Inspection Report Summary
Most inspections found deficiencies related to safety and medication management, including unlocked knives and insulin accessible to residents, locked gates restricting resident rights, and outdated or missing medical documentation. The facility received civil penalties and was required to submit plans of correction after the January 7, 2025 annual inspection, which cited several health and safety risks such as unsafe storage and inaccurate medication records. Earlier reports also noted issues with infection control and environmental hazards like mold and clutter, though the May 16, 2022 inspection included immediate health and safety concerns. The most recent report from January 30, 2025 did not identify new deficiencies but confirmed ongoing challenges with insulin management for a resident requiring staff assistance. Several complaint investigations were not listed, and there is no indication of license suspension or fines beyond those noted in January 2025.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 0
Jan 30, 2025
Visit Reason
The visit was an unannounced Case Management visit conducted by Licensing Program Analysts to assess the facility and verify resident care following an annual inspection.
Findings
During the visit, it was confirmed that resident R1 is on insulin on a sliding scale and is unable to determine the correct amount of insulin needed, requiring staff assistance. The Administrator requested an exception to retain R1 at the facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leonora Maquilan | Care Staff | Met with during the visit and explained the purpose of the visit. |
| Marvin Tom | Administrator/Director | Administrator requested an exception to retain resident R1 at the facility. |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 7
Jan 7, 2025
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing regulations.
Findings
Multiple deficiencies were observed including unlocked knives and insulin accessible to residents, unavailable staff and resident files, trash overflow, a locked side gate with a paddle lock, unsafe storage of various items in the backyard, and inaccurate medication administration records. Civil penalties and plans of correction were issued.
Severity Breakdown
Type A: 3
Type B: 4
Deficiencies (7)
| Description | Severity |
|---|---|
| Unlocked knives in the kitchen and unlocked insulin in the kitchen fridge accessible to residents. | Type A |
| All staff and resident files were not available during the visit. | Type B |
| Trash bags in the backyard and inside the garage not in the garbage bin due to overflow. | Type B |
| Left side gate with a paddle lock which poses an immediate health and safety risk to persons in care. | Type A |
| Washing machine, stove, wheelchair, shower chair, RV, etc. in the backyard posing health and safety risk. | Type B |
| Resident R3 on insulin sliding scale unable to determine amount of insulin needed due to poor vision without approved exception. | Type A |
| Medication Administration Record not having an accurate record of dosages of medications. | Type B |
Report Facts
Civil penalty: 500
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marvin Tom | Administrator/Director | Named as facility administrator; noted as out of the country during inspection. |
| Leonora Maquilan | Care Staff | Met with Licensing Program Analysts during inspection. |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 4
Jan 25, 2024
Visit Reason
Licensing Program Analyst Luisa Fontanilla conducted an unannounced annual required inspection of the Common Destiny facility to evaluate compliance with regulations.
Findings
The inspection identified multiple deficiencies including lack of updated medical documentation for a diabetic resident, absence of an approved exception for diabetes management, presence of cobwebs and mold on windows, missing required resident rights and nondiscrimination posters, and outdated medical assessment for a resident with dementia.
Deficiencies (4)
| Description |
|---|
| Windows were observed with cobwebs/mold on window frame and certain screen windows with holes. |
| Resident R5 is diabetic and on insulin but unable to manage own insulin and no approved exception. |
| Resident S3 has Dementia; last Physician's Report date is 11/15/2021. |
| No Resident Rights, Non discrimination and Resident Family Council posters were displayed. |
Report Facts
Capacity: 6
Census: 6
Deficiency due dates: Feb 1, 2024
Deficiency due dates: Feb 5, 2024
Deficiency due dates: Feb 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marvin Tom | Administrator | Facility administrator informed of visit and responsible for corrective actions |
| Luisa Fontanilla | Licensing Program Analyst | Conducted the inspection and authored the report |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 27, 2023
Visit Reason
The visit was an unannounced Annual Infection Control inspection conducted to evaluate the facility's compliance with infection control and safety standards.
Findings
The inspection found the facility to be in compliance with infection control requirements, including adequate PPE supplies, proper signage, locked sharps and toxins, functional safety equipment, and no deficiencies cited during the visit.
Report Facts
Water temperature: 110.2
Fire extinguisher last serviced: Sep 28, 2022
Facility room temperature: 68
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tom Marvin | Licensee | Met during inspection and named in report |
| Yuan Hong | Licensee | Met during inspection and named in report |
| Liridon Fici | Licensing Program Analyst | Conducted the inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 6
May 16, 2022
Visit Reason
Unannounced annual infection control inspection conducted to evaluate compliance with health and safety regulations.
Findings
The inspection found multiple deficiencies including unlocked cleaning supplies, gardening tools, knives, and medication room posing immediate health and safety risks. Full bed rails were used for residents not on hospice care, and a side gate was locked at night restricting resident rights. Additional issues included vertical blinds in disrepair, clutter in the backyard, and an outdated facility sketch missing key areas.
Severity Breakdown
Type A: 4
Type B: 2
Deficiencies (6)
| Description | Severity |
|---|---|
| Unlocked cleaning supplies, gardening tools, and knives accessible to clients. | Type A |
| Unlocked medication and medication room accessible to unauthorized persons. | Type A |
| Use of full bed rails for residents not on hospice care. | Type A |
| Side gate locked at night restricting residents' right to leave the facility. | Type A |
| Vertical blinds in disrepair and clutter in backyard posing potential health and safety risks. | Type B |
| Facility sketch not updated to include staff room, office in garage, and RV in backyard. | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: May 17, 2022
Plan of Correction Due Date: May 31, 2022
Plan of Correction Due Date: Jun 6, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marvin Tom | Administrator | Met during inspection and agreed to plans of correction. |
| Grace Luk | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection. |
Loading inspection reports...
