Inspection Reports for Evergreen Retirement Residence
225 Evergreen St, Burbank, CA 91505, United States, CA, 91505
Back to Facility ProfileInspection Report Summary
Most inspections of Evergreen Retirement Facility found no deficiencies, and the majority of complaint investigations were unsubstantiated. The most recent report from July 24, 2025, was an annual inspection with no deficiencies noted. Earlier reports identified some serious issues, including immediate health and safety risks related to delayed medical attention for residents in 2024 and 2023, and rodent infestations in late 2023, both of which were addressed with corrective actions. There was also a substantiated complaint in early 2023 about unsafe storage of hazardous chemicals accessible to residents. Overall, the facility’s compliance appears to have improved over time, with recent inspections showing no deficiencies and multiple complaint investigations finding no evidence of problems.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
2.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
30% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
73% occupied
Based on a July 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 72
Capacity: 99
Deficiencies: 0
Date: Jul 24, 2025
Visit Reason
The inspection was an unannounced required one-year annual inspection of the Evergreen Retirement Facility to assess compliance with licensing requirements.
Findings
The facility was found to be generally compliant with no immediate health and safety hazards observed. The kitchen, resident bedrooms, bathrooms, laundry, medication storage, and records were inspected and found to meet regulatory standards.
Report Facts
Fire inspection date: Mar 19, 2025
Hot water temperature: 106
Hospice waiver residents allowed: 12
Hospice residents currently: 1
Resident rooms: 72
Laundry machines: 8
Staff files reviewed: 5
Resident files reviewed: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tanya Quezada | Executive Director | Met with Licensing Program Analysts during inspection |
| Nadia Shahbazian | Licensing Program Analyst | Conducted the inspection |
| Mariana Agban | Licensing Program Analyst | Conducted the inspection |
| Eva Miller | Licensing Program Manager | Named in report header and signature |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 99
Deficiencies: 0
Date: Jul 2, 2025
Visit Reason
The visit was conducted as an unannounced complaint investigation regarding an allegation that facility staff did not safeguard a resident's confidential information.
Complaint Details
The complaint alleged that on 04/27/25, resident #1 observed resident #2 reading confidential paperwork belonging to resident #1 at the concierge desk area. The facility had no staff assigned to the lobby during the relevant hours, and the identity of the person who left the documents accessible was unknown. The allegation was unsubstantiated due to lack of evidence.
Findings
The investigation found insufficient evidence to confirm or deny that facility staff left resident's confidential information accessible to unauthorized persons. The allegation was deemed unsubstantiated.
Report Facts
Facility capacity: 99
Census: 73
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nadia Shahbazian | Licensing Program Analyst | Conducted the complaint investigation |
| Eva Miller | Licensing Program Manager | Oversaw the complaint investigation |
| Tanya Quezada | Executive Director/Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 99
Deficiencies: 0
Date: May 14, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that the facility coffee maker was in disrepair and staff were not providing hot water to residents for hot tea or coffee.
Complaint Details
The complaint was unsubstantiated based on resident and staff interviews and physical observations during the investigation.
Findings
The allegation was found to be unsubstantiated. Interviews with seven residents and three staff confirmed the coffee maker was broken but alternatives such as instant coffee and hot water were provided. The Licensing Program Analyst observed working coffee makers and hot water machines available for resident use.
Report Facts
Residents interviewed: 7
Staff interviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Saucedo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tannya Quezada | Administrator | Facility administrator met during the investigation |
| Troy Agard | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 99
Deficiencies: 0
Date: Jan 14, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that staff were threatening to evict a resident for verbally abusing another resident.
Complaint Details
The complaint alleged that staff were threatening to evict a resident for verbally abusing another resident. Interviews and document reviews showed the eviction letter was issued but later rescinded. The resident was not evicted at the time of the visit. The allegation was unsubstantiated.
Findings
The investigation found that the resident was issued an eviction letter for violating house rules but the eviction was rescinded and the resident was not evicted. Based on gathered information, the allegation was deemed unsubstantiated.
Report Facts
Facility capacity: 99
Census: 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jose Gary Tan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tanya Quezada | Executive Director | Met with Licensing Program Analyst during the investigation |
| Troy Agard | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 99
Deficiencies: 0
Date: Dec 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-08-30 regarding staff training, timeliness of assistance, facility security, and adequacy of food service at Evergreen Retirement Facility.
Complaint Details
The complaint investigation addressed multiple allegations including inadequate staff training, untimely assistance to residents, unsecured facility doors, and inadequate food service. All allegations were found to be unsubstantiated based on interviews, observations, and record reviews.
Findings
The investigation found all allegations to be unsubstantiated. Staff were adequately trained to meet resident needs, assisted residents in a timely manner, ensured the facility was secure, and provided adequate food service. No immediate health and safety risks were observed.
Report Facts
Residents interviewed: 5
Staff interviewed: 3
Pull cords tested: 4
Facility capacity: 99
Census: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nicholas Reed | Licensing Program Analyst | Conducted the complaint investigation |
| Naira Margaryan | Licensing Program Manager | Oversaw the complaint investigation |
| Rosio Julinek | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 99
Deficiencies: 0
Date: Nov 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff did not ensure residents were spoken to in an appropriate manner.
Complaint Details
The complaint alleged that the Wellness Director made upsetting comments about health treatments of a resident (R1). Interviews with the Administrator, Wellness Director, staff, and residents found no evidence to support the allegation. The complaint was unsubstantiated.
Findings
The investigation included interviews with staff, residents, and the Administrator, and a review of records. The allegation that the Wellness Director made upsetting comments was denied by all parties and residents interviewed expressed no concerns. The allegation was deemed unsubstantiated.
Report Facts
Complaint Control Number: 31-AS-20241118112448
Facility Capacity: 99
Census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Huma Rahimi | Licensing Program Analyst | Conducted the complaint investigation |
| Nichelle Gillyard | Licensing Program Manager | Oversaw the complaint investigation |
| Rosio Julinek | Administrator | Facility Administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 99
Deficiencies: 2
Date: Sep 4, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not seek medical attention for a resident in a timely manner.
Complaint Details
The complaint was substantiated. The investigation included interviews with the facility administrator, staff, and residents, and review of medical records from the hospital and skilled nursing facility. The Plan of Correction was submitted and cleared.
Findings
The allegation was substantiated based on interviews and review of medical records showing staff had knowledge of the resident's decline and increased needs since 10/22/22. The deficiency posed an immediate health and safety risk. The licensee submitted a Plan of Correction which was cleared on 03/18/24.
Deficiencies (2)
Pre-admission appraisal was not updated to note significant changes including illness or change in health care needs of the resident.
Staff had knowledge of resident's cognitive/physical decline and increased needs for service since 10/22/22, posing an immediate health and safety risk.
Report Facts
Capacity: 99
Census: 71
Deficiency count: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael Cava | Licensing Program Analyst | Conducted the complaint investigation and subsequent visit |
| Eva Miller | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 69
Capacity: 99
Deficiencies: 0
Date: Jun 12, 2024
Visit Reason
The inspection was an unannounced required one-year annual inspection to evaluate compliance with licensing regulations at Evergreen Retirement Facility.
Findings
The facility was found to be in compliance with all applicable regulations with no deficiencies observed. The physical plant, resident and staff files, medication storage, and safety measures were all in proper order.
Report Facts
Resident rooms: 72
Hospice waiver residents: 12
Fire extinguisher inspection date: May 22, 2024
Food stock duration: 2
Food stock duration: 7
Rooms reviewed: 6
Bathrooms reviewed: 6
Resident files reviewed: 5
Staff files reviewed: 6
Facility disaster drill date: Mar 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rocio Julinek | Administrator | Met with Licensing Program Analysts during inspection |
| Jasmin Saldivar | Wellness Coordinator | Joined the inspection |
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the inspection |
| Leizl De La Cerra | Licensing Program Analyst | Conducted the inspection |
| Naira Margaryan | Licensing Program Manager | Oversaw the inspection report |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 99
Deficiencies: 0
Date: May 17, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 04/05/2024 regarding inadequate food service, untimely response to call buttons, and staff stealing residents' belongings.
Complaint Details
The complaint included three allegations: 1) Staff do not provide adequate food service to residents; 2) Staff do not answer residents' call buttons in a timely manner; 3) Staff stole residents' belongings. All allegations were found to be unsubstantiated based on interviews, observations, and record reviews.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Food service was generally adequate with an alternative menu available, call buttons were functional and staff responded within 3 to 5 minutes, and no evidence supported the claim of stolen residents' belongings. No health and safety hazards were noted.
Report Facts
Residents interviewed: 7
Residents census: 67
Facility capacity: 99
Call button response time: 3
Call button response time: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Amber Mzczaczy | Executive Director | Met with Licensing Program Analyst during inspection and interview |
| Rosio Julinek | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 99
Deficiencies: 0
Date: May 17, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on 2023-07-27 regarding allegations that a resident's personal items were not safeguarded.
Complaint Details
The complaint alleged that a resident's jewelry box was previously tampered with and was now missing. Staff explained that the resident's belongings were locked in their room after hospital transfer until family retrieved them. Interviews with seven residents confirmed staff statements, and the resident did not list a jewelry box on the personal inventory. The allegation was unsubstantiated.
Findings
The investigation found no pertinent information to support the allegation that the resident's personal items were not safeguarded. Interviews with staff and residents, as well as document reviews, indicated the allegation was unsubstantiated and no health or safety hazards were noted.
Report Facts
Residents interviewed: 7
Total residents: 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation and site visits |
| Naira Margaryan | Licensing Program Manager | Oversaw the complaint investigation |
| Amber Maczaczy | Executive Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 99
Deficiencies: 0
Date: May 17, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that staff were not seeking appropriate medical services for residents and were forcing residents to accept emergency transport to the hospital.
Complaint Details
The complaint alleged that staff did not seek appropriate medical care and forced residents to accept emergency hospital transport. Investigations included interviews with staff and residents, review of medical and incident records, and a physical tour. Findings showed staff sought medical services as needed and residents were not forced to accept emergency transport. The complaint was unsubstantiated.
Findings
Based on interviews with staff and residents, review of facility records, and incident logs, there was insufficient information to support the allegations. The complaint was determined to be unsubstantiated and no health or safety hazards were noted during the visit.
Report Facts
Residents interviewed: 5
Staff interviewed: 3
Facility capacity: 99
Facility census: 67
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Naira Margaryan | Licensing Program Manager | Oversaw the complaint investigation |
| Amber Maczaczy | Executive Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 99
Deficiencies: 0
Date: Mar 15, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff did not prevent a resident from stealing another resident's personal belongings.
Complaint Details
The allegation was that staff failed to prevent resident R2 from stealing a wedding ring from resident R1. Interviews with residents and staff, as well as review of resident property records, did not substantiate the claim. The allegation was determined to be unsubstantiated.
Findings
The investigation found insufficient information to support the allegation that resident R2 stole jewelry from resident R1. Interviews and document reviews indicated that residents are responsible for securing their own belongings and no health or safety hazards were noted.
Report Facts
Capacity: 99
Census: 63
Inspection Report
Complaint Investigation
Census: 63
Capacity: 99
Deficiencies: 3
Date: Mar 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate multiple allegations including staff neglect in seeking timely medical attention for a resident after a fall, severe dehydration, wandering due to lack of supervision, medication administration failures, theft of resident belongings, and inadequate food service.
Complaint Details
The complaint was received on 2023-01-04 and investigated due to allegations including failure to seek timely medical attention after a resident's fall, severe dehydration, wandering, medication administration failures, theft, and inadequate food service. The fall and delayed medical attention allegation was substantiated, while the others were unsubstantiated.
Findings
The investigation substantiated that staff failed to seek timely medical attention for a resident who fell and sustained a head injury, posing an immediate health and safety risk. Other allegations including severe dehydration due to neglect, wandering away from the facility, failure to administer medications, theft of belongings, and inadequate food service were found to be unsubstantiated due to insufficient evidence.
Deficiencies (3)
Failure to immediately telephone 9-1-1 for an injury resulting in an imminent threat to a resident’s health; resident experienced a fall with head injury and was not sent to hospital until afternoon, posing immediate health and safety risk.
Failure to update pre-admission appraisal to document significant changes in resident's physical, medical, mental, and social condition; resident's condition declined requiring assistance with hydration to prevent sepsis, posing immediate health and safety risk.
Failure to meet acceptance and retention limitations for dementia care; resident began to express dementia symptoms but staff failed to accurately assess and meet needs, posing immediate health and safety risk.
Report Facts
Capacity: 99
Census: 63
Deficiencies cited: 3
Plan of Correction Due Date: Mar 18, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael Cava | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Eva Miller | Licensing Program Manager | Oversaw the complaint investigation and signed the report |
| Jonathan Perles | Facility Administrator | Interviewed during investigation confirming resident admission and fall incident |
| Rosio Julinek | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 99
Deficiencies: 0
Date: Mar 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-04-18 regarding staff assistance, bed bug issues, and verbal harassment of residents.
Complaint Details
The complaint involved three allegations: 1) staff did not ensure appropriate assistance was provided to a resident, 2) the facility did not properly address bed bugs, and 3) staff verbally harassed a resident. All allegations were found to be unsubstantiated based on interviews, observations, and document reviews.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Observations, interviews, and document reviews indicated no bed bugs, no verbal harassment, and that the resident in question did not require assistance as alleged.
Report Facts
Facility capacity: 99
Census: 63
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Naira Margaryan | Licensing Program Manager | Oversaw the complaint investigation |
| Amber Maczaczy | Executive Director | Facility representative met during inspection |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 99
Deficiencies: 0
Date: Mar 6, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff did not dispense medication as prescribed to residents.
Complaint Details
The complaint alleged that resident #1 had not received medication for two days and resident #2 was not receiving medications as per doctor's orders. The allegation was found to be unsubstantiated based on interviews, observations, and document review.
Findings
The investigation found insufficient information to support the allegation that residents missed medication. Staff and resident interviews, as well as medication records, confirmed that residents managed their own medications and no discrepancies were observed. The allegation was unsubstantiated and no health or safety hazards were noted.
Report Facts
Facility capacity: 99
Census: 63
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Naira Margaryan | Licensing Program Manager | Named in report as Licensing Program Manager |
| Amber Maczaczy | Executive Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 99
Deficiencies: 0
Date: Mar 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-02-21 regarding medication administration, staff training, timely assistance to residents, and staff smoking marijuana at the facility.
Complaint Details
The complaint investigation addressed four allegations: residents not receiving medications as prescribed, untrained staff assisting with medication, residents not assisted timely due to lack of staff, and staff smoking marijuana at the facility. All allegations were determined to be unsubstantiated based on interviews, observations, and document reviews.
Findings
After interviews, observations, and document reviews, all allegations were found to be unsubstantiated due to insufficient evidence. Residents were receiving medications as prescribed, staff were properly trained, residents were assisted timely, and no evidence of staff smoking marijuana was found.
Report Facts
Residents present during inspection: 64
Facility licensed capacity: 99
Number of residents interviewed: 6
Number of staff interviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar-Ettima | Licensing Program Analyst | Conducted the complaint investigation |
| Amber Maczaczy | Executive Director | Met with Licensing Program Analyst during investigation and provided information |
| Rosio Julinek | Administrator | Named as facility administrator in the report |
| Naira Margaryan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 99
Deficiencies: 0
Date: Jan 31, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff do not serve residents food of good quality, including claims that food is cold, overcooked or undercooked, and lacks variety.
Complaint Details
The complaint alleged poor food quality including cold, overcooked or undercooked food and lack of variety. The allegation was found to be unsubstantiated after investigation.
Findings
Based on observations, record review, and interviews with staff and residents, there was insufficient evidence to verify the allegation. Most residents and staff reported satisfaction with the food quality, temperature, and variety. The allegation was unsubstantiated and no health or safety hazards were noted.
Report Facts
Complaint Control Number: 31
Number of staff interviewed: 3
Number of residents interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Abeye Duguma | Licensing Program Analyst | Conducted the complaint investigation |
| Rosio Julinek | Administrator | Facility administrator met during investigation |
| Naira Margaryan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 99
Deficiencies: 0
Date: Nov 6, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations of staff financially abusing residents and failing to safeguard residents' personal belongings.
Complaint Details
The complaint involved allegations that staff took a resident's debit card and made unauthorized charges, and that a new debit card had been stolen from the facility. Investigations including interviews and record reviews found no evidence to support these allegations, resulting in an unsubstantiated determination.
Findings
After interviews with staff and residents, and review of relevant records, the allegations of financial abuse and failure to safeguard personal belongings were found to be unsubstantiated. No immediate health and safety hazards were noted during the visit.
Report Facts
Residents interviewed: 6
Staff interviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Rosie Julinek | Administrator | Facility administrator present during the investigation. |
| Amber Maczaczy | Executive Director | Facility executive director present during the investigation and received the exit interview. |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 99
Deficiencies: 2
Date: Oct 4, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff does not ensure the facility is free of rodents and pests.
Complaint Details
The complaint investigation was substantiated for rodents with sufficient evidence from observation, interviews, and document review. The cockroach allegation was unsubstantiated due to lack of evidence and ongoing pest control measures.
Findings
The investigation substantiated the allegation of rodents in the facility, with observations of rodent droppings and glue traps in multiple areas, and confirmed by staff interviews and pest management reports. However, the allegation regarding cockroaches was unsubstantiated as no cockroaches were observed during the visit and pest control services were in place.
Deficiencies (2)
The facility was not clean, safe, and sanitary at all times as rodent droppings were observed in food storage, kitchen, and reception areas, posing a potential health and safety risk.
The kitchen was not free from rodents as evidenced by rodent droppings in storage room/office and underneath the kitchen sink.
Report Facts
Capacity: 99
Census: 65
Plan of Correction Due Date: Oct 18, 2023
Pest Control Service Frequency: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar | Licensing Program Analyst | Conducted the complaint investigation visit |
| Amber Maczaczyj | Executive Director | Met with Licensing Program Analyst during inspection and involved in findings |
| Luis Pacheco | Culinary Director | Met with Licensing Program Analyst and signed the report on behalf of Executive Director |
| Rosio Julinek | Administrator | Facility Administrator involved in inspection and plan of correction |
| Arcadio Quijada | Maintenance | Met with Licensing Program Analyst during physical plant tour |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 99
Deficiencies: 0
Date: Oct 3, 2023
Visit Reason
The visit was conducted to perform additional interviews related to a complaint control number 28-AS-20230213105132.
Complaint Details
Visit was complaint-related, conducted to gather more information through resident interviews. No substantiation status stated.
Findings
Licensing Program Analyst interviewed residents to obtain further information pertaining to the complaint. An exit interview and copy of the report were provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosio Julinek | Administrator | Met with Licensing Program Analyst during the visit. |
| Tuesday Cabiness | Licensing Program Analyst | Conducted interviews and informed facility staff of the visit reason. |
| Amber Maczaczyj | Executive Director (in training) | Present during the visit and informed about the visit reason. |
| Troy Agard | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 99
Deficiencies: 0
Date: Jul 31, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that a resident's toileting needs were not being met and that the facility was not meeting residents' hair care needs.
Complaint Details
The complaint investigation was unsubstantiated based on interviews with staff and residents, document review, and observations. Allegations included a resident being covered in urine and feces and having matted hair, which were denied by staff and residents.
Findings
The investigation included interviews with staff, residents, and review of documents and observations. No evidence was found to substantiate the allegations; residents were assisted timely with toileting and hair care, and no residents were observed to be unclean or have matted hair. The allegations were determined to be unsubstantiated.
Report Facts
Capacity: 99
Census: 69
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alma Gonzalez | Licensing Program Analyst | Conducted the complaint investigation |
| Rosio Julinek | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 99
Deficiencies: 0
Date: Apr 24, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that staff failed to meet a resident's grooming needs.
Complaint Details
The complaint alleged that staff failed to meet resident #1's grooming needs, specifically that the resident's hair was braided and new hair growth looked tangled. The allegation was investigated and found to be unsubstantiated.
Findings
The investigation found no evidence to support the allegation. Staff interviews and record reviews indicated the resident was independent in grooming and the facility provided beauty salon services. The allegation was unsubstantiated.
Report Facts
Capacity: 99
Census: 67
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Jonathan Perles | Executive Director | Met with Licensing Program Analyst during the visit |
| Naira Margaryan | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 99
Deficiencies: 0
Date: Mar 28, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that facility staff do not keep residents' rooms clean and free of trash and that staff are not meeting residents' care needs.
Complaint Details
The complaint investigation was unsubstantiated based on inspection, observations, interviews with residents and staff, and record reviews. No evidence supported the allegations regarding cleanliness or care needs.
Findings
The investigation found that residents' rooms were clean and free of trash, and residents confirmed that cleaning was done as required. Staff interviews and record reviews confirmed that resident care needs were being met according to care plans and medication orders. Both allegations were unsubstantiated.
Report Facts
Residents interviewed: 6
Staff interviewed: 4
Facility capacity: 99
Census: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Antonia Alvizar | Licensing Program Analyst | Conducted the complaint investigation |
| Jonathan Perles | Executive Director | Met with Licensing Program Analyst during investigation |
| Rosio Julinek | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 99
Deficiencies: 1
Date: Feb 16, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that a resident inhaled and ingested hazardous chemicals.
Complaint Details
The complaint was substantiated based on interviews and investigation findings that resident #1 inhaled and ingested hazardous chemicals, specifically Lysol.
Findings
The investigation substantiated that resident #1 inhaled Lysol, posing an immediate health and safety risk. The resident had fallen twice during the visit and was assisted by paramedics. The Executive Director was informed and agreed to secure chemicals to prevent access by residents.
Deficiencies (1)
Storage Space: Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients were not stored where inaccessible to clients, evidenced by resident #1 inhaling Lysol.
Report Facts
Deficiencies cited: 1
Capacity: 99
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tuesday Cabiness | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jonathan Perles | Executive Director | Met with Licensing Program Analyst during investigation and agreed to plan of correction |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 99
Deficiencies: 0
Date: Feb 1, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate an allegation that the facility was not safeguarding a resident's personal items, specifically that Resident #1's money was stolen in December 2022.
Complaint Details
The complaint alleged the facility was not safeguarding a resident's personal items, specifically missing money. The allegation was unsubstantiated based on interviews and record reviews showing no reports or investigations of missing money.
Findings
The investigation found no substantiated evidence of missing money or reports thereof. Interviews with the resident, Executive Director, and Wellness Director confirmed no reports or investigations of missing money. The allegation was deemed unsubstantiated.
Report Facts
Capacity: 99
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jose Gary Tan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Jonathan Perles | Executive Director | Interviewed during investigation |
| Alex Estrada | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 99
Deficiencies: 0
Date: Sep 29, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2020-12-15 regarding residents' dietary needs not being met and residents' rooms not being at a comfortable temperature.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included neglect/lack of supervision regarding dietary needs and physical plant issues regarding room temperature. Both allegations were found unsubstantiated after interviews, observations, and record reviews.
Findings
The investigation found that the majority of residents and staff corroborated that dietary and diabetic needs were being met and that room temperatures were comfortable. Based on evidence and interviews, both allegations were found to be unsubstantiated.
Report Facts
Facility capacity: 99
Census: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth Ceniceros | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Avi Heyman | Administrator | Facility administrator present during the investigation |
| Theresa Williams | Med Tech - A.M. | Staff member who greeted the Licensing Program Analyst and provided information during the visit |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 99
Deficiencies: 0
Date: Jun 16, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2021-12-03 regarding staff not meeting residents' needs, inadequate food service, and lack of activities.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff shortages leading to inadequate care, inadequate food service due to lack of nutrition knowledge, and absence of activities. Interviews, observations, and document reviews did not corroborate these allegations.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and residents denied the claims, and observations and document reviews confirmed adequate staffing, knowledgeable food service, and provision of activities.
Report Facts
Facility capacity: 99
Census: 52
Complaint receipt date: Dec 3, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Leana Silva | Administrator | Facility administrator interviewed during investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Annual Inspection
Census: 55
Capacity: 99
Deficiencies: 5
Date: Jun 9, 2022
Visit Reason
Unannounced required 1-year visit focusing on COVID-19 Infection Control Practices and general facility compliance.
Findings
The inspection found multiple deficiencies including lack of soap, paper towels, and sanitizer in some resident rooms, improperly stored PRN medication, maintenance issues such as broken glass on fire extinguisher compartments, water damage, plumbing problems, and obstructions in passageways. Some issues were corrected during the visit.
Deficiencies (5)
Some resident rooms did not have soap, paper towels or sanitizer, posing an immediate health, safety or personal rights risk.
PRN medication for one resident was not centrally stored, posing an immediate health, safety or personal rights risk.
Broken glass on fire extinguisher compartment and electrical doors in disrepair; window in room 308 does not stay open; wall in room 210 has water damage from possible leak.
Shower facet in room 208 needs replacement or repair; sink in room 308 does not drain properly.
Two water tanks, a loose door, and plastic sheeting obstructing passageways.
Report Facts
Capacity: 99
Census: 55
Resident rooms inspected: 9
Centrally stored resident medication records reviewed: 4
Plan of Correction Due Dates: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leana Silva | Executive Director | Assisted with the inspection and participated in exit interview. |
| Tahni Harp | Sales and Marketing Director | Met with Licensing Program Analyst and assisted with observations during inspection. |
| Alberto Lopez | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Stefanie Coronel | Licensing Program Manager | Supervisor of the inspection and named in the report. |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 99
Deficiencies: 0
Date: Dec 8, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-12-03 regarding staff not meeting residents' needs, inadequate food service, and lack of activities.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff shortages leading to neglect, inadequate food service, and no activities provided. Interviews and observations did not corroborate these claims, and the facility was found to be in compliance.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff interviews, resident interviews, and document reviews showed sufficient staffing, knowledgeable food service staff with dietitian oversight, and active resident participation in scheduled activities.
Report Facts
Staff interviewed: 5
Residents interviewed: 6
Facility capacity: 99
Facility census: 56
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Rosie Julinek | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 99
Deficiencies: 0
Date: Oct 12, 2021
Visit Reason
The visit was conducted as an unannounced complaint investigation regarding an allegation that the facility has insufficient staffing.
Complaint Details
The complaint alleged insufficient staffing at the facility. The investigation was unannounced and included multiple visits. The allegation was found to be unsubstantiated based on observations, interviews, and record reviews.
Findings
The investigation included interviews, observations, and record reviews, concluding there was insufficient evidence to prove the allegation of insufficient staffing. Resident and staff interviews indicated that residents' needs were met and staffing was sufficient. The allegation was determined to be unsubstantiated.
Report Facts
Residents present: 55
Total licensed capacity: 99
Dependent residents: 11
Independent residents: 43
Caregivers: 8
Caregivers/Med Tech: 4
Total caregivers: 12
Residents interviewed: 13
Residents stating sufficient care: 9
Residents stating delayed assistance: 3
Residents unable to answer: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation and site visits |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
| Avi Heyman | Administrator | Facility Administrator during investigation |
| Mele Tongamoa-Liu | Wellness Director | Met with Licensing Program Analyst during inspection |
| Rosio Julinek | Facility Administrator | Met with Licensing Program Analyst during subsequent site visit |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 99
Deficiencies: 0
Date: Oct 6, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit regarding allegations that staff failed to provide adequate food service to residents at Evergreen Retirement Facility.
Complaint Details
The complaint alleged that staff failed to provide adequate food service to residents, specifically that the food did not meet residents’ dietary needs. The allegation was found to be unsubstantiated after investigation.
Findings
The investigation included interviews with staff, residents, and review of food menus and supplies. The findings indicated that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation occurred, resulting in an unsubstantiated finding.
Report Facts
Staff interviewed: 7
Residents interviewed: 13
Residents reporting sufficient food quantity: 8
Residents reporting food taste too salty: 4
Residents unable to answer: 1
Menu review period (days): 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosio Julinek | Administrator | Met during inspection and denied allegation |
| Mele Tongamoa-Liu | Wellness Director | Participated in exit interview |
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 99
Deficiencies: 0
Date: Oct 1, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2020-03-05 regarding staffing adequacy and provision of activities at the facility.
Complaint Details
The complaint alleged inadequate staffing and lack of resident activities. The investigation concluded the allegations were unsubstantiated.
Findings
The investigation found the allegations to be unsubstantiated based on interviews with residents, staff, and review of documents, confirming adequate staffing and provision of activities prior to the pandemic.
Report Facts
Complaint control number: 28-AS-20200305085330
Complaint control number: 31-AS-20200520093733
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yelena Avetisyan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Rosie Julinek | Administrator | Met with the Licensing Program Analyst during the visit |
| Cassandra Harris | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 99
Deficiencies: 0
Date: Sep 24, 2021
Visit Reason
An unannounced complaint investigation visit was conducted due to allegations of insufficient staffing and failure to meet residents' needs at Evergreen Retirement Facility.
Complaint Details
The complaint was substantiated regarding insufficient staffing caused by staff resignations during the pandemic. However, the allegation that residents' needs were not met was unsubstantiated based on resident interviews and observations.
Findings
The allegation of insufficient staffing was substantiated due to staff resignations during the pandemic, but no deficiency was issued as the department was notified prior and residents did not report care concerns. The allegation that staff failed to meet residents' needs was unsubstantiated as residents confirmed they continued to receive necessary care despite some delays.
Report Facts
Capacity: 99
Census: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yelena Avetisyan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Rosie Julinek | Administrator met during the visit and designated Med-Tech Abigail Leonin to sign the report | |
| Abigail Leonin | Med-Tech | Designated to sign the report on behalf of the administrator |
| Cassandra Harris | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 50
Capacity: 99
Deficiencies: 2
Date: Jun 1, 2021
Visit Reason
Licensing Program Analyst Galarza conducted an unannounced Required 1-year visit focusing on COVID-19 Infection Control Practices at Evergreen Retirement Facility.
Findings
The inspection found multiple deficiencies including lack of required COVID-19 signage at the main entrance and throughout the facility, absence of hand sanitizer in most resident rooms and common areas, staff and residents not consistently wearing masks, and inaccuracies in medication administration records for two residents.
Deficiencies (2)
Facility main entrance lacks required COVID-19 signs; signs not posted in common areas to promote handwashing, cough/sneeze etiquette, and physical distancing; 11 out of 12 resident rooms lacked hand sanitizer; housekeeping staff observed not wearing mask; majority of residents not wearing masks in common areas.
Medication Administration Records (MAR) for two residents were inaccurate; medications listed but not reordered or discharged properly; physician discharge orders not observed.
Report Facts
Residents present: 50
Licensed capacity: 99
Resident rooms inspected: 12
Medication records reviewed: 6
Residents with inaccurate MAR: 2
Hospice waiver residents: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mele Liu | Wellness Director | Met during inspection and exit interview |
| Noemi Galarza | Licensing Program Analyst | Conducted the inspection |
| Lisa Hicks | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 99
Deficiencies: 2
Date: Apr 23, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 08/07/2020 alleging that the facility did not safeguard residents' personal property.
Complaint Details
The complaint investigation was substantiated. The allegation was that the facility did not safeguard resident's personal property, including a missing land line telephone. Interviews with residents, staff, and the administrator, as well as record reviews, supported the substantiation.
Findings
The investigation found that the facility did not safeguard residents' personal property, specifically a missing land line telephone and other valuables. The facility's theft and loss policy was not in compliance with Title 22, placing responsibility for lost or stolen property on residents unless negligence by staff is proven. The allegations were substantiated based on interviews and record review.
Deficiencies (2)
The licensee did not ensure an adequate theft and loss program as required by Health and Safety Code Section 1569.153. The facility's contract of admission did not meet the required standard of responsibility for residents' personal property.
The licensee did not ensure that the facility's Theft and Loss policy aligns with Title 22 requirements, posing a potential risk for the personal rights of persons in care.
Report Facts
Census: 65
Total Capacity: 99
Deficiency Count: 2
Plan of Correction Due Date: Apr 30, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LaJean Nicole Spencer | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Christine Yee | Licensing Program Manager | Oversaw the complaint investigation |
| Jonathan Isaacs | Administrator | Interviewed during investigation regarding safeguarding of resident property |
| Mele Tongamoa-Liu | Medtech and Director of Wellness | Interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 99
Deficiencies: 0
Date: Sep 14, 2020
Visit Reason
The inspection was conducted in response to a complaint alleging inadequate staffing, poor communication with authorized representatives, and failure to provide proper notification of rate increases at Evergreen Retirement Facility.
Complaint Details
The complaint included allegations of inadequate staffing, failure to promptly or appropriately answer communications to authorized representatives, and failure to provide proper notification of rate increases. The investigation concluded these allegations were unsubstantiated.
Findings
The investigation found sufficient staffing levels and timely communication with authorized representatives. The facility provided proper notification of rate increases. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 99
Census: 65
Staff caregivers: 6
Med-tech staff: 3
Residents interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LaJean Nicole Spencer | Licensing Program Analyst | Conducted the complaint investigation |
| Mele Tongamoa-Liu | Medtech and Director of Wellness | Interviewed during telephonic investigation and exit interview |
| Jonathan Isaacs | Administrator | Interviewed regarding staffing and communication allegations |
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