Inspection Report
Complaint Investigation
Census: 159
Capacity: 293
Deficiencies: 1
Nov 25, 2024
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that the facility roof is in disrepair with leaks affecting resident rooms, the dining room, and hallways.
Findings
The investigation found that although no active leaks were observed during the visit, there was evidence of past leaks including brown spots on the ceiling and a plastic bag taped to a ceiling to contain leaking water. The roof is in disrepair and scheduled for repair in 2025. The allegation was substantiated as the roof leaks pose a potential health, safety, or personal rights risk to residents.
Complaint Details
The complaint was substantiated based on observations, interviews with residents and staff, and record review. Residents reported water leaking through the fire sprinkler in a shared bedroom for the past three years during heavy rains. Staff confirmed a temporary measure of taping a plastic bag to the ceiling to contain leaks. The facility plans to repair the ceiling by 12/09/2024.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. | Type B |
Report Facts
Capacity: 293
Census: 159
Deficiency POC Due Date: Dec 9, 2024
Number of residents interviewed: 4
Years of leaking reported: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Tania Dupre | Administrator | Facility administrator interviewed during the investigation |
| Ismael Damian | Maintenance Director | Identified areas affected by roof leaks |
| Rob Johnston | Facility Administrator named in report header |
Inspection Report
Follow-Up
Census: 159
Capacity: 293
Deficiencies: 1
Nov 25, 2024
Visit Reason
An unannounced case management visit was conducted to address a deficiency observed during a prior complaint investigation, specifically regarding unpaid annual licensing fees.
Findings
The facility had not paid their annual licensing fees due on 07/12/2024 and had an outstanding balance of $4,455.00, which poses a potential health or safety risk to clients in care. The facility will be cited for this deficiency.
Complaint Details
The visit was triggered by a deficiency observed during a complaint investigation.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to pay annual licensing fees due on 7/12/2024, with a current balance of $4,455.00. | Type B |
Report Facts
Outstanding licensing fees: 4455
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the inspection and authored the report |
| Tania Dupre | Administrator | Met with Licensing Program Analyst during inspection |
| Collette Escalante | Business Office Manager | Met with Licensing Program Analyst during inspection |
| Tricia Danielson | Licensing Program Manager | Supervisor of the inspection |
Inspection Report
Annual Inspection
Census: 161
Capacity: 293
Deficiencies: 0
Jul 25, 2024
Visit Reason
The inspection was an unannounced Required Annual Inspection conducted to evaluate compliance with licensing regulations for the facility.
Findings
The facility was found to be in compliance with all applicable regulations. The physical plant, medication storage, food service, care and supervision, and records were all inspected and found satisfactory with no violations cited.
Report Facts
Facility capacity: 293
Census: 161
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tania Dupre | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Venus Mixson | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jazmond D Harris | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 150
Capacity: 293
Deficiencies: 0
Dec 14, 2023
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2020-08-18 alleging that facility staff did not follow a resident's care agreement and physician's orders.
Findings
The investigation found the allegations unsubstantiated due to lack of supporting evidence, as relevant records prior to 2021 were moved off site and no additional information was provided. The preponderance of evidence standard was not met.
Complaint Details
The complaint alleged that staff did not follow Resident 1's care agreement by taking her to the emergency room before contacting the Power of Attorney, and did not follow physician's orders by continuing medication administration beyond the prescribed period. Both allegations were found unsubstantiated.
Report Facts
Complaint received date: Aug 18, 2020
Complaint control number: 08-AS-20200818154152
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mark Mandel | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tania Dupre | Administrator | Met with Licensing Program Analyst during investigation and received investigative findings |
| Simon Jacob | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 150
Capacity: 293
Deficiencies: 0
Jul 28, 2023
Visit Reason
The visit was an unannounced annual inspection to ensure the facility's compliance with California Code of Regulations, Title 22, Division 6.
Findings
The facility was found to be in good repair with no pathway obstruction, clean and odor-free resident units, working smoke and carbon monoxide detectors, and proper food storage. Staff records and resident interviews revealed no discrepancies. No deficiencies were observed during the inspection.
Report Facts
Food supply duration: 7
Food supply duration: 2
Facility units: 149
Residents approved for hospice care: 10
Non-ambulatory residents capacity: 290
Bedridden residents capacity: 3
Hot water temperature: 117.6
Indoor temperature: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Shaw Ross | Licensing Program Analyst | Conducted the unannounced annual visit and inspection |
| Collette Escalante | Business Office Manager | Met with Licensing Program Analyst and received report |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 168
Capacity: 293
Deficiencies: 0
Oct 11, 2022
Visit Reason
The visit was an unannounced case management inspection conducted in response to an incident reported on October 10, 2022, concerning a potential inappropriate relationship between a staff member and a resident.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst interviewed one staff member and one resident and reviewed pertinent documents.
Complaint Details
The complaint involved a potential inappropriate relationship between Staff #1 and Resident #1. The complaint was investigated during the visit with interviews and document review, and no deficiencies were found.
Report Facts
Capacity: 293
Census: 168
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Johnston | Executive Director | Met with during the inspection |
| Deanna Lyons | Resident Services Director | Met with during the inspection |
| Tricia Danielson | Licensing Program Analyst | Conducted the case management visit and investigation |
| Deborah Mullen | Licensing Program Manager | Named in the report header |
Inspection Report
Census: 167
Capacity: 293
Deficiencies: 0
Aug 5, 2022
Visit Reason
The visit was an unannounced case management incident inspection following receipt of a death report concerning Resident #1.
Findings
No deficiencies were cited during the visit. Licensing staff obtained pertinent documents and toured the facility, concluding with an exit interview and provision of the report copy.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the case management visit and obtained pertinent documents. |
| Reyna Lacey | Regional Manager | Conducted the case management visit and obtained pertinent documents. |
| Donna Daniel-Herr | Administrator | Facility administrator met with licensing staff during the visit. |
| Deanna Lyons | Resident Care Director | Facility staff met with licensing staff during the visit. |
Inspection Report
Annual Inspection
Census: 167
Capacity: 293
Deficiencies: 0
Jul 28, 2022
Visit Reason
The Licensing Program Analyst arrived unannounced to conduct an annual inspection with emphasis on infection control.
Findings
The facility was found to be in compliance with COVID-19 mitigation requirements, including appropriate postings, sufficient hygiene supplies, PPE, and an approved COVID-19 Mitigation Plan. No deficiencies were observed during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Johnston | Administrator | Met with Licensing Program Analyst during inspection. |
| Deeanna Lyons | Resident Care Director | Met with Licensing Program Analyst during inspection. |
| Tricia Danielson | Licensing Program Analyst | Conducted the annual inspection. |
| Deborah Mullen | Licensing Program Manager | Named in report header. |
Inspection Report
Complaint Investigation
Census: 122
Capacity: 293
Deficiencies: 0
Sep 24, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on October 7, 2020, regarding a resident's bed being in disrepair.
Findings
The investigation found that the resident's bed was functioning properly after an outside vendor inspection, and staff were shown how to operate the bed's crank system. The allegation was found to be unsubstantiated.
Complaint Details
The complaint alleged that a resident's bed was in disrepair. The investigation included interviews and review of facility records. The resident had passed away in December 2020. The allegation was unsubstantiated due to lack of evidence.
Report Facts
Capacity: 293
Census: 122
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Adam Hamer | Licensing Program Analyst | Conducted the complaint investigation visit |
| Dennis Prejusa | Resident Care Director | Met with the Licensing Program Analyst during the investigation |
| Denise Powell | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 134
Capacity: 293
Deficiencies: 1
Aug 12, 2021
Visit Reason
An unannounced complaint investigation visit was conducted due to a complaint received on 07/16/2020 alleging that staff did not properly handle food service, specifically that food supposed to be served hot was served cold to residents.
Findings
The investigation found that during the COVID-19 lockdown, residents were served cold food that was supposed to be hot due to logistical challenges and lack of equipment. The allegation was substantiated with evidence including interviews and records review. A citation was issued and a plan of correction was developed.
Complaint Details
The complaint was substantiated. Staff did not properly handle food service during the COVID-19 lockdown, serving cold food instead of hot food to residents. The issue was ongoing and known by staff. A citation was issued in accordance with California Code of Regulations, Title 22.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not observe procedures which protect the safety, acceptability and nutritive values of food served to residents. | Type B |
Report Facts
Residents affected: 1
Capacity: 293
Census: 134
Plan of Correction Due Date: Sep 3, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Adam Hamer | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Rob Johnston | Administrator | Facility administrator interviewed during the investigation and involved in plan of correction. |
| Denise Powell | Licensing Program Manager | Oversaw the licensing program and signed the report. |
Inspection Report
Annual Inspection
Census: 122
Capacity: 293
Deficiencies: 0
Jun 15, 2021
Visit Reason
An unannounced annual required licensing inspection was conducted to verify compliance with statutes, regulations, and infection control practices, including COVID-19 mitigation measures.
Findings
The facility was found to be in compliance with all applicable regulations and infection control practices, including COVID-19 mitigation. No deficiencies were observed during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Johnston | Administrator | Present during inspection and exit interview |
| Lisa Chavarria | Resident Care Director | Present during inspection and exit interview |
| Adam Hamer | Licensing Program Analyst | Conducted the inspection |
| Denise Powell | Licensing Program Manager | Named in report header |
Inspection Report
Census: 136
Capacity: 293
Deficiencies: 0
Dec 2, 2020
Visit Reason
The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment.
Findings
During the visit, no deficiencies were issued. The team interviewed the Administrator and Assisted Living Director and conducted a walk-through of the facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Donna Daniel-Herr | Administrator | Interviewed during the visit and discussed purpose of the visit. |
| Lisa Chavarria | Assisted Living Director | Interviewed during the visit and discussed purpose of the visit. |
Report
May 3, 2021
File
report_9_374600378_inx8_2021-05-03.pdf
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