Inspection Report Summary
Most inspections found deficiencies related primarily to resident care, medication management, and facility safety, with several substantiated complaints involving inadequate supervision, improper medication administration, and failure to maintain confidential records. The facility received civil penalties for repeated issues, including an immediate safety risk when a resident eloped and was not properly reported, and for incomplete personnel records and unlocked disinfectants. Some complaints about harassment, food service, and staff conduct were unsubstantiated. The most recent report from September 18, 2025, was a complaint investigation with no deficiencies found, indicating some improvement. While issues have persisted over time, recent findings suggest the facility is addressing prior concerns.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
Sep 18, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-08-27 regarding allegations of staff not preventing resident harassment, inadequate food service, and failure to provide adequate notice of fee increase to residents.
Findings
The investigation included interviews with staff, residents, and witnesses, as well as review of relevant documents. All allegations were found to be unsubstantiated based on the evidence gathered during the visit.
Complaint Details
The complaint involved three allegations: staff did not prevent resident harassment, staff did not provide adequate food service, and licensee did not provide adequate notice of fee increase. After investigation, all allegations were determined to be unsubstantiated.
Report Facts
Capacity: 120
Census: 44
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maureen Lee | Memory Care Director | Met with during the investigation and involved in interview |
| Justin Zackzewski | Director of Hospitality | Received copy of the report during exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 42
Capacity: 120
Deficiencies: 3
Aug 26, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing requirements at Elegance Berkeley facility.
Findings
The facility was generally well maintained with adequate safety measures such as fire safety equipment and emergency plans. However, deficiencies were cited related to unlocked disinfectants posing safety risks, incomplete personnel records, and a staff member not properly associated with the facility. Civil penalties were assessed for failure to correct deficiencies.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Disinfectants were unlocked and unattended, posing a potential health, safety or personal rights risk to persons in care. | Type B |
| Personnel records were incomplete, lacking health screenings, first aid, and sufficient training. | Type B |
| Staff member (S2) was not associated with the facility, posing a potential health, safety or personal rights risk. | Type B |
Report Facts
Civil penalty amount: 500
Personnel records reviewed: 7
Resident files reviewed: 10
Hot water temperature range: 108-120
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Named in relation to findings and plans of correction |
| Maureen Lee | Memory Care Director | Met with Licensing Program Analysts during inspection |
| Lisha Holmes | Licensing Program Analyst | Conducted inspection and signed report |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 120
Deficiencies: 0
Jul 8, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations of staff working while under the influence of alcohol and staff being disrespectful to residents and residents' families.
Findings
The investigation found the allegations to be unsubstantiated after interviews with residents, staff, and witnesses, and review of personnel records revealed no evidence of staff working under the influence of alcohol or being disrespectful to residents or their families.
Complaint Details
The complaint was unsubstantiated. Allegations included staff working while under the influence of alcohol and staff disrespectful to residents and residents' families. Interviews and personnel record reviews did not support the allegations.
Report Facts
Capacity: 120
Census: 42
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met during the investigation and received the exit interview and report |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 120
Deficiencies: 4
Jun 11, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to allegations including failure to ensure residents receive medications as necessary, inadequate supervision of residents, communication issues between medical staff and facility staff, and facility fax machine disrepair.
Findings
The investigation substantiated the allegations that staff did not ensure residents received medications properly, supervision was inadequate especially related to resident elopement, medical staff communication was hindered by a non-working fax machine, and the facility fax was confirmed to be in disrepair.
Complaint Details
The complaint was substantiated. Allegations included failure to ensure residents received medications, inadequate supervision, communication failures with medical staff, and fax machine disrepair. Interviews and records confirmed these issues.
Severity Breakdown
Type A: 3
Type B: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to assure residents received administration of medication(s) as necessary. | Type A |
| Insufficient number of trained direct care staff to support residents' physical, social, emotional, safety and health care needs. | Type A |
| Failure to ensure proper communication with physicians and pharmacies due to incorrect contact information. | Type A |
| Facility fax machine was not working and maintenance was inadequate. | Type B |
Report Facts
Capacity: 120
Census: 45
Plan of Correction Due Date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met with during inspection and received exit interview |
| Annemarie Domizio | Executive Director | Facility administrator mentioned in relation to findings |
| Lisha Holmes | Licensing Program Analyst | Conducted complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Plan of Correction
Capacity: 120
Deficiencies: 3
May 20, 2025
Visit Reason
The inspection was an unannounced proof of correction (POC) visit conducted to verify correction of previously cited deficiencies.
Findings
The facility had three deficiencies from a prior inspection on 2025-05-02 that were not cleared, related to HVAC system repairs, notification to a resident's physician, and confidentiality of resident records. Civil penalties totaling $3300 were assessed for failure to correct these deficiencies.
Deficiencies (3)
| Description |
|---|
| Licensee/ED to assess HVAC system, thermostat, and make repairs; provide proof of training and invoices by POC date. |
| Licensee/ED to inform resident's physician by written communication, provide proof of notice to CCLD, review regulation, and certify with signatures by POC. |
| Licensee/ED to review regulation and ensure all resident records are maintained confidentially; provide in-service training for Care Staff with signatures as proof. |
Report Facts
Civil penalties assessed: 1100
Total civil penalties: 3300
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met with Licensing Program Analyst during inspection |
| Lisha Holmes | Licensing Program Analyst | Conducted the proof of correction inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 0
May 2, 2025
Visit Reason
The visit was conducted as a case management follow-up resulting from an unannounced initial 10-day complaint dated 04/30/2025 regarding the facility.
Findings
The Licensing Program Analyst met with the Director of Hospitality to discuss the complaint and requested emails and correspondences related to a resident's admission. The discussion involved personnel responsible for administration, supervision, and resident care.
Complaint Details
The visit was triggered by an unannounced initial 10-day complaint dated 04/30/2025 #15-AS-20250430171112. The complaint involved issues related to personnel and resident admission documentation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met with Licensing Program Analyst to discuss complaint and facility operations. |
| Annmarie E Domizio | Administrator/Director | Named as facility administrator/director. |
| Tsedey Mekonnen | Concierge | Received copy of the report during exit interview. |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and case management visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the visit. |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 2
May 2, 2025
Visit Reason
The inspection was a case management visit conducted as a result of a complaint dated 2025-04-22 regarding resident R1 and related unusual incident reports (UIRs).
Findings
The inspection found deficiencies related to fire safety due to locked gates preventing emergency exit and unlawful eviction procedures including failure to provide timely and lawful eviction notices to resident R1 and their responsible party.
Complaint Details
The visit was triggered by a complaint dated 2025-04-22 (#15-AS-20250422160308) concerning resident R1's repeated exit seeking and discharge procedures. The complaint included issues with eviction notices and facility security measures.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Fire Safety: Locks were found on two gates preventing emergency exiting, violating State Fire Marshal regulations. | Type A |
| Eviction Procedures: The licensee failed to provide a timely eviction notice to the licensing agency and the notice provided to R1's responsible party was unlawful. | Type B |
Report Facts
Capacity: 120
Census: 43
Civil penalty: 500
Plan of Correction Due Date: May 2, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and authored the report |
| Annemarie Domizio | Executive Director | Facility administrator met during inspection |
| Justin Zackzewski | Director of Hospitality | Facility staff met during inspection and involved in complaint discussion |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 2
May 2, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2025-04-18 regarding resident care reassessment and thermostat functionality.
Findings
The investigation substantiated two allegations: staff did not ensure residents' thermostats were working properly, affecting temperature regulation in some apartments, and staff failed to properly reassess residents' care needs, including failure to provide written records to the resident's physician. Deficiencies were cited accordingly.
Complaint Details
The complaint investigation was substantiated. Allegations included improper reassessment of residents' care needs and failure to ensure thermostats were working properly. The investigation involved interviews with staff and residents, review of records, and on-site observations. The preponderance of evidence supported the allegations.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Licensee/ED did not ensure the facility maintained a comfortable temperature for all residents at all times. | Type B |
| Licensee/ED did not provide written record to R1's physician for the decision making for care and services. | Type B |
Report Facts
Capacity: 120
Census: 43
Deficiencies cited: 2
Plan of Correction Due Date: May 9, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst and named in findings |
| Justin Zackzewski | Director of Hospitality | Met with Licensing Program Analyst during investigation |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 1
May 2, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-04-30 regarding confidentiality breaches of resident information.
Findings
The investigation substantiated that staff did not keep all information or records regarding the resident confidential, specifically involving an unlawful eviction notice containing confidential information delivered in the presence of other residents.
Complaint Details
The complaint was substantiated. Staff failed to keep resident information confidential, including delivering an unlawful eviction notice containing confidential information signed by other residents. The notice was hand delivered to R1 in the presence of other residents, violating confidentiality.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee/ED did not ensure that R1's and RP's records be presented and maintained with confidentiality. | Type B |
Report Facts
Capacity: 120
Census: 43
Deficiency Type: 1
Plan of Correction Due Date: May 9, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met with Licensing Program Analyst during investigation |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Capacity: 120
Deficiencies: 0
Mar 28, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2025-01-08 alleging that staff did not provide resident medication as requested.
Findings
The investigation reviewed medication records, progress notes, and conducted interviews with staff and residents. The evidence did not support the allegation of medication not being provided as requested, and the complaint was determined to be unsubstantiated.
Complaint Details
The complaint alleged that staff did not provide resident medication as requested. The investigation found no evidence of medication errors or omissions, and the allegation was unsubstantiated.
Report Facts
Facility capacity: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met with during the investigation |
| Annemarie Domizio | Executive Director | Onboarding Executive Director met during the investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Conducted and signed the complaint investigation report |
| Lisha Holmes | Licensing Program Analyst | Conducted and signed the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 120
Deficiencies: 2
Mar 28, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to allegations received on 12/16/2024 regarding resident care and medication mishandling.
Findings
The investigation substantiated that staff allowed a resident to remain soiled for several hours and mishandled medication administration, including failure to document time, date, and dosage. The facility lacked sufficient and competent staff to meet resident needs.
Complaint Details
The complaint was substantiated. Allegations included staff allowing a resident to be soiled while in care and mishandling a resident's medication. Evidence included staff and witness interviews, record reviews, and observations confirming the allegations.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Personnel Requirements-General 87411(a): Facility personnel were insufficient in numbers and competence to meet resident bowel and incontinence care needs. | Type A |
| Incidental Medical and Dental Care 87465(d): Facility staff failed to assure residents received proper medication administration and documentation. | Type A |
Report Facts
Capacity: 120
Census: 42
Plan of Correction Due Date: Apr 4, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Justin Zackzewski | Director of Hospitality | Met during investigation and received exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw licensing program and signed report |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 1
Feb 5, 2025
Visit Reason
The visit was conducted as a case management and complaint investigation related to amended complaints concerning medication administration records and incontinence care plans, as well as reporting requirements for resident deaths.
Findings
The facility failed to provide timely written reports of a resident's death within seven days, posing a potential health and safety risk. There were also issues with documentation and signatures for updated incontinence care plans for residents and their responsible parties.
Complaint Details
The visit was complaint-related, involving amended complaints 15-AS-20241223152240 and 15-AS-20241223091751. The complaint was substantiated by the finding that the Interim Executive Director did not comply with reporting requirements for a resident's death.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide a written report of death for resident R2 within seven days as required by Title 22 California Code of Regulations Section 87211 Reporting Requirements (a). | Type B |
Report Facts
Census: 47
Total Capacity: 120
Deficiencies cited: 1
Plan of Correction Due Date: Feb 10, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Claudia Redditt | Director of Business Administration | Met during inspection and involved in review of documentation |
| Annemarie Domizio | Executive Director | Mentioned in relation to time constraints and complaint follow-up |
| Lisha Holmes | Licensing Program Analyst | Conducted inspection and signed report |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor of inspection |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 3
Jan 14, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to multiple allegations including staff leaving residents in soiled diapers causing injury, staff sleeping during work hours, and staff screaming at residents.
Findings
The investigation substantiated allegations that staff left residents in soiled diapers for extended periods resulting in injury, staff were sleeping during work hours without approved accommodations, and staff screamed at residents, posing potential health and safety risks. Other allegations such as staff eating residents' food and not allowing residents to watch TV were unsubstantiated.
Complaint Details
The complaint investigation was substantiated based on evidence including staff and witness interviews, observations, and record reviews. Allegations of neglect, staff sleeping on duty, and verbal abuse were confirmed. Other complaints were found unsubstantiated due to lack of sufficient evidence.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Insufficient and incompetent number of staff to meet residents' incontinence care needs. | Type B |
| Personnel not in good health or physically and mentally capable of performing assigned tasks; staff member found sleeping during work hours. | Type B |
| Care staff screaming/yelling at residents, posing potential health and safety risks. | Type B |
Report Facts
Capacity: 120
Census: 48
Deficiency count: 3
Plan of Correction Due Date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Interim Executive Director | Met with investigators during the inspection and involved in investigation findings. |
| Annemarie Domizio | Executive Director | Met with investigators during the inspection and involved in investigation findings. |
| Robert Coe | Administrator | Named as facility administrator in the report. |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation. |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation. |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Jan 2, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff did not prevent a resident from harassing another resident.
Findings
The investigation found insufficient evidence to substantiate the allegation of staff failing to prevent resident harassment. Interviews with residents, staff, and witnesses did not confirm the complaint, resulting in an unsubstantiated finding with no citations issued.
Complaint Details
Allegation: Staff did not prevent resident from harassing another resident. The complaint was unsubstantiated after interviews and review of records showed no preponderance of evidence to prove the allegation.
Report Facts
Capacity: 120
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Claudia Redditt | Director of Business Administration | Met with during investigation and received exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report as Licensing Program Manager |
| Robert Coe | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Jan 2, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that staff did not store an adequate amount of milk for residents.
Findings
The investigation found no preponderance of evidence to substantiate the allegation. The facility had a sufficient variety, quality, and quantity of perishable and non-perishable foods to meet residents' dietary needs. No citations were issued.
Complaint Details
The complaint alleged that staff did not store an adequate amount of milk for residents. The allegation was unsubstantiated after investigation including interviews with staff and review of vendor purchase orders.
Report Facts
Capacity: 120
Census: 47
Number of care staff reporting allegation: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Claudia Redditt | Director of Business Administration | Met with during the investigation and exit interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Robert Coe | Administrator | Facility administrator named in the report |
| Douglas Blake | Interim Executive Director | Met with Licensing Program Analyst during investigation |
| Annemarie Domizio | Executive Director | Suggested meeting with Director of Business Administration due to time constraints |
Inspection Report
Capacity: 120
Deficiencies: 0
Dec 12, 2024
Visit Reason
The visit was an unannounced case management inspection conducted in response to an Unusual Incident Report regarding Resident #1 (R1).
Findings
The Licensing Program Analyst reviewed R1's medical and functional reports, confirmed R1's ability to leave the facility unassisted, and noted that R1 was locked out but safely returned to the facility. The facility is installing a keyless entry system. No deficiencies were cited, and an internal investigation is underway for staff and resident incidents.
Report Facts
Capacity: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the case management visit and inspection |
| Mary Anne Watral | Interim-Executive Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 5
Nov 20, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to multiple allegations received on 2024-08-15 regarding safety, sanitation, medication management, and record keeping at Elegance Berkeley facility.
Findings
The investigation substantiated several allegations including failure to maintain residents' rooms in a safe and sanitary condition, failure to safeguard residents' personal belongings, improper maintenance of residents' records, and improper management and dispensing of medications. Some allegations related to laundry services, mail delivery, and dietary care plans were unsubstantiated.
Complaint Details
The complaint was substantiated based on evidence that staff did not maintain residents' rooms safely and cleanly, did not safeguard personal belongings, failed to properly maintain records, and did not properly manage or dispense medications. Some allegations about laundry services, mail delivery, and dietary care plans were found unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 4
Deficiencies (5)
| Description | Severity |
|---|---|
| The premises were not maintained in a state of good repair and did not provide a safe and healthful environment, specifically R1's bedroom. | Type B |
| Failure to safeguard residents' cash, personal property, and valuables, specifically R1's clothing items. | Type B |
| Residents' records did not contain required documentation for allowable health conditions, specifically for R1. | Type B |
| Failure to assist residents with self-administered medications as needed, specifically failure to document R1's blood sugar and medication administration. | Type B |
| Failure to ensure sufficient amounts of medicines, testing equipment, and supplies for diabetes care, specifically failure to test R1's blood sugar and dispense medication as prescribed. | Type A |
Report Facts
Capacity: 120
Census: 47
Civil penalty: 250
Plan of Correction Due Date: Dec 3, 2024
Plan of Correction Due Date: Nov 21, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Administrator | Named as facility administrator |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
| Douglas Blake | Interim Executive Director | Met with Licensing Program Analyst during investigation |
| Mary Anne Watral | Operations Specialist | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 1
Oct 24, 2024
Visit Reason
The visit was an unannounced case management inspection triggered by a complaint and needs further investigation regarding Resident #1's overdue reappraisal and functional evaluation.
Findings
The licensee failed to complete the required annual reappraisal and functional evaluation for Resident #1 by the due date, posing an immediate health, safety, or personal rights risk to persons in care.
Complaint Details
The visit was complaint-related, involving a needs further investigation and case management regarding Resident #1. The complaint was substantiated by the finding that the reappraisal was overdue.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to complete Resident #1's annual medical assessment and reappraisal as required by Title 22 California Code of Regulations, Section 87705. | Type A |
Report Facts
Capacity: 120
Census: 49
Deficiencies cited: 1
Plan of Correction Due Date: Oct 29, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Executive Director | Met with Licensing Program Analyst during inspection and discussed Resident #1's case |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and investigation |
| Yvonne Flores-Larios | Licensing Program Manager / Supervisor | Named as supervisor and licensing program manager overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 0
Oct 24, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 10/15/2024 regarding medication administration, blood pressure monitoring, billing practices, and staff training at the facility.
Findings
The investigation found all allegations to be unsubstantiated based on interviews, document reviews, and evidence provided. No deficiencies were cited, and the complaint was determined to be invalid as the preponderance of evidence standard was not met.
Complaint Details
The complaint included allegations that staff did not provide resident's medication as prescribed, failed to monitor blood pressure before medication administration, billed residents for services not rendered, and lacked adequate training. All allegations were found unsubstantiated after review of medication records, billing statements, interviews with the Executive Director and Resident #1, and prior complaint documentation.
Report Facts
Capacity: 120
Census: 49
Complaint control number: 15-AS-20241015162638
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Interim-Executive Director | Met with Licensing Program Analyst during investigation and provided information related to complaint |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation visit |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 2
Sep 16, 2024
Visit Reason
An unannounced initial 10-day complaint visit was conducted as a case management follow-up to investigate concerns related to resident care and reporting compliance.
Findings
The licensee failed to report blood in a resident's urine on multiple occasions, did not have an updated physician's report or reappraisal for a resident with dementia, and medication errors were identified that were not reported to the licensing agency. An immediate civil penalty was assessed.
Complaint Details
The visit was complaint-related, triggered by allegations concerning failure to report blood in resident's urine, lack of updated medical assessments, and medication errors. The complaint was substantiated as deficiencies were confirmed.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Resident (R1) with dementia did not have an updated annual medical assessment and reappraisal as required. | Type A |
| Licensee failed to report occurrences such as blood in resident's urine and medication errors to the licensing agency as required. | Type A |
Report Facts
Civil penalty amount: 250
Deficiency count: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Interim-Executive Director | Met with Licensing Program Analyst during inspection |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 1
Sep 16, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to an allegation that staff were not administering medications to a resident on multiple dates.
Findings
The investigation substantiated the allegation that the licensee did not assure the resident received prescribed medications on the noted dates. Medication records were inconsistent and lacked a clear legend, and staff failed to administer medications as required.
Complaint Details
The complaint was substantiated. The allegation involved staff not administering medications to a resident on multiple dates including 4/29/24, 7/4/24, 7/21/24, 7/26/24-7/29/24, 8/9/24, and 8/20/24. Interviews and record reviews confirmed the deficiency.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to assure residents received administration of medication(s) as required by Title 22 California Code of Regulations 87465(d). | Type A |
Report Facts
Capacity: 120
Census: 49
Plan of Correction Due Date: Sep 19, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Douglas Blake | Interim-Executive Director | Facility representative met during the investigation |
| Robert Coe | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 2
Sep 16, 2024
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2024-09-11 regarding staff not preventing a resident from eloping and not distributing residents' medications as prescribed.
Findings
The complaint investigation was substantiated with deficiencies cited related to case management and medication distribution. The complaint was closed after the investigation.
Complaint Details
The complaint was substantiated based on allegations that staff failed to prevent a resident from eloping and did not distribute medications as prescribed. Deficiencies were cited on Case Management LIC809D and Complaint #15-AS-20240830161136 LIC 9099D on 09/11/24.
Deficiencies (2)
| Description |
|---|
| Staff did not prevent a resident from eloping. |
| Staff do not distribute residents' medications as prescribed. |
Report Facts
Complaint Control Number: 15-AS-20240911142042
Facility Capacity: 120
Census: 49
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation visit |
| Douglas Blake | Interim-Executive Director | Met with Licensing Program Analyst during investigation |
| Robert Coe | Administrator | Facility administrator named in report header |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report signature section |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 2
Sep 11, 2024
Visit Reason
The visit was an unannounced case management inspection triggered by an incident involving an Assisted Living Resident (R1) who eloped from the facility on 09/08/2024 without signing out.
Findings
The licensee failed to prevent R1 from leaving unassisted, posing an immediate safety risk, and failed to report the incident and a COVID positive case within required timelines. An immediate civil penalty of $250 was assessed.
Complaint Details
The complaint involved an Assisted Living Resident who left the facility unassisted on 09/08/2024 and was found by the Berkeley Fire Department and taken to the hospital. The facility did not notify Community Care Licensing until 09/09/2024. Additionally, a staff member tested positive for COVID on or around 09/07/2024 but the incident was not reported to CCLD as required.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to implement safety measures to address behaviors such as wandering, allowing R1 to leave unassisted and unnoticed, posing an immediate safety risk. | Type A |
| Failure to report occurrences such as epidemic outbreaks within 24 hours to the licensing agency. | Type B |
Report Facts
Civil penalty amount: 250
Plan of Correction Due Date: Sep 18, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Executive Director | Met during inspection and involved in reporting the AWOL incident. |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and interviews. |
| Yvonne Flores-Larios | Licensing Program Manager | Supervised the inspection and signed the report. |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 1
Sep 11, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff mismanaged a resident's medications.
Findings
The investigation substantiated the allegation that the facility failed to document resident medication refusals, times of medication administration, and blood pressure readings, posing an immediate safety risk. The facility did not utilize a Medication Administration Record (MAR) and was unable to recover online data managed by a third-party vendor.
Complaint Details
The complaint alleging staff mismanagement of resident's medications was substantiated based on interviews and records reviewed. The preponderance of evidence standard was met.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to document resident's medication refusals, blood pressure, and medication administration times as required by CCR 87506(b)(10), posing an immediate safety risk. | Type A |
Report Facts
Capacity: 120
Census: 49
Deficiency count: 1
Plan of Correction Due Date: Sep 13, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Douglas Blake | Executive Director | Met with Licensing Program Analyst during investigation |
| Keoni Myles | Director of Health and Wellness | Met with Licensing Program Analyst during investigation |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 1
Sep 3, 2024
Visit Reason
The inspection was conducted as a case management visit resulting from an unannounced initial 10-day complaint investigation.
Findings
The licensee was found deficient for failing to have an updated annual medical assessment and reappraisal for Resident 1, which poses an immediate health, safety, or personal rights risk. A deficiency was cited to LIC D with a warning that failure to correct may result in civil penalties.
Complaint Details
The visit was triggered by a complaint resulting in an unannounced initial 10-day complaint visit. Deficiency cited to LIC D. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Resident (R1) did not have an updated annual medical assessment and reappraisal as required for persons with dementia. | Type B |
Report Facts
Capacity: 120
Census: 48
Plan of Correction Due Date: Sep 10, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Douglas Blake | Executive Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 0
Aug 21, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility does not have an administrator on the premises.
Findings
The allegation that the facility lacked an administrator on the premises was unsubstantiated. The Licensing Program Analyst conducted an annual inspection prior to the investigation and confirmed that there was an interim administrator in place following the resignation of the former Executive Director.
Complaint Details
The complaint alleged that the facility did not have an administrator on the premises. The allegation was found to be unsubstantiated after investigation and interviews with facility staff.
Report Facts
Facility capacity: 120
Resident census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Administrator | Named as the facility administrator |
| Douglas Blake | Executive Director | Met during the investigation and interview |
| Mary Anne Watral | Operations Specialist | Met during the investigation and interview |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 1
Aug 21, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation of uncleared adults on the premises.
Findings
The allegation of uncleared adults on the premises was substantiated. A deficiency was cited under LIC809D on 08/21/2024 during the annual inspection. The complaint was closed following the investigation.
Complaint Details
The complaint was substantiated regarding uncleared adults on the premises.
Deficiencies (1)
| Description |
|---|
| Uncleared adults on the premises |
Report Facts
Capacity: 120
Census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation visit |
| Robert Coe | Administrator | Facility administrator named in the report |
Inspection Report
Annual Inspection
Census: 48
Capacity: 120
Deficiencies: 2
Aug 21, 2024
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The facility was generally found to be safe and sanitary with adequate lighting, temperature, and supplies. However, deficiencies were cited due to the Executive Director not having criminal record clearance on file and incomplete personnel records for all seven reviewed staff files. A civil penalty was assessed.
Deficiencies (2)
| Description |
|---|
| Executive Director did not have criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care. |
| Seven out of seven personnel records were incomplete. |
Report Facts
Civil penalty amount: 100
Personnel records reviewed: 7
Staff files reviewed: 5
Resident files reviewed: 7
Fire extinguisher service date: Jul 16, 2024
Hot water temperature: 117.1
Facility fire clearance capacity: 225
Bedridden resident capacity: 50
Food supply duration (perishable): 2
Food supply duration (non-perishable): 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Administrator/Executive Director | Named in deficiency for lacking criminal record clearance |
| Lisha Holmes | Licensing Program Analyst | Conducted the inspection and authored the report |
| Mary Anne Watral | Operations Specialist | Met with Licensing Program Analyst during inspection |
| Douglas Blake | Executive Director | Met with Licensing Program Analyst during inspection; noted as not having criminal record clearance on file |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor of the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 1
Jul 30, 2024
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by a complaint received on 2024-06-11 regarding the facility's failure to provide family with requested resident records and alleged failure to follow COVID procedures.
Findings
The allegation that the facility did not provide family with requested resident records was substantiated, with evidence showing that resident #1's records were not provided to the responsible party despite multiple requests. The allegation that the facility did not follow COVID procedures was unsubstantiated, as the facility maintained an Infection Control Plan and complied with relevant regulations.
Complaint Details
The complaint was substantiated regarding failure to provide requested resident records. The responsible party stated multiple requests were made in October 2023 without response. The facility did not have a Power of Attorney on record. The allegation regarding failure to follow COVID procedures was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide resident #1's records to the responsible party as required by CCR 87506(c)(1). | Type B |
Report Facts
Capacity: 120
Census: 48
Deficiency count: 1
Plan of Correction Due Date: Jul 30, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Executive Director | Met with Licensing Program Analyst during investigation and named in findings related to failure to provide resident records |
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 48
Capacity: 120
Deficiencies: 0
Jul 30, 2024
Visit Reason
The visit was an unannounced case management inspection conducted due to an elopement incident involving Resident #1 (R1).
Findings
The facility reported the elopement of R1, who was later returned safely by family after being transported to the hospital for observation. Staff reassessed R1 and updated the functional evaluation to include wandering and exit-seeking behaviors. No deficiencies were cited during this visit.
Report Facts
Capacity: 120
Census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Executive Director | Met with Licensing Program Analyst during inspection and involved in reporting the elopement incident |
| Lisha Holmes | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 0
May 2, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that facility staff did not provide adequate supervision resulting in a resident eloping from the facility.
Findings
The investigation found that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove it; therefore, the allegation was unsubstantiated. No citations were issued during the visit.
Complaint Details
The complaint alleged inadequate supervision by facility staff leading to a resident eloping. The investigation included interviews with the Executive Director and staff, review of reports, and examination of safety devices. The allegation was found unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 120
Census: 49
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Executive Director | Met during the investigation and named in findings |
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 7
Apr 25, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to multiple allegations received on 08/30/2023 regarding resident care and facility maintenance issues at Elegance Berkeley.
Findings
The investigation substantiated multiple allegations including residents being left in soiled clothing, improper maintenance of resident's bedroom and facility grounds, failure to meet incontinence needs, removal of resident's hygiene products, inadequate supervision of a resident, and failure to safeguard personal belongings. One allegation regarding facility grounds security was unsubstantiated.
Complaint Details
Complaint investigation was substantiated based on evidence including interviews, observations, and document reviews. Allegations involved neglect of resident care needs, improper facility maintenance, and failure to safeguard resident belongings. One allegation regarding facility grounds security was unsubstantiated due to lack of evidence.
Severity Breakdown
Type A: 1
Type B: 6
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to implement safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials, evidenced by 3 residents in Memory Care Unit leaving unassisted posing immediate safety risks. | Type A |
| Failure to ensure incontinent residents are checked during known incontinent periods, evidenced by resident R1 left in urine soaked clothing for extended time. | Type B |
| Failure to provide safe, healthful and comfortable accommodations, evidenced by improper upkeep of resident R1's bedroom. | Type B |
| Failure to keep incontinent residents clean and dry and maintain facility free of odors from incontinence, evidenced by unmet incontinence care needs of resident R1. | Type B |
| Failure to safeguard resident cash, personal property and valuables, evidenced by missing and destroyed assistive walking devices of resident R1. | Type B |
| Failure to maintain facility in clean, safe, sanitary and good repair condition, evidenced by strong urine smell in facility. | Type B |
| Failure to allow resident to wear own clothes and keep personal possessions, evidenced by removal of resident R1's hygiene items. | Type B |
Report Facts
Capacity: 120
Census: 47
Deficiency count: 7
Residents who left unassisted: 3
Plan of Correction Due Dates: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LaTiana James | Director of Health and Wellness | Met with during inspection and discussed findings |
| Andrew Badoud | Administrator | Facility administrator named in report header |
| Alicia Delmundo | Licensing Program Analyst | Conducted complaint investigation and signed report |
| Bennett Fong | Licensing Program Manager | Oversaw investigation and signed report |
| Jeremy Fong | Licensing Program Manager | Conducted subsequent investigation |
| Robert Coe | Executive Director | Voicemail left during inspection |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 120
Deficiencies: 0
Mar 28, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff were not rendering services as agreed in the resident's Admission Agreement and were not providing daily activities for residents.
Findings
The investigation concluded that staff are rendering services as agreed in the resident's Admission Agreement and that daily activities are being provided. The allegations were found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff were not rendering services as agreed in the resident's Admission Agreement and were not providing daily activities for residents. The investigation found these allegations unsubstantiated.
Report Facts
Residents observed in Memory Support: 20
Staff members observed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Executive Director | Met with during investigation and named in findings |
| Tea James | Director of Health and Wellness | Interviewed during investigation and named in findings |
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 120
Deficiencies: 2
Mar 28, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including unlawful eviction and failure of staff to provide a resident's Power of Attorney (POA) with requested documents.
Findings
The investigation substantiated that the eviction letter dated 12/5/2023 was unlawful and that the facility failed to provide the requested documents to the resident's POA. Deficiencies were cited under California Health and Safety Code related to eviction procedures and admission agreements.
Complaint Details
The complaint was substantiated. Allegations included unlawful eviction and failure to provide requested documents to the resident's POA. The preponderance of evidence standard was met, confirming the allegations.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to send a written report of any eviction to the licensing agency within five days, specifically no copy of the eviction letter dated 3/7/2024 was sent. | Type B |
| Admission agreement missing the Resident Handbook as an addendum and failure to send a copy to the POA. | Type B |
Report Facts
Capacity: 120
Census: 45
Deficiency count: 2
Plan of Correction Due Date: Apr 4, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Coe | Executive Director | Met with during inspection and named in findings |
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 1
Aug 15, 2023
Visit Reason
Unannounced complaint investigation visit conducted to investigate allegations including facility disrepair, medication dispensing issues, pest control, and resident supervision.
Findings
The allegation that the facility was in disrepair was substantiated due to a kitchen electrical outlet being in disrepair, posing a potential health and safety risk. Allegations regarding medication dispensing, pest control, and resident supervision were found to be unsubstantiated.
Complaint Details
Complaint investigation was initiated based on allegations received on 05/23/2023. The allegation that the facility was in disrepair was substantiated. Allegations that staff did not dispense medication as prescribed, did not keep the facility free of pests, and left resident unattended were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Kitchen electrical outlet was in disrepair, posing a potential health and safety or personal rights risk to persons in care. | Type B |
Report Facts
Capacity: 120
Census: 48
Deficiency count: 1
Plan of Correction Due Date: Aug 29, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisha Holmes | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Mary Anne Watral | Interim Executive Director | Met with Licensing Program Analyst during investigation |
| Andrew Badoud | Administrator | Facility Administrator notified of findings during investigation |
Inspection Report
Annual Inspection
Census: 69
Capacity: 120
Deficiencies: 1
Aug 15, 2023
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate the facility's compliance with licensing regulations.
Findings
The facility was generally found to be safe and sanitary with adequate fire safety equipment, emergency plans, and environmental conditions. However, a deficiency was cited because the Interim-Executive Director did not have criminal record clearance, posing an immediate risk to persons in care.
Deficiencies (1)
| Description |
|---|
| Interim-Executive Director did not have criminal record clearance as required by Health and Safety Code Section 1569.17(b), posing an immediate health, safety, or personal rights risk to persons in care. |
Report Facts
Fire extinguisher service date: Jul 10, 2023
Staff records reviewed: 5
Resident records reviewed: 5
Perishable food supply: 2
Non-perishable food supply: 7
Fire clearance capacity: 225
Bedridden capacity: 50
Hot water temperature: 109.3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Watral | Interim-Executive Director | Met with Licensing Program Analyst during inspection; named in deficiency for lack of criminal record clearance |
| Sergio Lepez | Director of Maintenance | Accompanied Licensing Program Analyst during facility tour |
Inspection Report
Census: 48
Capacity: 120
Deficiencies: 0
May 25, 2023
Visit Reason
The visit was an unannounced post licensing inspection conducted by a Licensing Program Analyst to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be in compliance with no deficiencies cited. Staff were fingerprint cleared, the facility was well maintained with adequate lighting, hygiene items, furniture, and safety equipment including fire extinguishers and detectors. Emergency plans were on file and the environment was comfortable.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrew Badoud | Executive Director | Met with Licensing Program Analyst during the inspection and received the exit interview. |
| Claudia Lopes | Director of Business Administration | Met with Licensing Program Analyst during the inspection. |
Inspection Report
Census: 23
Capacity: 120
Deficiencies: 0
Dec 5, 2022
Visit Reason
An unannounced case management visit was conducted as a result of receiving a resident from Grand Lake Gardens and to check on the resident's status.
Findings
The visit found that supplies were adequate, staffing was stable, and there were no imminent health or safety concerns on the date of the visit.
Report Facts
Residents from Grand Lake Gardens: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrew Badoud | Administrator | Met with Licensing Program Analyst during the visit |
| Catherine Lin | Licensing Program Analyst | Conducted the unannounced case management visit |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Original Licensing
Capacity: 120
Deficiencies: 2
Aug 22, 2022
Visit Reason
The visit was a pre-licensing inspection conducted to evaluate the facility's readiness for licensing approval.
Findings
The facility was toured and evaluated for compliance with licensing requirements. Corrections were observed including water temperature needing adjustment and staff association requirements. The facility was not ready to be licensed at the time of inspection.
Deficiencies (2)
| Description |
|---|
| Water temperature needs to be maintained between 105-120 degrees F. |
| All staff needs to be associated to the facility prior to working at the facility. |
Report Facts
Facility capacity: 120
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrew Badoud | Executive Director | Met with Licensing Program Analysts during inspection and named in report |
Inspection Report
Original Licensing
Capacity: 120
Deficiencies: 0
Aug 22, 2022
Visit Reason
The visit was a pre-licensing inspection conducted to evaluate the facility prior to licensing.
Findings
The Licensing Program Analysts completed a Component III presentation and discussed COVID-19 infection control requirements with facility leadership. The exit interview was conducted and a copy of the report was provided to the Executive Director.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrew Badoud | Executive Director | Met with Licensing Program Analysts during the pre-licensing inspection and received the report. |
| Nicole Dockson | Vice President | Participated in the Component III presentation during the pre-licensing inspection. |
| Angelica Gonzalez-Gillam | Director of Health and Wellness | Participated in the Component III presentation during the pre-licensing inspection. |
Inspection Report
Original Licensing
Capacity: 120
Deficiencies: 0
Feb 17, 2022
Visit Reason
This was an initial licensing evaluation conducted via telephone call to assess the applicant and administrator's understanding of Title 22 regulations and facility operation requirements.
Findings
The applicant and administrator successfully completed Component II of the licensing process, demonstrating understanding of facility operation, staff qualifications, program policies, and other regulatory requirements. No clients were in care at the time of the evaluation.
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