Most inspections found no deficiencies, and several complaint investigations were unsubstantiated. The most recent report from July 18, 2025, cited recordkeeping deficiencies related to missing pre-admission appraisals, functional assessments, and a reappraisal for a resident with dementia. Earlier reports noted issues with personnel health screenings, emergency drill documentation, and criminal record clearances, including civil penalties for missing clearances and staff sleeping in non-designated areas. There were no fines, license suspensions, or immediate jeopardy findings listed in the available reports. The facility’s record shows some isolated administrative and staffing documentation issues but no clear pattern of worsening or severe problems over time.
The inspection was conducted as the Annual 1-year required inspection for the facility.
Findings
The inspection found that the physical plant met safety and environmental standards, but resident records were missing required documents including Pre-Admission Appraisals and Functional Capabilities Assessments for all residents, and a reappraisal was missing for one resident diagnosed with Dementia. Type B deficiencies were cited for these recordkeeping violations.
Severity Breakdown
Type B: 3
Deficiencies (3)
Description
Severity
Missing pre-admission appraisal for residents R1, R2, R3, R4, and R5.
Type B
Missing Functional Capabilities Assessment for residents R1, R2, R3, R4, and R5.
Type B
Missing annual reappraisal for resident R1 diagnosed with Dementia.
An unannounced case management visit was conducted to deliver a copy of the amended report related to the Annual inspection conducted on September 11, 2024.
Findings
No deficiencies were issued during the visit. The amended report was reviewed with the caregivers and a copy was provided.
The inspection was an unannounced annual 1-year required inspection conducted to assess compliance with licensing regulations.
Findings
The facility was generally clean and well-maintained with proper safety equipment and adequate food supplies. However, deficiencies were found related to personnel health screening, emergency drill documentation, and criminal record clearance for staff.
Severity Breakdown
Type B: 2Type A: 1
Deficiencies (3)
Description
Severity
Personnel records for 3 out of 5 staff did not have TB test results, posing a potential health risk.
Type B
Emergency drill logs for 2024 were not present in the facility, violating quarterly drill requirements.
Type B
One staff member had a criminal record clearance but was not associated with the facility, posing an immediate risk.
An unannounced infection control annual inspection visit was conducted to evaluate compliance with health and safety regulations.
Findings
The inspection found no immediate physical hazards, adequate infection control practices, and current vaccination status for staff and residents. However, two staff members (S1 and S2) were identified as not associated with the facility and lacked required criminal record clearance transfers, resulting in civil penalties. Additionally, staff were observed sleeping on living room couches, violating accommodation requirements.
Severity Breakdown
Type A: 1Type B: 1
Deficiencies (2)
Description
Severity
Failed to request a transfer of criminal record clearance for two staff members (S1 and S2) not associated with the facility.
Type A
Staff sleeping on living room couches instead of designated living accommodations.
Type B
Report Facts
Civil penalty amount: 200Capacity: 8Census: 7
Employees Mentioned
Name
Title
Context
Jaime Vado
Licensing Program Analyst
Conducted the inspection and signed the report
Jackie Jin
Licensing Program Manager
Supervisor of the inspection
Cynthia Advincula
Administrator
Facility administrator present during inspection
Emma Advincula
Caregiver
Met with Licensing Program Analyst during inspection
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 and found no accessible water or fire safety hazards. Infection control practices, medication storage, environmental safety, and emergency preparedness were reviewed and found generally adequate. Some staff files were inaccessible, and additional signage for masking and social distancing was recommended.
Report Facts
Residents present: 4Staff present: 2Capacity: 8
Employees Mentioned
Name
Title
Context
Emma Advincula
Caregiver
Met with Licensing Program Analyst during inspection and discussed findings
An unannounced complaint investigation visit was conducted in response to an allegation of illegal eviction received on 07/24/2020.
Findings
The investigation found that the facility initially issued an eviction notice due to pandemic-related issues but later rescinded it after addressing the resident's physical therapy, medication, and care needs. The resident remains in care and is receiving the previous level of care with family assistance. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleging illegal eviction was investigated and found to be unsubstantiated.
Report Facts
Capacity: 8Census: 7
Employees Mentioned
Name
Title
Context
Jaime Vado
Licensing Program Analyst
Conducted the complaint investigation
Cynthia Advincula
Administrator
Provided interview information regarding eviction notice
Evangeline Panglinan
Staff person met during inspection
Julio Montes
Licensing Program Manager
Named in report
Loading inspection reports...
Need Help?
Let us help you or a loved one find the perfect senior home.