Inspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated. The most recent report from April 2, 2025, showed no deficiencies while the facility was non-operational due to cosmetic upgrades. Earlier reports identified some issues with staff training, safety hazards like uneven pavement causing injury, and a failure to notify the Department about bankruptcy filing in a timely manner. Fire code deficiencies noted in 2023 remained uncorrected as of September that year but were not mentioned in later inspections, suggesting some improvement. Overall, the facility’s record shows isolated and mostly minor issues with no fines or enforcement actions listed in the available reports.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Capacity: 6
Deficiencies: 0
Apr 2, 2025
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was non-operational due to cosmetic upgrades. The inspection found no deficiencies, with all safety and operational requirements met, including locked storage of medications and cleaning products, operational smoke and carbon monoxide detectors, and maintained emergency equipment.
Report Facts
Bedrooms inspected: 6
Bathrooms inspected: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sergei Entona | Residential Care Coordinator (RCC) | Met with Licensing Program Analyst during inspection |
| Lavinia Muscan | Licensing Program Analyst | Conducted the inspection visit |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 0
Dec 10, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-08-20 regarding staff smoking illegal drugs on the premises and staff stealing residents' medications.
Findings
The investigation found the allegation of staff smoking illegal drugs on the premises to be unsubstantiated due to lack of evidence and contradictory statements. The allegation of staff stealing residents' medications was found to be unfounded as the facility had no residents or medications at the time due to remodeling.
Complaint Details
The complaint investigation was triggered by allegations that staff were smoking illegal drugs on the premises and stealing residents' medications. The allegation of drug use was unsubstantiated, and the medication theft allegation was unfounded.
Report Facts
Facility capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavinia Muscan | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Laura Munoz | Licensing Program Manager | Named in report as Licensing Program Manager |
| Dr. Benjamin Foulk | Administrator | Facility administrator interviewed during investigation |
| Serge Entona | RCC | Met with Licensing Program Analyst during inspection |
Inspection Report
Capacity: 6
Deficiencies: 0
Dec 10, 2024
Visit Reason
The visit was an unannounced health and safety check conducted by the Licensing Program Analyst to assess the facility's compliance with health regulations.
Findings
No concerns were noted during the inspection. The facility had no residents since February/March 2024, and no citations were issued per Title 22 Regulations.
Report Facts
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sergei Entona | RCC | Met with Licensing Program Analyst during inspection |
| Lavinia Muscan | Licensing Program Analyst | Conducted the health and safety check |
| Laura Munoz | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 1
Jun 6, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the licensee failed to report to the Department that they filed for bankruptcy.
Findings
The investigation substantiated that the licensee filed for bankruptcy on May 21, 2024, but failed to notify the Department, the State Long-Term Care Ombudsman, residents, and legal representatives within two business days as required. A facility tour and food inspection found adequate food supply for residents.
Complaint Details
The complaint was substantiated. The licensee failed to provide required notifications regarding bankruptcy filing within the required timeframe.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days of filing for bankruptcy. This requirement was not met. | Type B |
Report Facts
Capacity: 6
Census: 0
Plan of Correction Due Date: Jun 20, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavinia Muscan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Laura Munoz | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Lenore Alexius | Administrator | Met with the Licensing Program Analyst during the investigation |
Inspection Report
Capacity: 6
Deficiencies: 0
Jun 6, 2024
Visit Reason
The visit was conducted as a health and safety check in response to the facility filing for bankruptcy.
Findings
The licensing program analyst checked the food supply and conducted a brief walkthrough. No concerns or citations were noted during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavinia Muscan | Licensing Program Analyst | Conducted the health and safety check and inspection. |
| Lenore Alexius | Administrator | Met with during the inspection. |
| Benjamin Foulk | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Annual Inspection
Capacity: 6
Deficiencies: 0
Apr 22, 2024
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate the facility's compliance and readiness for reopening after a period of non-operation due to cosmetic upgrades.
Findings
The facility was non-operational at the time of inspection but scheduled to reopen soon. Files for 2 residents temporarily residing at a sister facility and 2 staff members were reviewed and found to contain the required paperwork and training. No deficiencies were cited during this inspection.
Report Facts
Residents' files reviewed: 2
Staff files reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavinia Muscan | Licensing Program Analyst | Conducted the annual inspection visit |
| Lenore Alexius | Administrator | Met with Licensing Program Analyst during inspection |
| Benjamin Foulk | Administrator/Director | Named as facility administrator/director |
Inspection Report
Follow-Up
Census: 4
Capacity: 6
Deficiencies: 1
Sep 5, 2023
Visit Reason
The visit was conducted as a joint follow-up with the El Dorado Hills Fire District to verify correction of previously cited fire code deficiencies that had not been corrected since a prior correction notice issued on 02/21/2023.
Findings
The facility had outstanding fire code deficiencies from a previous correction notice that remained uncorrected. A second correction notice was issued with a due date of 7 calendar days from the visit date, and a follow-up visit will be conducted to ensure corrections are made.
Deficiencies (1)
| Description |
|---|
| Fire code deficiencies noted in prior correction notice have not been corrected. |
Report Facts
Correction notice due date: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Benjamin Foulk | Licensee | Met during the visit and explained the purpose of the visit |
| Jennifer Hinch | Administrator | Met during the visit and received the report |
| Laura Munoz | Licensing Program Manager | Conducted the visit |
| Lavinia Muscan | Licensing Program Analyst | Conducted the visit |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 0
Aug 22, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the licensee did not maintain liability insurance.
Findings
The investigation found that the facility had current liability insurance, and the allegation was determined to be unfounded.
Complaint Details
The complaint allegation that the licensee did not maintain liability insurance was investigated and found to be unfounded.
Report Facts
Facility capacity: 6
Census: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lavinia Muscan | Licensing Program Analyst | Conducted the complaint investigation |
| Jaynae Boyles | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Jennifer Hinch | Administrator | Met with investigators during the visit |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 1
Apr 5, 2023
Visit Reason
The visit was conducted as a required unannounced annual inspection to evaluate compliance with regulatory standards for the facility.
Findings
The facility was generally clean, well organized, and compliant with most requirements including resident and staff files, first aid and CPR training, fire drills, and required postings. However, a deficiency was found related to staff training where one out of two staff training records did not meet the required initial training standards.
Deficiencies (1)
| Description |
|---|
| Staff training did not contain the required initial training as required by HSC 1569.69(a)(2) for employees assisting residents with self-administration of medications. |
Report Facts
Staff training records reviewed: 2
Resident files reviewed: 4
Capacity: 6
Census: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rod Fleeman | Administrator | Met with during inspection and involved in facility tour |
| Melissa Parks | Licensing Program Analyst | Conducted the annual inspection |
| Lavinia Muscan | Licensing Program Analyst | Conducted the annual inspection and signed the report |
| Laura Munoz | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
May 11, 2022
Visit Reason
The visit was an unannounced required annual inspection conducted by the Licensing Program Analyst to assess compliance with regulations.
Findings
No deficiencies were observed during the inspection. The facility was found to be in compliance with all applicable regulations, including valid administrator certification, functional safety equipment, clean common areas, and adequate food supplies.
Report Facts
Capacity: 6
Census: 6
Food supply: 2
Food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| DeAnna Williams-Lyons | Licensing Program Analyst | Conducted the annual inspection and infection control questionnaire |
| Omita Khan | Administrator | Facility administrator met with Licensing Program Analyst during inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
May 13, 2021
Visit Reason
The inspection was an unannounced Required-1 Year Inspection conducted to evaluate infection control and overall health and safety compliance at the facility.
Findings
The facility was found to be in substantial compliance with no immediate health, safety, or personal rights violations observed. No deficiencies were cited during this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Priya Lal | administrator | Met with Licensing Program Analyst during inspection and participated in facility tour. |
Inspection Report
Complaint Investigation
Census: 2
Capacity: 6
Deficiencies: 3
Feb 26, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations that the facility failed to meet residents' care needs, staff were not properly trained, the facility did not provide a safe environment, and failed to report an incident to licensing.
Findings
The investigation found the allegations that staff were not properly trained, the facility did not provide a safe environment, and failed to report an incident to licensing to be substantiated, posing an immediate health and safety risk. One allegation was found unsubstantiated due to insufficient evidence.
Complaint Details
The complaint was received on 10/05/2020 and included allegations that the facility failed to meet residents' care needs, staff were not properly trained, the facility did not provide a safe environment, and failed to report an incident to licensing. The investigation involved interviews with staff, residents, a witness, and review of records. The allegations regarding training, safety environment, and reporting were substantiated; one allegation was unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Uneven pavement in the driveway causing a fall with injury. | Type A |
| Staff did not have required training on file, including incomplete training and improper medication handling. | Type B |
| Failure to submit an incident report to licensing regarding a witnessed fall with injury. | Type B |
Report Facts
Capacity: 6
Census: 2
Staff training records reviewed: 5
Staff with incomplete training: 3
Plan of Correction Due Date: Mar 26, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| DeAnna Williams-Lyons | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Priya Lal | Administrator | Facility administrator interviewed during investigation |
| Benjamin Foulk | Administrator | Named as facility administrator in report header |
| Laura Munoz | Licensing Program Manager | Oversaw licensing program and signed report |
Loading inspection reports...
