report

Annual Inspection
Census: 134 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Shantela YadaoExecutive DirectorMet during inspection and involved in exit interview
Marcella TarinLicensing Program AnalystConducted the inspection and authored the report

Inspection Report

Annual Inspection
Census: 134 Capacity: 183 Deficiencies: 0 Date: Sep 15, 2025

Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Marcella Tarin to evaluate compliance with licensing requirements at Carlton Plaza of San Jose.

Findings
No deficiencies were cited during the inspection per California Code of Regulations Title 22. Two technical violations were issued related to the remodeling of the resident dining area and water temperature exceeding regulatory limits.

Report Facts
Water temperatures exceeding limit: 10 Resident bedrooms toured: 10 Resident bathrooms toured: 10 Resident records reviewed: 4 Medication records reviewed: 5 Staff records reviewed: 5 Technical Violations issued: 2

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with LPA during inspection and involved in exit interview
Marcella TarinLicensing Program AnalystConducted the unannounced annual inspection
Jin JackieLicensing Program ManagerNamed as Licensing Program Manager on report

Inspection Report

Plan of Correction
Census: 95 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Deficiency citation: 1 Capacity: 183 Census: 95

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during the POC visit
Steve ChangLicensing Program AnalystConducted the unannounced POC visit

Inspection Report

Plan of Correction
Census: 95 Capacity: 183 Deficiencies: 1 Date: Aug 6, 2025

Visit Reason
The visit was an unannounced Plan of Correction (POC) visit conducted to clear a Type A deficiency cited during a prior complaint investigation visit on 2025-08-05.

Complaint Details
The Type A deficiency was cited during a complaint investigation visit for complaint number 26-AS-20240812112833 on 2025-08-05.
Findings
No deficiencies were cited during the POC visit on 2025-08-06. The facility provided a plan of corrections with staff training, and a Letter of Deficiencies Cleared was issued.

Deficiencies (1)
Type A deficiency cited on 2025-08-05 related to code section 87464(f)(1).
Report Facts
Capacity: 183 Census: 95 Plan of Correction due date: 1

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during the POC visit
Steve ChangLicensing Program AnalystConducted the unannounced POC visit
Romeo ManzanoLicensing Program ManagerNamed in the report header

Inspection Report

Complaint Investigation
Census: 95 Capacity: 183 Deficiencies: 1 Date: 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.

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.
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.

Deficiencies (1)
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.
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
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and involved in providing information about the incidents
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit
Romeo ManzanoLicensing Program ManagerNamed in report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 95 Capacity: 183 Deficiencies: 1 Date: 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.

Complaint Details
The complaint alleged neglect and lack of supervision resulting in a resident-on-resident altercation. The allegation was substantiated based on interviews, document reviews, and observations. The Department found that the facility failed to provide adequate supervision, leading to multiple incidents between residents R1 and R2, including physical altercations causing injury to R1.
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.

Deficiencies (1)
The facility did not provide the necessary care and supervision to resident R1 and R2 to meet their care needs, leading to multiple falls and head injuries to R1, posing an immediate health and safety risk.
Report Facts
Capacity: 183 Census: 95 Incidents: 3 Plan of Correction Due Date: Due date mentioned as 08/06/2025 for submission of plan of correction

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during investigation and named in findings related to supervision failures
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit
Chihhsien ChangLicensing EvaluatorConducted complaint investigation and signed report
Romeo ManzanoSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 131 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Facility capacity: 183 Census: 131 Complaint control number: 26-AS-20240607150519

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and named in findings
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit
Chihhsien ChangEvaluator / Licensing Program AnalystConducted the complaint investigation
Romeo ManzanoLicensing Program ManagerNamed in report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 131 Capacity: 183 Deficiencies: 0 Date: Jul 7, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not prevent a resident from being harmed by another resident on 06/04/2024.

Complaint Details
The complaint alleged that staff failed to prevent harm between residents R1 and R2. The investigation included interviews with residents, staff, and review of surveillance footage and reports. The allegation was found unsubstantiated.
Findings
The investigation found that on 06/04/2024, residents R1 and R2 had an incident in the memory care unit hallway where R1 grabbed R2, R2 pushed R1 away causing R1 to fall and be sent to the hospital. Staff responded promptly. The allegation was determined to be unsubstantiated due to insufficient evidence to prove the claim.

Report Facts
Facility capacity: 183 Census: 131 Complaint control number: 26-AS-20240607150519

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and named in findings
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit

Inspection Report

Complaint Investigation
Census: 93 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

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
NameTitleContext
Steve ChangLicensing Program AnalystConducted the unannounced complaint investigation visit
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during investigation and provided information

Inspection Report

Complaint Investigation
Census: 93 Capacity: 183 Deficiencies: 0 Date: Oct 31, 2024

Visit Reason
The inspection was conducted in response to a complaint alleging that the facts provided in a 30 day eviction notice for a resident were without foundation or merit.

Complaint Details
The complaint alleged that the 30 day eviction notice facts were without foundation or merit. The investigation included interviews with staff and the resident, review of incident and fire reports, and facility inspection. The resident denied the accusations. The Department found the allegation unfounded and no citations were issued.
Findings
The investigation found the allegation to be unfounded after interviews, document reviews, and facility tour. The resident was accused of inappropriate behavior and causing a fire, but the Department concluded the allegation was false or without reasonable basis.

Report Facts
Facility capacity: 183 Census: 93 Complaint control number: 26-AS-20240521084801

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and named in findings
Steve ChangLicensing Program AnalystConducted investigation visit
Chihhsien ChangLicensing EvaluatorConducted complaint investigation

Inspection Report

Complaint Investigation
Census: 136 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Complaint received date: May 15, 2023 Medication administration start date: May 13, 2023 Medication not administered period: 5

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and named in findings
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit

Inspection Report

Complaint Investigation
Census: 136 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Capacity: 183 Census: 136

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with during investigation and exit interview
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit

Inspection Report

Complaint Investigation
Census: 136 Capacity: 183 Deficiencies: 0 Date: Sep 18, 2024

Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation that facility staff were not administering a resident's medication per physician's order.

Complaint Details
The complaint alleged that staff were not administering resident's medication per physician's order. After interviews and document review, the allegation was found to be unfounded, meaning it was false or without reasonable basis.
Findings
The investigation found that the facility did not receive the doctor's order for the medication before 5/13/2023 and started administering the medication to the resident on 5/13/2023. The allegation was determined to be unfounded with no citations noted during the visit.

Report Facts
Capacity: 183 Census: 136

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet during investigation and exit interview
Steve ChangLicensing Program AnalystConducted the unannounced investigation visit

Inspection Report

Complaint Investigation
Census: 136 Capacity: 183 Deficiencies: 0 Date: Sep 18, 2024

Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation that staff did not adequately supervise a resident, resulting in the resident sustaining a fracture while in care.

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 insufficient evidence to prove occurrence.
Findings
Based on interviews, document reviews, and investigation, the allegation was found to be unsubstantiated. The resident's fall was unwitnessed, staff responded promptly by calling 911, and no citations were issued during the visit.

Report Facts
Facility capacity: 183 Resident census: 136 Complaint control number: 26-AS-20230711083943

Employees mentioned
NameTitleContext
Shantela YadaoAdministrator / Executive DirectorMet during investigation and exit interview
Steve ChangLicensing Program AnalystConducted the investigation visit
Chihhsien ChangLicensing EvaluatorConducted investigation and signed report
Romeo ManzanoSupervisorSupervisor overseeing the investigation

Inspection Report

Annual Inspection
Census: 94 Capacity: 183 Deficiencies: 2 Date: 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)
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
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during inspection and named in plan of correction statements
Steve ChangLicensing Program AnalystConducted the inspection visit
Chihhsien ChangLicensing EvaluatorNamed as licensing evaluator and analyst on report
Romeo ManzanoLicensing Program ManagerNamed as supervisor and licensing program manager

Inspection Report

Annual Inspection
Census: 94 Capacity: 183 Deficiencies: 2 Date: Sep 12, 2024

Visit Reason
An unannounced annual inspection visit was conducted by Licensing Program Analysts to evaluate compliance with licensing requirements at Carlton Plaza of San Jose.

Findings
The inspection found deficiencies related to personnel records and medication documentation, with two staff files missing health screening forms and one resident file having inaccurate centrally stored medication forms. Facility safety equipment was generally in good condition with minor issues promptly corrected.

Deficiencies (2)
2 out of 5 staff files were observed without health screen form which poses/posed 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/posed a potential health, safety or personal rights risk to persons in care.
Report Facts
Capacity: 183 Census: 94 Staff files reviewed: 5 Resident files reviewed: 5 POC Due Date: Sep 19, 2024

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during inspection and named in plan of correction statements
Steve ChangLicensing Program AnalystConducted the unannounced annual inspection visit
Chihhsien ChangLicensing EvaluatorPrepared and signed the inspection report
Romeo ManzanoSupervisorSupervisor overseeing the inspection

Inspection Report

Complaint Investigation
Census: 145 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Facility capacity: 183 Resident census: 145

Employees mentioned
NameTitleContext
Yoliana SanchezExecutive AssistantMet with Licensing Program Analysts during the inspection and provided information related to the incident
Steve ChangLicensing Program AnalystConducted the inspection
Manuel MonterLicensing Program AnalystConducted the inspection

Inspection Report

Complaint Investigation
Census: 145 Capacity: 183 Deficiencies: 0 Date: May 30, 2024

Visit Reason
The visit was conducted to open a complaint and obtain additional information regarding an incident report involving a resident found unresponsive.

Complaint Details
The complaint investigation was related to an incident where a resident was found unresponsive in their bedroom. The facility called 911, and paramedics and police responded. The resident had been in hospice care but graduated in January 2024.
Findings
No deficiencies were cited during the visit. The facility staff and Executive Assistant reported the resident was normal prior to the incident and had recently graduated from hospice care.

Employees mentioned
NameTitleContext
Yoliana SanchezExecutive AssistantMet with Licensing Program Analysts during the investigation and provided police report case number.

Inspection Report

Census: 138 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analysts during the incident visit and provided information about the incident and follow-up actions.
Steve ChangLicensing Program AnalystConducted the unannounced case management-incident visit.
Manuel MonterLicensing Program AnalystConducted the unannounced case management-incident visit.

Inspection Report

Census: 138 Capacity: 183 Deficiencies: 0 Date: 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 injuries or hospitalizations reported. Some smoke and water damage occurred in multiple rooms, which were being dried and expected to be restored by 05/13/2024. The resident involved denied causing the fire, and the facility took corrective actions including updating the resident's care plan and removing lighters.

Report Facts
Rooms affected: 5

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analysts during the visit and provided information about the incident and follow-up actions.
Steve ChangLicensing Program AnalystConducted the unannounced case management-incident visit.
Manuel MonterLicensing Program AnalystConducted the unannounced case management-incident visit.

Inspection Report

Complaint Investigation
Census: 138 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Census: 138 Total Capacity: 183

Employees mentioned
NameTitleContext
Shantela YadaoAdministratorMet with Licensing Program Analyst during the visit and provided information about the incident
Steve ChangLicensing Program AnalystConducted the unannounced Case Management - Incident visit

Inspection Report

Complaint Investigation
Census: 138 Capacity: 183 Deficiencies: 0 Date: 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, resulting in the resident's death. The visit aimed to investigate the incident and gather relevant information.

Complaint Details
This visit was complaint-related due to the incident of the resident found unresponsive and subsequent death. Family members stated no complaints against the facility. The case requires further investigation.
Findings
The resident was found unresponsive on 11/3/2023 and pronounced dead shortly after paramedic assessment. Staff and family interviews indicated the resident was weak due to cancer and on continuous oxygen. Family members had no complaints against the facility. Further investigation is needed pending the resident's death certificate.

Report Facts
Capacity: 183 Census: 138 Time of incident: 700 Time 911 called: 715 Time pronounced dead: 725

Employees mentioned
NameTitleContext
Shantela YadaoAdministratorMet with Licensing Program Analyst during the visit and provided information about the incident
Steve ChangLicensing Program AnalystConducted the unannounced Case Management - Incident visit

Inspection Report

Complaint Investigation
Census: 92 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

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
NameTitleContext
Steve ChangLicensing Program AnalystConducted the unannounced complaint investigation visit
Jennell ReveraFormer Executive DirectorInterviewed during investigation and named as Administrator
Shantela YadaoExecutive DirectorInterviewed during investigation and met with during visit
Maricel OngDirector of Memory CareInterviewed during investigation
Romeo ManzanoLicensing Program ManagerNamed in report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 92 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Complaint Control Number: 26 Complaint Receipt Date: May 25, 2021 Facility Capacity: 183 Facility Census: 92

Employees mentioned
NameTitleContext
Jennell ReveraFormer Executive DirectorInterviewed during investigation and named in findings
Shantela YadaoCurrent Executive DirectorInterviewed during investigation and named in findings
Maricel OngDirector of Memory CareInterviewed during investigation and named in findings
Steve ChangLicensing Program AnalystConducted the complaint investigation visit

Inspection Report

Complaint Investigation
Census: 92 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Complaint Control Number: 26 Complaint Control Number Full: 20220713121043

Employees mentioned
NameTitleContext
Steve ChangLicensing Program AnalystConducted the unannounced complaint investigation visit
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during investigation and exit interview
Brandee AcostaMemory Care DirectorInterviewed during investigation
Veronica ChavezStaffInterviewed during investigation

Inspection Report

Complaint Investigation
Census: 92 Capacity: 183 Deficiencies: 0 Date: Nov 8, 2022

Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 07/13/2022 regarding a suspicious death at the facility.

Complaint Details
The complaint alleged a suspicious death. After interviews with family members, staff, and review of medical records, the Department found the allegations to be unfounded, meaning the allegation was false or without reasonable basis.
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.

Report Facts
Capacity: 183 Census: 92

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with during investigation and exit interview
Steve ChangLicensing Program AnalystConducted the complaint investigation visit
Brandee AcostaMemory Care DirectorInterviewed during investigation
Veronica ChavezStaffInterviewed during investigation

Inspection Report

Annual Inspection
Census: 90 Capacity: 183 Deficiencies: 2 Date: 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)
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
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analysts and involved in inspection and corrective action discussions
Steve ChangLicensing Program AnalystConducted inspection and documented findings
Simi RaiLicensing Program AnalystConducted inspection and documented findings

Inspection Report

Annual Inspection
Census: 90 Capacity: 183 Deficiencies: 0 Date: Sep 13, 2022

Visit Reason
The inspection was a required unannounced one-year comprehensive inspection of the facility to evaluate compliance with licensing regulations.

Findings
The facility was inspected thoroughly including resident rooms, common areas, and safety equipment. No citations were issued, and the facility demonstrated sufficient infection control measures and safety compliance, with minor issues noted such as uncovered trash cans and missing handwashing posters, which the Executive Director committed to correcting within three days.

Report Facts
Fire extinguisher service date: Sep 8, 2022 Inspection start time: 1045 Inspection end time: 1159

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analysts and addressed purpose of visit; involved in facility tour and corrective commitments
Steve ChangLicensing Program AnalystConducted inspection and evaluation
Simi RaiLicensing Program AnalystConducted inspection and evaluation

Inspection Report

Follow-Up
Census: 90 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during the visit and provided training on resident rights.

Inspection Report

Follow-Up
Census: 90 Capacity: 183 Deficiencies: 0 Date: Aug 24, 2022

Visit Reason
This visit is a follow-up case management visit conducted to review prior case management on 08/11/2022.

Findings
No deficiencies or citations were noted during this unannounced case management visit. Staff had completed training on resident rights and redirecting dementia residents with behaviors.

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during the visit and provided training on resident rights.
Steve ChangLicensing Program AnalystConducted the unannounced case management visit.

Inspection Report

Census: 89 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Shantela YadaoExecutive DirectorInterviewed regarding the incident during the Case Management visit.

Inspection Report

Complaint Investigation
Census: 89 Capacity: 183 Deficiencies: 0 Date: Aug 11, 2022

Visit Reason
An unannounced Case Management visit was conducted to investigate an incident at the facility.

Complaint Details
The visit was triggered by an incident requiring further investigation. No citation was issued, and the department indicated the need for further investigation.
Findings
The Licensing Program Analyst interviewed the Executive Director and obtained updated incident and resident reports. The facility plans to provide more staff training. No citations were issued during this investigation.

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorInterviewed regarding the incident and involved in the exit interview.
Steve ChangLicensing Program AnalystConducted the unannounced Case Management visit.

Inspection Report

Complaint Investigation
Census: 131 Capacity: 183 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Complaint Control Number: 26-AS-20210317094839 Number of staff interviewed: 5

Employees mentioned
NameTitleContext
Steve ChangLicensing Program AnalystConducted the complaint investigation visit
Jennell ReveraAdministratorFacility administrator interviewed during investigation
Shantela YadaoExecutive DirectorMet during the inspection visit and exit interview

Inspection Report

Complaint Investigation
Census: 131 Capacity: 183 Deficiencies: 0 Date: 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.

Complaint Details
The complaint alleged that staff threatened to hit the resident. The investigation included interviews with the resident's responsible party, staff, and administrator. The resident was unable to provide detailed information due to neurocognitive disorder. The allegation was reported to law enforcement. The investigation concluded the allegation was unsubstantiated due to lack of preponderance of evidence.
Findings
The department investigated the allegation through interviews, observations, and record reviews and found the allegation to be unsubstantiated. No deficiencies or citations were noted during the investigation.

Report Facts
Capacity: 183 Census: 131

Employees mentioned
NameTitleContext
Jennell ReveraAdministratorNamed as facility administrator during investigation
Steve ChangLicensing Program AnalystConducted the complaint investigation visit
Chihhsien ChangLicensing EvaluatorConducted the investigation and signed the report
Shantela YadaoExecutive DirectorMet with during the inspection visit
Romeo ManzanoSupervisorSupervisor overseeing the investigation

Inspection Report

Annual Inspection
Census: 85 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst during inspection and provided information on vaccination rates and facility operations
Steve ChangLicensing Program AnalystConducted the inspection and toured the facility

Inspection Report

Annual Inspection
Census: 85 Capacity: 183 Deficiencies: 0 Date: Sep 15, 2021

Visit Reason
The visit was a required, unannounced 1-year inspection to evaluate the facility's compliance with licensing and COVID-19 protocols.

Findings
The inspection found that all residents were fully vaccinated and about 85% of staff were vaccinated. The facility conducted COVID testing for unvaccinated staff and maintained infection control measures such as hand sanitizers and mask usage. Some trash cans lacked covers, but the facility planned to replace them. No citations were issued during this inspection.

Report Facts
Vaccination rate: 85 Capacity: 183 Census: 85

Employees mentioned
NameTitleContext
Shantela YadaoExecutive DirectorMet with Licensing Program Analyst and provided information about vaccination and facility operations
Steve ChangLicensing Program AnalystConducted the inspection and toured the facility
Chihhsien ChangLicensing EvaluatorSigned the inspection report
Romeo ManzanoSupervisorSupervisor overseeing the inspection

Inspection Report

Census: 130 Capacity: 183 Deficiencies: 0 Date: 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
NameTitleContext
Jennell ReveraExecutive DirectorMet with Licensing Program Analysts during the tele-visit
Steve ChangLicensing Program AnalystConducted tele-visit
Gladys KuizonLicensing Program AnalystConducted tele-visit
Elenteny BarbaraProgram Clinical ConsultantConducted tele-visit

Inspection Report

Complaint Investigation
Census: 136 Capacity: 183 Deficiencies: 0 Date: Nov 3, 2020

Visit Reason
Unannounced case management tele-visit to review an incident report about a resident fall.

Complaint Details
Visit was complaint-related due to a resident fall incident. No deficiencies were cited, indicating no substantiated violations.
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.

Report Facts
Capacity: 183 Census: 136

Employees mentioned
NameTitleContext
Jennell ReveraExecutive DirectorInterviewed regarding the resident fall incident and facility interventions.
Steve ChangLicensing Program AnalystConducted the unannounced case management tele-visit.
Joanne RoadillaLicensing Program AnalystConducted the unannounced case management tele-visit.

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