Inspection Report Summary
Most inspections found no deficiencies, with several complaint investigations resulting in unsubstantiated allegations. However, some reports cited deficiencies related to resident care, medication management, incident reporting, and personal rights violations. The most serious issues included immediate health and safety risks from medication errors, inadequate supervision leading to resident falls, and failure to report incidents timely, with civil penalties assessed in some cases. The most recent report from October 15, 2025, found one deficiency involving late notification to the licensing agency about a resident elopement but no immediate safety concerns. Overall, the facility shows some improvement in compliance over time, though isolated issues with reporting and resident rights have recurred.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 48
Capacity: 100
Deficiencies: 1
Oct 15, 2025
Visit Reason
An unannounced Case Management visit was conducted in conjunction with Complaint #29-AS-20250818182949 regarding a resident elopement incident that occurred on 08/01/2025.
Findings
The facility failed to notify Community Care Licensing (CCL) of the elopement incident within the required timeframe, constituting a violation of reporting requirements. No immediate safety concerns were observed during the visit.
Complaint Details
The visit was triggered by a complaint received on 08/18/2025 regarding Resident #1 eloping from the facility on 08/01/2025. The complaint was substantiated by the finding that the facility did not notify CCL in a timely manner.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide CCL notification of an incident involving the unexplained absence of a resident within seven days as required by licensing regulations. | Type B |
Report Facts
Census: 48
Total Capacity: 100
Deficiency Count: 1
Plan of Correction Due Date: Oct 29, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Quoc Huynh | Licensing Program Analyst | Conducted the inspection and authored the report |
| Leticia Flores | Office Manager | Met with the Licensing Program Analyst during the inspection |
| Virginia Sumulong | Administrator/Director | Facility Administrator named in the report header |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 100
Deficiencies: 0
Aug 12, 2025
Visit Reason
An unannounced Case Management Incident visit was conducted to follow up on a SOC 341 report received by the department regarding an incident involving a resident and staff member.
Findings
No immediate health or safety concerns were observed during the physical plant tour. The case was referred to the Investigation Bureau for further investigation. No deficiencies were cited during this visit.
Complaint Details
The visit was triggered by a SOC 341 report involving Resident #1 and Staff #1. A detective from the Los Angeles Police Department investigated an incident at the facility on 08/11/2025. Further investigation by the licensing agency is needed.
Report Facts
Capacity: 100
Census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Celia Garcia | Executive Director | Met with Licensing Program Analyst during inspection |
| Quoc Huynh | Licensing Program Analyst | Conducted the unannounced Case Management Incident visit |
Inspection Report
Complaint Investigation
Capacity: 100
Deficiencies: 0
Mar 19, 2025
Visit Reason
An unannounced Case Management - Incident visit was conducted to follow up on a LIC 624 Incident report and SOC 341 received by the department regarding an incident involving two residents on 2025-03-06.
Findings
The Licensing Program Analyst and Assistant Administrator conducted a physical plant tour and obtained documents pertinent to the investigation. No immediate or potential health and safety concerns were observed at the time of the visit. The case was referred to the Investigation Bureau for further investigation.
Complaint Details
The visit was triggered by a complaint involving an incident on 2025-03-06 with two residents. The case was referred to the Investigation Bureau and further investigation is needed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Anguinia | Executive Director | Met with Licensing Program Analyst during the visit and explained the reason for the visit. |
| Virginia Sumulong | Assistant Administrator | Met with Licensing Program Analyst and conducted physical plant tour during the visit. |
| Sandra Urena | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit. |
Inspection Report
Annual Inspection
Census: 48
Capacity: 100
Deficiencies: 0
Jan 30, 2025
Visit Reason
The inspection was an unannounced Case Management - Annual Continuation Inspection to review compliance with care plans, medical records, personnel records, medications, and infection control protocols.
Findings
All records including residents' care plans, medical records, and personnel files were in order. Medications were properly stored, labeled, and documented with no errors observed. Infection control supplies and protocols were adequate. No deficiencies were cited.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the inspection and was involved in findings related to records, medications, and infection control. |
Inspection Report
Annual Inspection
Census: 48
Capacity: 100
Deficiencies: 0
Jan 24, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted to ensure the facility's compliance with Title 22 Regulations.
Findings
The facility was found to be in good condition with no health or safety hazards observed. Common areas, restrooms, laundry, bedrooms, kitchen, dining, and outdoor areas were clean, functional, and properly maintained. Fire extinguishers and detectors were serviced and operational.
Report Facts
Hot water temperature: 113.8
Fire extinguisher last serviced date: Oct 15, 2024
Smoke and carbon monoxide detector test date: Nov 19, 2024
Facility temperature: 74
Refrigerator temperature: 40
Freezer temperature: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the annual inspection and toured the facility |
| David Aguiniga | Executive Director | Met with Licensing Program Analyst during inspection |
| Virginia Sumulong | Executive Assistant | Met with Licensing Program Analyst and toured facility |
| Marilou Mendoza | Administrator/Director | Facility Administrator named in report header |
| Kasandra Lopez | Licensing Program Manager | Named in report signature section |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 100
Deficiencies: 0
Dec 12, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff physically assaulted a resident resulting in injuries.
Findings
The investigation included multiple interviews, document reviews, and medical record assessments. The allegation was found to be unsubstantiated due to insufficient evidence, no witnesses, and conflicting accounts. The resident had bruising noted at the hospital, but no signs of abuse were confirmed at the facility.
Complaint Details
The complaint alleged that staff physically assaulted a resident causing bruising and pain. The resident reported being hit in the chest and grabbed on the arm by a staff member. The investigation included interviews with staff, residents, and the resident's authorized person, review of medical records, photos of bruising, and internal facility investigations. No witnesses confirmed the incident, and staff denied the allegations. The allegation was deemed unsubstantiated.
Report Facts
Capacity: 100
Census: 47
Number of residents interviewed: 5
Number of staff interviewed: 8
Number of photos obtained: 3
Years resident lived at community (one resident): 13
Years staff member S1 employed at community: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Esther Cortez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kasandra Lopez | Licensing Program Manager | Oversaw the complaint investigation |
| David Aguiniga | Administrator | Facility administrator interviewed during investigation |
| Virginia Sumulong | Assistant Administrator | Assistant administrator interviewed during investigation |
| Rafael Silva | Interim Administrator | Interim administrator at time of incident interviewed during investigation |
| Tillman Pink | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 100
Deficiencies: 0
Nov 15, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2023-02-27 regarding multiple allegations about resident care and facility management at Glen Park at Valley Village.
Findings
The investigation found insufficient evidence to substantiate any of the seven allegations, including pressure injuries, incontinence care, administrator presence, grooming assistance, infection control, incident reporting, and communication with responsible parties. No deficiencies were cited during the visit.
Complaint Details
The complaint involved seven allegations: 1) Resident sustained pressure injuries while in care; 2) Staff do not meet resident's incontinence needs; 3) Administrator is not at the facility sufficient hours to permit adequate attention to management; 4) Staff do not assist resident with grooming; 5) Staff do not follow infection control protocol; 6) Staff do not report incidents to appropriate parties; 7) Staff do not communicate with responsible party regarding resident's care. All allegations were found to be unsubstantiated based on interviews, record reviews, and observations.
Report Facts
Facility capacity: 100
Resident census: 43
Complaint received date: Feb 27, 2023
Investigation visit date: Nov 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tillman Pink | Administrator | Named in allegation regarding management attention and presence at the facility |
| David Aguiniga | Executive Director | Met with during inspection visit |
| Virginia Sumulong | Assistant Administrator | Interviewed during investigation and provided management coverage |
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kristin Heffernan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 100
Deficiencies: 2
Nov 14, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 09/29/2023 regarding staff verbally abusing residents and not providing medication in a timely manner.
Findings
The investigation substantiated that staff verbally abused residents, including an incident where Staff #4 cursed at a resident during medication time. It was also substantiated that staff did not provide medications in a timely manner due to staffing shortages. A third allegation regarding residents' files being up to date was unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations of verbal abuse by staff and untimely medication administration. The allegation that staff were not ensuring residents' files were up to date was unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff #4 responded back to Resident #1 with cursing when medication was requested, violating residents' personal rights. | Type B |
| Facility was short staffed and residents were not given their medications in a timely manner, posing an immediate risk to residents' health. | Type B |
Report Facts
Capacity: 100
Census: 43
Deficiencies cited: 2
Plan of Correction Due Date: Nov 21, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation |
| David Aguiniga | Executive Director | Met with Licensing Program Analyst during investigation |
| Tillman Pink | Administrator | Facility Administrator named in report |
| Staff #4 | Named in verbal abuse deficiency for cursing at a resident |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 100
Deficiencies: 3
Oct 9, 2024
Visit Reason
The visit was an unannounced Case Management - Deficiencies inspection conducted in conjunction with a complaint investigation (Complaint control # 29-AS-20240311081755) to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint.
Findings
The facility staff performed wound care treatment to Resident #1's pressure injury without being skilled professionals, and there were no home health logs or staff notes documenting the care and treatment plan. Resident #1 was admitted without an exception request despite having a prohibited health condition requiring full assistance with activities of daily living, posing an immediate health and safety risk.
Complaint Details
The visit was conducted in conjunction with a complaint investigation (Complaint control # 29-AS-20240311081755). Deficiencies were observed during the complaint investigation but were not related to the complaint itself.
Severity Breakdown
Type A: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility staff performed wound care treatment to Resident #1’s pressure injury, which posed an immediate health and safety risk to residents in care. | Type A |
| No home health logs or staff notes were available at the facility regarding Resident #1’s home health care and treatment plan, posing an immediate health and safety risk. | Type A |
| Facility admitted and retained Resident #1 who had no capacity for self-care without submitting an exception request for the prohibited health condition, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 100
Census: 42
Deficiencies cited: 3
Plan of Correction Due Date: Oct 23, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Conway | Licensing Program Analyst | Conducted the inspection and authored the report |
| David Aguiniga | Administrator | Facility administrator met during inspection and was made aware of treatment plan and deficiencies |
| Desaree Perera | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 100
Deficiencies: 0
Oct 9, 2024
Visit Reason
The visit was conducted as a Case Management - Incident investigation in response to a Report of Suspected Dependent Adult/Elder Abuse alleging that Resident #1 was sexually assaulted by Resident #2.
Findings
The investigation found insufficient evidence to prove that staff neglect or lack of supervision led to the alleged incident. Resident #1 reported inappropriate touching by Resident #2, who denied the allegations. Staff have been closely supervising both residents since the incident, and no further incidents have occurred.
Complaint Details
The complaint involved an allegation of sexual assault by one resident against another. The Department conducted interviews with the administrator, staff, residents, and law enforcement. Surveillance footage was reviewed but no evidence was found. The Department found insufficient evidence to substantiate neglect or lack of supervision by staff.
Report Facts
Capacity: 100
Census: 42
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Aguiniga | Administrator | Met with Licensing Program Analyst during the visit and involved in the investigation |
| Valeria Conway | Licensing Program Analyst | Conducted the Case Management - Incident visit and signed the report |
| Desaree Perera | Licensing Program Manager | Named in the report as Licensing Program Manager |
| Laarni Santiago | Investigator | Assigned to the investigation of the complaint |
| Zabel Chochian | Licensing Program Analyst | Responded to the facility for the Case Management - Incident visit on 01/31/2024 |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 100
Deficiencies: 0
Oct 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of neglect/lack of care and supervision, specifically that a resident sustained an unstageable pressure injury while in care at the facility as a result of facility neglect.
Findings
The investigation found insufficient evidence to substantiate the allegation that the facility was responsible for neglect or lack of care causing the resident's pressure injury. The pressure injury likely worsened due to inadequate care by the home health nurse, and caregivers were not trained or qualified to provide wound care.
Complaint Details
The complaint alleged neglect/lack of care and supervision resulting in a resident sustaining an unstageable pressure injury. After investigation including interviews, record reviews, and site visits, the allegation was deemed unsubstantiated due to lack of sufficient evidence implicating the facility.
Report Facts
Facility capacity: 100
Census: 42
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Conway | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| David Aguiniga | Facility Administrator met during investigation | |
| Dennis Seng | Investigator | Assigned to the complaint investigation and conducted interviews |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 41
Capacity: 100
Deficiencies: 0
Sep 18, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation regarding allegations that staff were not notifying residents of a COVID outbreak at the facility.
Findings
The investigation found that although staff did not provide written notices, residents were verbally informed about the COVID cases and offered PPE equipment. The allegation that staff did not notify residents was deemed unsubstantiated due to insufficient evidence.
Complaint Details
The complaint alleged that staff were not notifying residents of a COVID outbreak. The investigation included interviews with administrators, staff, and residents, and review of records. The allegation was found unsubstantiated.
Report Facts
COVID cases: 3
COVID cases: 1
Date: Sep 12, 2024
Date: Sep 20, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation |
| David Aguiniga | Executive Director | Interviewed during the investigation and provided information about resident notification |
| Virginia Sumulong | Assistant Administrator | Interviewed during the investigation and informed of the reason for the visit |
| Marilou Mendoza | Administrator | Facility Administrator named in the report |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 41
Capacity: 100
Deficiencies: 0
Sep 18, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following a complaint alleging that staff do not provide a safe environment for a resident.
Findings
The investigation found insufficient evidence to support the allegation that staff do not provide a safe environment for the resident. The resident refused to be interviewed, and staff interviews indicated the resident has a tendency to become quickly irritated. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that staff do not provide a safe environment for a resident. The resident (R1) did not feel safe but did not provide specific details. Attempts to interview the resident and acquaintances were unsuccessful. Staff reported the resident has behavioral issues but no abusive behavior was substantiated. The complaint was unsubstantiated.
Report Facts
Capacity: 100
Census: 41
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation |
| David Aguiniga | Executive Director | Interviewed during the investigation |
| Virginia Sumulong | Assistant Administrator | Informed of the reason for the visit |
| Kasandra Lopez | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 100
Deficiencies: 0
Sep 4, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2023-05-08, including questionable death, staff abuse, hiding prohibited health conditions, theft of residents' money and belongings, threats to residents, and unlawful eviction.
Findings
All allegations investigated were deemed unsubstantiated based on interviews with residents and staff, record reviews, medication audits, and document examination. No evidence was found to support claims of medication errors causing death, staff abuse, hiding health conditions, theft, threats, or unlawful evictions. Evictions were found to be in compliance with facility policies and regulations.
Complaint Details
The complaint investigation addressed nine allegations: questionable death, staff abusing residents, staff hiding prohibited health conditions, staff stealing residents' money, staff stealing residents' belongings, staff threatening residents, and unlawful eviction of residents. Each allegation was investigated through interviews, record reviews, and audits, and all were found unsubstantiated.
Report Facts
Deaths reviewed: 4
Medications audited: 5
Eviction notices reviewed: 5
Residents evicted: 2
Inspection Report
Complaint Investigation
Census: 40
Capacity: 100
Deficiencies: 0
Aug 22, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that staff did not prevent residents from causing harm to others, did not meet medical needs, and did not properly report incidents involving residents.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with residents and staff, medication audits, and records reviews indicated that staff generally intervened appropriately, medications were administered as prescribed, and emergency incidents were properly reported.
Complaint Details
The complaint investigation addressed three main allegations: 1) staff failing to prevent harm between residents, 2) staff not meeting residents' medical needs due to med tech availability issues, and 3) staff not properly reporting incidents. All allegations were deemed unsubstantiated due to lack of sufficient evidence.
Report Facts
Residents interviewed: 6
Med techs on staff: 5
Incident reports with emergency calls: 17
Medication Administration Records reviewed: 6
Medication review sample: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and subsequent visits |
| Marilou Mendoza | Executive Director | Met with Licensing Program Analyst during investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 2
May 22, 2024
Visit Reason
The visit was conducted to investigate complaints received on 2023-08-14 regarding bed bugs in the facility and failure to safeguard residents' belongings.
Findings
The investigation substantiated that the facility had ongoing bed bug issues and failed to safeguard residents' belongings, as the previous administrator left residents' clothes and belongings in the open parking lot. Another allegation that the facility was not meeting clients' needs was unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations of bed bugs and failure to safeguard residents' belongings. The allegation that the facility was not meeting clients' needs was unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not provide residents safe, healthful and comfortable accommodations as bed bugs were observed and confirmed, posing a potential health, safety, and personal rights risk. | Type B |
| Facility failed to safeguard residents' cash, personal property, and valuables as former administrator stored residents' belongings outside in the parking lot. | Type B |
Report Facts
Capacity: 100
Census: 37
Deficiencies cited: 2
Plan of Correction Due Date: May 28, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Desaree Perera | Licensing Program Manager | Oversaw complaint investigation |
| Marilou Mendoza | Administrator | Current administrator interviewed during investigation |
| Virgina Gigi Sumulong | Assistant Administrator | Assistant administrator interviewed during investigation |
| Marhlyn Sapugay | Previous administrator acknowledged improper handling of residents' belongings |
Inspection Report
Census: 38
Capacity: 100
Deficiencies: 2
May 15, 2024
Visit Reason
Licensing Program Analyst Teresa Camara conducted a Case Management - Deficiencies visit to the facility to review medication and personnel records as part of regulatory compliance oversight.
Findings
The facility failed to maintain medication records for a former resident and personnel records for two former employees, which posed potential health and safety risks to residents in care.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to keep medication records for resident 1 (R1) who no longer resides at the facility, violating the requirement to maintain such records for at least one year. | Type B |
| Failed to keep personnel records for two former employees (S1 and S2), violating the requirement to retain personnel records for at least three years following termination. | Type B |
Report Facts
Deficiencies cited: 2
Plan of Correction Due Date: May 22, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilou Mendoza | Administrator | Met with Licensing Program Analyst during inspection |
| Gigi Sumulong | Assistant Administrator | Assisted in locating records during inspection |
| Teresa Camara | Licensing Program Analyst | Conducted the inspection visit |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 100
Deficiencies: 1
May 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 02/07/2023 regarding facility staff not noticing a resident's absence.
Findings
The investigation found that the facility staff failed to notice that resident 1 (R1) had signed out on 1/17/2023 and never returned, remaining unaware of R1's whereabouts until notified of the resident's death on 2/3/2023. This failure to follow up on the resident's absence was substantiated and posed an immediate health and safety risk.
Complaint Details
The complaint alleged that facility staff did not notice a resident's absence. The investigation substantiated this allegation, finding that staff failed to follow up on the resident who signed out and never returned, remaining unaware of the resident's death for nearly three weeks.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate supervision to resident who signed out and never returned, violating basic services requirements. | Type A |
Report Facts
Capacity: 100
Census: 38
Plan of Correction Due Date: May 22, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation and subsequent visit |
| Tillman Pink | Administrator | Administrator at the time of the incident and submitted the death report |
| Marilou Mendoza | Met with Licensing Program Analyst during the subsequent complaint visit | |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 100
Deficiencies: 1
May 15, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that staff stole residents' medications and falsified medication records.
Findings
The investigation found no evidence that residents' medications were stolen or that staff falsified medication records. However, missing medication records for a former resident and missing personnel records for two staff members were identified and addressed in a Case Management - Deficiencies visit.
Complaint Details
The complaint allegations were unsubstantiated based on interviews, medication audit, and record review.
Deficiencies (1)
| Description |
|---|
| Facility did not maintain all medication records for a former resident and personnel records for two staff members were missing. |
Report Facts
Capacity: 100
Census: 38
Medication audit sample size: 7
Staff interviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the subsequent complaint investigation visit |
| Marilou Mendoza | Administrator met with during the investigation | |
| Angel Ascencio | Licensing Program Analyst | Conducted the initial complaint investigation visit |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 100
Deficiencies: 1
May 14, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that facility staff violated a resident's personal rights and retaliated against the resident.
Findings
The investigation substantiated that facility staff searched a resident's personal dresser and nightstand drawers without permission, violating the resident's personal rights. However, the allegation that staff retaliated against the resident by taking away personal hygiene items was unsubstantiated, as items were only temporarily removed during the search and returned to the resident's room.
Complaint Details
The complaint alleged that facility staff violated a resident's personal rights by searching personal drawers without permission and retaliated against the resident by removing personal hygiene items. The personal rights violation was substantiated; the retaliation allegation was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility staff searched resident R1's dresser and nightstand drawers without prior permission, violating personal rights as per CCR 87468.2. | Type B |
Report Facts
Capacity: 100
Census: 38
Deficiency count: 1
Plan of Correction Due Date: May 31, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Marilou Mendoza | Executive Director | Facility administrator interviewed during investigation |
| Kasandra Lopez | Licensing Program Manager | Oversaw complaint investigation and signed report |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 1
Apr 26, 2024
Visit Reason
The visit was conducted to conclude an investigation initiated by a complaint alleging an illegal eviction of Resident #1 at the facility.
Findings
The investigation found that the eviction notice issued to Resident #1 did not comply with Title 22 requirements as it lacked specific facts regarding the date, place, witnesses, and circumstances of the eviction. The allegation of illegal eviction was substantiated.
Complaint Details
The complaint alleged that Resident #1 was issued an illegal eviction. The allegation was substantiated based on the eviction notice not meeting regulatory requirements.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Eviction Procedures. The licensee failed to include specific facts in the eviction notice to permit determination of the date, place, witnesses, and circumstances concerning the reasons for the eviction. | Type B |
Report Facts
Capacity: 100
Census: 37
Deficiency Plan of Correction Due Date: May 3, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Conway | Licensing Program Analyst | Conducted the complaint investigation and visit |
| Desaree Perera | Licensing Program Manager | Oversaw the complaint investigation |
| Marilou Mendoza | Administrator | Facility administrator involved in the investigation and interview |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 0
Apr 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff do not meet the minimum qualifications required.
Findings
The investigation found that staff member #1 meets the minimum requirements including State Certification, background check, and required training. The allegation that staff do not meet minimum qualifications was deemed unsubstantiated.
Complaint Details
The complaint alleged that staff do not meet the minimum qualifications required. The allegation was investigated and found to be unsubstantiated based on document review and interviews.
Report Facts
Capacity: 100
Census: 37
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation visit |
| Marylou V. Mendoza | Executive Director | Met with Licensing Program Analyst during the investigation |
| Virginia Sumulong | Assistant Administrator | Met with Licensing Program Analyst during the investigation |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 0
Apr 3, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that staff refuse to let residents leave the facility, staff tie/lock up resident doors, and residents in care are denied food.
Findings
The investigation found all allegations to be unsubstantiated. Interviews and observations revealed that doors are locked from the outside for safety but not tied or locked from the inside, residents are not refused food, and residents have access to meals as per the monthly menu.
Complaint Details
The complaint included allegations that staff refuse to let residents leave the facility by locking doors, staff tie or lock resident doors, and residents are denied food. After investigation including interviews with staff and residents, observations of meal service, and review of policies, all allegations were deemed unsubstantiated.
Report Facts
Capacity: 100
Census: 37
Residents observed at lunch: 15
Residents receiving meals in room: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation visit |
| Marylou V. Mendoza | Executive Director | Interviewed during the investigation |
| Virginia Sumulong | Assistant Administrator | Interviewed during the investigation |
| Rafael Silva | Interim Administrator | Interviewed during initial complaint visit |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 100
Deficiencies: 3
Mar 12, 2024
Visit Reason
The inspection visit was an unannounced case management deficiencies inspection conducted due to deficiencies observed during the investigation of complaint control #29-AS-20240311081755.
Findings
Deficiencies were found including unlocked laundry room cabinets containing detergents and chemical supplies accessible to residents, a resident's room door left wide open with accessible scissors, and a delay in providing a new wheelchair prescribed for a resident since December 2023.
Complaint Details
The visit was triggered by complaint control #29-AS-20240311081755. The complaint involved concerns about wheelchair support and accessibility of hazardous materials to residents. The investigation found deficiencies supporting the complaint.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| 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. | Type A |
| Based on observations, licensee did not ensure detergents, cleaning solutions and scissors were kept inaccessible to residents, posing an immediate risk. | Type A |
| Personal Rights: Resident's prescription order for a new wheelchair was not processed in a timely manner, posing a potential risk to residents. | Type B |
Report Facts
Capacity: 100
Census: 38
Plan of Correction Due Date: Mar 13, 2024
Plan of Correction Due Date: Mar 29, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilou Mendoza | Administrator | Met during inspection and interview related to wheelchair deficiency |
| Virginia Sumulong | Met during inspection | |
| Valeria Conway | Licensing Program Analyst | Conducted inspection and signed report |
| Zabel Chochian | Licensing Program Analyst | Conducted inspection |
| Desaree Perera | Licensing Program Manager | Supervisor of inspection |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 0
Jan 31, 2024
Visit Reason
The visit was a case management incident response to a SOC341 report submitted by the facility Administrator regarding an allegation of sexual assault between two residents.
Findings
The Licensing Program Analyst conducted a brief physical plant tour, discussed the case with facility administrators, and obtained records for the involved residents. The incident was referred to the Community Care Licensing Investigation's Branch for further investigation.
Complaint Details
The complaint involved an allegation by Resident #1 that they were sexually assaulted two weeks prior by another resident. The facility submitted reports to Adult Protective Services, the Local Long Term Care Ombudsman, and local law enforcement. Law enforcement was scheduled to visit the facility on the day of the inspection. The incident was assigned to a Special Investigator for further investigation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marilou Mendoza | Administrator | Met during the visit and involved in submitting reports related to the incident. |
| Virgina Gigi Sumulong | Assistant Administrator | Met during the visit and involved in case discussion. |
| Zabel Chochian | Licensing Program Analyst | Conducted the case management visit. |
| Laarni Santiago | Special Investigator | Assigned to investigate the incident. |
Inspection Report
Annual Inspection
Census: 38
Capacity: 100
Deficiencies: 0
Jan 27, 2024
Visit Reason
The visit was an unannounced required annual inspection conducted to ensure the facility's compliance with Title 22 Regulations.
Findings
The Licensing Program Analyst toured the facility including the kitchen and dining areas, finding the facility clean, with operable appliances, sufficient food supplies, and proper temperature controls. No health or safety hazards were observed during this part of the annual inspection.
Report Facts
Facility Capacity: 100
Census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the annual inspection and toured the facility |
| Virginia Sumulong | Administrator who arrived during the inspection | |
| Jessyca Munoz | Met with the Licensing Program Analyst at the start of the inspection |
Inspection Report
Census: 39
Capacity: 100
Deficiencies: 1
Oct 5, 2023
Visit Reason
An unannounced case management visit was conducted due to a deficiency observed during a visit to the facility on 10/05/2023.
Findings
The facility failed to ensure that Virginia Sumulong (also known as Virginia De Los Reyes) was properly associated with the facility prior to working there from 9/18/23 to 10/5/23. Civil penalties were assessed for this deficiency.
Deficiencies (1)
| Description |
|---|
| Failure to ensure that Virginia Sumulong was cleared and associated to the facility prior to being present from 9/18/23 to 10/5/23. |
Report Facts
Civil penalty amount: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Virginia Sumulong | Assistant Administrator | Named in deficiency for working at the facility without proper association. |
| Tillman Pink | Administrator | Facility Administrator during the inspection. |
| Christine Yee | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Kristin Heffernan | Licensing Program Manager | Supervisor overseeing the licensing evaluation. |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 100
Deficiencies: 3
Sep 29, 2023
Visit Reason
Unannounced Case Management - Deficiencies visit due to deficiencies observed during the course of audit investigations for complaints C#29-AS-20210310091929 and C#29-AS-20220826155207.
Findings
The facility failed to maintain adequate safeguards and accurate records of residents' cash, personal property, and valuables, including lack of resident signatures on ledgers. The surety bond coverage was insufficient relative to the amount of residents' funds safeguarded. Additionally, some residents' personal and incidental funds were mishandled due to lack of supporting documentation for cash withdrawals, purchases, and rent miscalculations, resulting in a total refund amount of $9,038 for 16 residents.
Complaint Details
The visit was complaint-related, triggered by complaints C#29-AS-20210310091929 and C#29-AS-20220826155207. The audit investigation substantiated deficiencies related to cash handling and fund mismanagement.
Severity Breakdown
Type B: 2
Type A: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Safeguards for Resident Cash, Personal Property, and Valuables - Residents' signatures were not found on cash ledgers, inconsistent with facility policies. | Type B |
| Surety Bond – Insufficient Coverage - Current $11,000 bond coverage is insufficient for the amount of residents' funds safeguarded ($44,000 to $53,000 per month). | Type B |
| Some residents’ personal and incidental funds were mishandled due to lack of supporting documents for cash withdrawals, purchases, and rent miscalculation. | Type A |
Report Facts
Refund amount: 9038
Residents with cash handled: 16
Surety bond coverage: 11000
Residents census: 44
Facility capacity: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the unannounced Case Management - Deficiencies visit and authored the report. |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection. |
| Molly Ayala | Facility representative met during the inspection. |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 100
Deficiencies: 0
Sep 29, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that the licensee falsified residents' cash resource records and commingled resident cash resources with facility funds.
Findings
The investigation found insufficient evidence to substantiate the allegations. Although the facility's cash resource records were not documented appropriately and inaccurate receipts were kept, no evidence of falsification or commingling of residents' funds with facility funds was found. The allegations were deemed unsubstantiated.
Complaint Details
The complaint alleged that the licensee falsified residents' cash resource records by recording more money given than actually provided, and that resident cash resources were commingled with facility funds. The investigation included financial audits and interviews. Both allegations were found unsubstantiated due to lack of sufficient evidence.
Report Facts
Capacity: 100
Census: 44
Audit report completion date: Aug 29, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the unannounced complaint investigation visit and authored the report |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Molly Ayala | LVN | Facility representative met during the investigation |
| Pink Tillman | Administrator | Facility administrator mentioned in the report |
| Brian Balisi | Licensing Program Analyst | Initiated the complaint investigation and conducted telephonic interviews |
| Elizabeth Flores | Assistant Administrator | Participated in telephonic interview during investigation |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 100
Deficiencies: 0
Aug 16, 2023
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 2023-08-14 regarding allegations that residents were locked inside the facility and that the facility was understaffed.
Findings
The investigation found that the front door was unlocked and residents were able to exit and enter the facility at any time. Staffing levels were reviewed and found sufficient with three caregivers, two medtechs, and two housekeeping staff per shift. The allegations were deemed unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated regarding allegations that residents were locked inside the facility and that the facility was understaffed.
Report Facts
Staff caregivers per shift: 3
Staff medtechs per shift: 2
Staff housekeeping per shift: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation |
| Marhlyn Sapugay | Facility administrator met during investigation |
Inspection Report
Census: 49
Capacity: 100
Deficiencies: 1
Jul 6, 2023
Visit Reason
A Case Management - Deficiency visit was conducted to evaluate compliance with medication storage regulations.
Findings
A medication audit revealed that Resident #1's medications Olanzapine 10 mg, Clozapine 50 mg, and Clorazapine 100 mg were not centrally stored as required, due to a recent medication change and off-cycle pharmacy delivery. One citation was issued for failure to maintain a record of centrally stored medications.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to maintain a record of dosages of medications which are centrally stored as required by regulation. | Type B |
Report Facts
Deficiencies cited: 1
Plan of Correction Due Date: Jul 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Ascencio | Licensing Program Analyst | Conducted the Case Management - Deficiency visit and medication audit |
| Rafael Silva | Interim Administrator | Met with Licensing Program Analyst during the visit |
| Elizabeth Monarrez | Quality Assurance Specialist | Met with Licensing Program Analyst during the visit |
| Kristin Heffernan | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the visit |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 100
Deficiencies: 0
Jun 13, 2023
Visit Reason
The inspection was conducted in response to a complaint alleging that the facility failed to maintain a comfortable temperature.
Findings
The investigation found that although one resident reported issues with air vents, temperature measurements and interviews with other residents confirmed that room temperatures were within a comfortable and regulatory range. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that the facility failed to maintain a comfortable temperature. The investigation included interviews with residents and temperature measurements. The complaint was found to be unsubstantiated.
Report Facts
Room temperature range: 73.4
Room temperature range: 77.7
Facility capacity: 100
Census: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Ascencio | Licensing Program Analyst | Conducted the complaint investigation |
| Kristin Heffernan | Licensing Program Manager | Named in report as Licensing Program Manager |
| Rafael Silva | Interim Executive Director | Unable to meet with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 100
Deficiencies: 1
May 24, 2023
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following a complaint received on 05/22/2023 regarding the facility not taking appropriate measures to eradicate bed bugs.
Findings
The investigation confirmed that Resident #1 had bed bugs and was refusing care and housekeeping services, posing a health and safety risk to themselves and others. The facility was found to have failed to provide safe, healthful, and comfortable accommodations due to the presence of bed bugs, substantiating the complaint.
Complaint Details
The complaint was substantiated. Resident #1 was found to have bed bugs and was refusing care and housekeeping services. The facility failed to eradicate bed bugs and provide safe accommodations. Resident #1 was on isolation protocol for bed bugs since May 16th. The complaint investigation was conducted by Licensing Program Analyst Angel Ascencio.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87468.1 Personal Rights of Residents in All Facilities. The facility did not provide Resident #1 a safe, healthful and comfortable accommodation as bed bugs were observed and confirmed, posing a potential health, safety, and personal rights risk to residents in care. | Type B |
Report Facts
Capacity: 100
Census: 54
Deficiency count: 1
Plan of Correction Due Date: Jun 16, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angel Ascencio | Licensing Program Analyst | Conducted the complaint investigation and cited deficiencies |
| Rafael Silva | Interim Administrator | Interviewed during investigation and provided information about Resident #1 and facility actions |
| Elizabeth Monarrez | Quality Assurance Specialist | Interviewed during investigation and provided information about Resident #1's condition and refusal of care |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 1
Mar 30, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted to investigate the allegation that staff mismanaged a resident's medication.
Findings
The investigation substantiated the allegation that staff mismanaged resident medication, including incidents where medications were mixed between residents and residents received incorrect medications. A medication audit found medication boxes filed under wrong resident labels and missing labels or dividers in medication drawers.
Complaint Details
The complaint was substantiated. The allegation involved staff mismanaging resident medication, including giving the complainant another resident's medication without proper documentation or signature. Interviews with residents and staff confirmed medication errors. The investigation included interviews, medication audits, and record reviews.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to keep centrally stored medication in a safe and locked place accessible only to employees, as evidenced by medication being mixed between residents posing a health and safety risk. | Type A |
Report Facts
Residents present during audit: 57
Total licensed capacity: 100
Plan of Correction due date: Apr 7, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Angel Ascencio | Licensing Program Analyst | Assisted in conducting the complaint investigation and medication audit |
| Pink Tillman | Administrator | Facility administrator not available during visit |
| Jessyca Munoz | Receptionist | Met with LPAs during the visit |
| Rafael Silva | Quality Assurance Director | Participated in exit interview |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 100
Deficiencies: 0
Mar 17, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 01/19/2021 concerning staff misuse of resident medication, staff qualifications, resident wandering, denial of resident access, failure to address medical condition changes, and unsafe environment.
Findings
All allegations were investigated through interviews with complainants, staff, and review of documentation. No sufficient evidence was found to substantiate any of the allegations, and all were deemed unsubstantiated at the time of the investigation.
Complaint Details
The complaint included nine allegations: staff using resident medication, staff not meeting minimum qualifications, failure to prevent resident wandering, failure to address resident's medical condition change, denial of resident access to the facility, and failure to provide a safe environment. Each allegation was investigated and found unsubstantiated based on interviews and evidence gathered.
Report Facts
Capacity: 100
Census: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pink Tillman | Administrator | Named in allegations regarding staff qualifications and handling of resident care |
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation report |
| Malikah Silla | Facility Representative | Met with Licensing Program Analyst during inspection and exit interview |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 1
Mar 10, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that the facility did not notify the resident's Power of Attorney (POA) of moving him to the hospital.
Findings
The investigation found sufficient evidence to substantiate the allegation that the facility failed to notify the resident's POA of the hospitalization. The facility did not have a record of notifying the POA, and the required incident report form was not located. Citations were issued for deficiencies related to reporting requirements.
Complaint Details
The complaint was substantiated. The allegation was that the facility did not notify the resident's POA of moving the resident to the hospital on 01/22/2021. Interviews and record reviews confirmed the facility failed to notify the POA and CCLD, posing a potential health and safety risk.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit a written report within seven days of any incident threatening the welfare, safety, or health of any resident, specifically failing to inform the resident's POA and CCLD of hospitalization. | Type B |
Report Facts
Capacity: 100
Census: 57
Deficiency count: 1
Plan of Correction due date: Mar 17, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation |
| Pink Tillman | Administrator | Facility administrator interviewed during the investigation |
| Elizabeth Flores | Assistant Administrator | Interviewed regarding contact protocols for hospital admissions |
| Brian Balisi | Licensing Program Analyst | Initiated the complaint investigation and conducted telephone interviews |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 0
Feb 14, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that a resident sustained unexplained bruising while in care.
Findings
The investigation found insufficient evidence to support the allegation of unexplained bruising on the resident. Documentation and medical records did not substantiate the complaint, and interviews with the resident or complainant were not obtained. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that a resident sustained an excessive amount of unexplained bruising on their thigh while in care. The investigation included record reviews and interviews but found no evidence to support the allegation. The complaint was unsubstantiated.
Report Facts
Capacity: 100
Census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and facility visit |
| Brian Balisi | Licensing Program Analyst | Initiated the complaint investigation and conducted telephonic interviews |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Pink Tillman | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 1
Feb 14, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident fell and was left on the floor until the following morning, and that facility staff did not provide basic needs to residents.
Findings
The investigation substantiated the allegation that a resident fell and was left on the floor until the following morning due to inadequate staff supervision, posing an immediate health and safety risk. The allegation that facility staff did not provide basic needs to residents was found to be unsubstantiated based on interviews and record reviews.
Complaint Details
The complaint investigation was initiated due to allegations that a resident fell and was left on the floor until the following morning, and that facility staff did not provide basic needs to residents. The fall allegation was substantiated, while the basic needs allegation was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff did not provide adequate supervision, resulting in a resident falling, which poses an immediate health and safety risk to residents in care. | Type A |
Report Facts
Facility capacity: 100
Census: 57
Plan of Correction due date: Feb 24, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in relation to the investigation and report |
| Pink Tillman | Administrator | Facility administrator mentioned in the report |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 1
Feb 10, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that the facility did not notify a family member of a resident's hospitalization and did not return all of the resident's belongings to the family member.
Findings
The investigation substantiated that the facility failed to inform the family members and the licensing agency about the resident's hospitalization on 10/23/2020, constituting a violation of reporting requirements. However, the allegation that the facility did not return all of the resident's belongings was unsubstantiated due to insufficient evidence that the missing items were part of the resident's personal property.
Complaint Details
The complaint investigation was initiated due to allegations that the facility did not notify a family member of a resident's hospitalization and did not return all of the resident's belongings. The allegation regarding failure to notify was substantiated, while the allegation regarding belongings was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit a written report within seven days of an incident threatening the welfare, safety, or health of any resident, specifically failing to inform family members and the licensing agency about a resident's hospitalization. | Type B |
Report Facts
Capacity: 100
Census: 57
Deficiencies cited: 1
Plan of Correction Due Date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Brian Balisi | Licensing Program Analyst | Initiated the complaint investigation and conducted telephone interviews |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Pink Tillman | Administrator | Facility Administrator mentioned in the report |
| Elizabeth Flores | Assistant Administrator | Facility Assistant Administrator interviewed telephonically during the investigation |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 100
Deficiencies: 1
Feb 7, 2023
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations that the facility abandoned a resident, failed to return the resident's personal belongings, and failed to issue a refund.
Findings
The allegation that the facility abandoned a resident was substantiated, as the resident was left at the hospital for two days before being allowed to return. The allegations regarding failure to return personal belongings and failure to issue a refund were deemed unsubstantiated.
Complaint Details
The complaint investigation was substantiated for the allegation that the facility abandoned Resident #1 at the hospital for two days. The allegations of illegal eviction, failure to return personal belongings, and failure to issue a refund were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility abandoned Resident #1 for 2 days at the hospital, posing an immediate health, safety, and personal rights risk. | Type A |
Report Facts
Capacity: 100
Census: 57
Deficiency count: 1
Plan of Correction due date: Feb 8, 2023
Staff training completion date: Feb 15, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tillman Pink | Administrator | Named in findings related to refusal to accept resident back and abandonment |
| Angel Ascencio | Licensing Program Analyst | Conducted the complaint investigation |
| Kristin Heffernan | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 54
Capacity: 100
Deficiencies: 3
Jan 4, 2023
Visit Reason
The inspection was an unannounced required annual inspection to evaluate compliance with Title 22 Regulations and ensure health and safety standards at the facility.
Findings
The facility was generally found to be in good condition with clean and well-maintained resident rooms, kitchen, and common areas. However, deficiencies were noted related to water temperature exceeding safe limits in two resident bathrooms, unlocked laundry rooms with accessible cleaning supplies, and unclean flooring in the second-floor laundry room.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Hot water temperature in two resident bathrooms exceeded 120 degrees F, posing an immediate health and safety risk. | Type A |
| Laundry rooms on the first and second floors were unlocked with accessible cleaning supplies and laundry detergent, posing an immediate health and safety risk. | Type A |
| The flooring in the second-floor laundry room was unclean, posing a potential health and safety risk. | Type B |
Report Facts
Census: 54
Total Capacity: 100
Deficiencies cited: 3
Water temperature: 122
Water temperature: 120.3
Facility temperature: 72
Fire extinguisher last serviced: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted inspection and signed report |
| Sandra Urena | Licensing Program Analyst | Conducted inspection |
| Janyce Pink | Assistant Administrator | Met with inspectors during visit and discussed findings |
| Tillman Pink | Administrator | Facility Administrator involved in addressing deficiencies |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing inspection |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 100
Deficiencies: 1
Jan 4, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not report incidents to the department in a timely manner.
Findings
The investigation found sufficient evidence to substantiate the allegation that staff failed to submit Special Incident Reports (SIRs) timely or at all. Three incident reports from 2020 were drafted but not submitted, and only one of two recent COVID-19 positive cases was reported to the department. Citations were issued for these deficiencies.
Complaint Details
The complaint alleged that facility staff did not report incidents to the department in a timely manner. The allegation was substantiated based on interviews and record reviews showing unsubmitted incident reports and incomplete COVID-19 case reporting.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit written incident reports within seven days of occurrence as required by CCR 87211(a)(1)(D). | Type B |
Report Facts
Incident Reports not submitted: 3
COVID-19 positive cases: 2
Capacity: 100
Census: 54
Plan of Correction Due Date: Jan 13, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation and record review. |
| Ashley Smith | Licensing Program Analyst | Conducted the unannounced subsequent visit to deliver findings. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Rafael Silva | Administrator | Facility administrator named in the report. |
| Brian Balisi | Licensing Program Analyst | Initiated the complaint investigation on 09/30/2020. |
Inspection Report
Plan of Correction
Census: 49
Capacity: 100
Deficiencies: 3
Nov 15, 2022
Visit Reason
Unannounced Plan of Correction (POC) visit to follow up on the Plan of Correction citation issued during the complaint visit conducted on 2022-11-01.
Findings
The facility staff was unable to produce missing incident reports or proof of training as required by the Plan of Correction. Additional incident reports for three residents were not submitted to the Community Care Licensing (CCL) and Regional Center as required, and CCL was not notified of a resident hospitalization.
Complaint Details
Visit was a follow-up to a complaint visit conducted on 11/01/2022 under complaint #29-AS-20221028135145.
Deficiencies (3)
| Description |
|---|
| Failure to produce missing incident reports or proof of training as indicated on the Plan of Correction issued on 11/1/2022. |
| Additional incident reports for Resident #1, #2, and #3 were not submitted to CCL and Regional Center as required. |
| CCL was not notified as required of Resident #1's hospitalization on 8/23/2022. |
Report Facts
Capacity: 100
Census: 49
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the unannounced Plan of Correction visit. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 100
Deficiencies: 0
Nov 15, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 06/14/2022 regarding allegations of staff hitting residents, pulling residents' hair, failure to prevent resident abuse, and not ensuring resident needs are met.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Interviews with residents and staff did not reveal any witnessed abuse or neglect. All allegations were deemed unsubstantiated at the time of the report.
Complaint Details
The complaint involved allegations that staff hit a resident, pulled residents' hair, did not prevent another resident from physically abusing a resident, and did not ensure that resident needs were met. All allegations were investigated through interviews and document reviews and were found to be unsubstantiated due to lack of evidence.
Report Facts
Capacity: 100
Census: 49
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 100
Deficiencies: 1
Nov 1, 2022
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation that the facility did not report incidents to Community Care Licensing (CCL) or Regional Center.
Findings
The investigation found sufficient evidence that the licensee failed to submit required incident reports for Resident #1 to both CCL and Regional Center for multiple incidents occurring between 2/9/2022 and 9/26/2022. This failure to report poses a potential health and safety risk for residents in care.
Complaint Details
The complaint was substantiated. The licensee failed to report incidents involving Resident #1 to CCL and Regional Center as required. Incidents included ER visits, hospitalizations, treatment for scabies, COVID results, peanut allergy, falls, and arm injury.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit incident reports within seven days of occurrence for incidents threatening the welfare, safety, or health of any resident, as required by CCR 87211(a)(1)(D). | Type B |
Report Facts
Capacity: 100
Census: 48
Plan of Correction Due Date: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 48
Capacity: 100
Deficiencies: 0
Nov 1, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-06-02 regarding allegations of unsafe environment, unmet hygiene needs, and lack of dignity and respect towards residents.
Findings
The investigation found insufficient evidence to substantiate the allegations that the licensee failed to create a safe environment, failed to meet resident hygiene needs, or failed to treat residents with dignity and respect. No deficiencies were cited and the report was signed and delivered.
Complaint Details
The complaint involved allegations that the licensee failed to create a safe environment for residents, failed to meet resident hygiene needs, and failed to treat residents with dignity and respect. Interviews with residents and staff revealed mixed responses, with Resident #1 expressing dissatisfaction but no concrete evidence was found to substantiate the claims. The complaint was deemed unsubstantiated.
Report Facts
Capacity: 100
Census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 100
Deficiencies: 1
Sep 7, 2022
Visit Reason
The visit was an unannounced Case Management inspection conducted in response to an incident on 2022-09-03 where a staff member allegedly left the facility unattended during the night shift, leaving residents without supervision.
Findings
It was confirmed that the facility lacked staff presence and on-duty supervision from approximately 1:00 a.m. to 2:30 a.m., violating Title 22 Regulations. An immediate civil penalty was issued due to this staffing deficiency.
Complaint Details
The visit was triggered by a complaint regarding Staff #1 leaving the facility unattended during the night shift on 2022-09-03, leaving residents without supervision for approximately 90 minutes. The complaint was substantiated as a violation of staffing requirements.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Personnel requirements – Facility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident needs. The facility experienced an incident where no staff were present for approximately one hour, posing an immediate health and safety risk. | Type A |
Report Facts
Civil penalty amount: 500
Deficiency count: 1
Staff absence duration (minutes): 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janyce Pink | Assistant Administrator | Interviewed during the visit and involved in staffing issue |
| Elsie Campos | Licensing Program Analyst | Conducted the inspection visit |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervised the inspection and cited deficiencies |
| Tillman Pink Jr. | President/Owner | Contacted and arrived at the facility after staffing incident |
| Jill Nakata | Regional Manager | Conducted interview with medication staff during investigation |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 100
Deficiencies: 0
Jun 7, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2022-02-28 alleging that a facility staff member inappropriately handled a resident's financial information.
Findings
The investigation found insufficient evidence to support the allegation that facility staff inappropriately handled resident financial information. Interviews with staff and residents confirmed no inappropriate handling occurred. The allegation was deemed unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint alleged that the facility requested Resident #1's financial information such as their ID and demanded verification of bank PIN information. Interviews with staff and Resident #1 denied these claims. The allegation was unsubstantiated.
Report Facts
Capacity: 100
Census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report as Licensing Program Manager |
| Pink Tillman | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 100
Deficiencies: 1
Apr 12, 2022
Visit Reason
The inspection visit was conducted as an unannounced Case Management-Deficiencies inspection due to deficiencies observed during the investigation of complaint control #29-AS-20210930102747.
Findings
The Licensing Program Analyst observed holes in the walls and ceilings in hallways and residents' rooms with some wiring exposed, which posed potential health, safety, and personal rights risks for persons in care. The holes remained open for approximately three months without any plastic barriers to prevent debris from dropping.
Complaint Details
The visit was triggered by complaint control #29-AS-20210930102747. Deficiencies were substantiated based on observations during the inspection.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to maintain clean, safe, sanitary, and good repair conditions as evidenced by holes in walls and ceilings with exposed wiring in hallways and residents' rooms. | Type B |
Report Facts
Capacity: 100
Census: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the inspection and observed deficiencies |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor named in the report |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Apr 6, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff was unlawfully evicting a resident while in care.
Findings
The investigation found that Resident #1 was hospitalized and temporarily not allowed to return immediately due to concerns about the level of care needed. However, the resident returned to the facility on 2022-03-31, and there was insufficient evidence to support the claim of unlawful eviction. The allegation was deemed unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint alleged that staff unlawfully evicted a resident while in care. The resident was hospitalized on 2022-03-19 and returned on 2022-03-31 after a delay due to staff concerns about meeting care needs. The allegation was unsubstantiated.
Report Facts
Complaint Control Number: 29-AS-20220401110453
Facility Capacity: 100
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation |
| Ashley Smith | Licensing Program Analyst | Arrived unannounced for complaint visit |
| Janyce Pink | Assistant Administrator | Met with LPAs during the investigation and was notified of the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on report |
| Jessica Munoz | Authorized to sign the report |
Inspection Report
Annual Inspection
Census: 36
Capacity: 100
Deficiencies: 4
Apr 6, 2022
Visit Reason
The visit was an unannounced annual continuation inspection initiated on 2022-01-26 to evaluate compliance with licensing requirements.
Findings
The inspection found deficiencies in personnel records, resident records, and medication management, including missing medical assessments, outdated first aid certifications, missing resident appraisals, and a medication that could not be located during the audit.
Severity Breakdown
Type A: 1
Type B: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Four out of ten staff did not have a medical assessment with tuberculosis screening results. | Type B |
| Three out of ten care staff require an up-to-date first aid certification. | Type B |
| One out of nine residents has a medication being administered that could not be located at the time of the visit. | Type A |
| Four out of nine residents need an updated appraisal. | Type B |
Report Facts
Staff files reviewed: 10
Resident files reviewed: 9
Residents audited for medications: 5
Administrator Certificate expiration date: Jun 10, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janyce Pink | Administrator | Met with Licensing Program Analysts and notified of report findings. |
| Ashley Smith | Licensing Program Analyst | Conducted inspection and signed report. |
| Elsie Campos | Licensing Program Analyst | Conducted inspection. |
| Jessyca Munoz | Authorized to sign the report on behalf of the facility. |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 0
Mar 29, 2022
Visit Reason
An unannounced complaint investigation visit was conducted to investigate the allegation that the facility did not file incident reports in a timely manner.
Findings
The investigation found that incident reports for Resident 1 were filed and faxed appropriately, and recent incident reports were also properly documented. Therefore, the allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that the facility did not file incident reports for Resident 1 in a timely manner. After review of incident logs and documentation from November 2019 through recent months, the allegation was found unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 100
Census: 37
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and physical plant tours |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Qwutaria Rogers | Office Manager | Met with Licensing Program Analyst during investigation and stated authorization to sign and receive reports |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 0
Mar 24, 2022
Visit Reason
Unannounced complaint investigation visit conducted to investigate an allegation that the facility did not follow up with a resident's doctor appointment.
Findings
The investigation found that the resident appeared to have attended all scheduled medical appointments from November 2019 until relocation from the facility. Interviews with residents and review of appointment calendars indicated timely attendance and rescheduling of missed appointments. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged the facility did not follow up with Resident 1's doctor appointment. After review of records, interviews, and multiple visits, the allegation was found unsubstantiated.
Report Facts
Facility capacity: 100
Resident census: 37
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Tillman Pink | Administrator | Facility administrator met during investigation |
| Janyce Pink | Assistant Administrator | Facility assistant administrator met during investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Mar 18, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations including staff administering incorrect medication resulting in death, resident injuries due to falls, resident wandering away from the facility, unqualified staff administering medication, and the facility not meeting residents' needs.
Findings
The investigation found insufficient supporting information and documentation to substantiate any of the allegations. Records and interviews indicated no evidence of medication error causing death, no confirmed incidents of resident wandering, and no unqualified staff administering medication. All allegations were deemed unsubstantiated at this time.
Complaint Details
The complaint was received on 2020-02-18 and involved allegations of medication error resulting in death, resident falls causing injuries, resident wandering, unqualified staff administering medication, and unmet resident needs. The investigation included record reviews, interviews with staff and administrators, and attempts to obtain identifying information. All allegations were found unsubstantiated due to lack of evidence.
Report Facts
Capacity: 100
Census: 36
Complaint received date: Feb 18, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yelena Avetisyan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Eva Miller | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Rafael Silva | Assistant Administrator | Interviewed during investigation regarding allegations |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Mar 18, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff were mishandling residents and their personal funds at the facility.
Findings
Interviews revealed that the staff member named in the complaint had sporadic contact with residents, and residents denied any abuse or mishandling. The facility's accounting department manages residents' personal funds appropriately. The allegations were unsubstantiated based on the investigation and interviews.
Complaint Details
The complaint alleged staff mishandling residents and their personal funds. The investigation included interviews with staff, residents, and administrators. The allegations were found to be unsubstantiated.
Report Facts
Capacity: 100
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yelena Avetisyan | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Eva Miller | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Tillman Pink Jr | Administrator | Facility administrator named in the report |
| Rafael Silva | Assistant Administrator | Interviewed during the investigation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Mar 16, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-09-30 regarding allegations about medication administration, incident reporting, care and supervision, and emergency services access at the facility.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Residents were receiving medications as prescribed, staff properly reported incidents to appropriate agencies, provided adequate care and supervision, and did not prevent clients from contacting emergency services. No deficiencies were cited.
Complaint Details
The complaint included allegations that a resident was not receiving medications as prescribed, staff did not properly report incidents, staff did not provide adequate care and supervision, and staff were preventing a client from contacting emergency services. All allegations were investigated and deemed unsubstantiated.
Report Facts
Capacity: 100
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Janyce Pink | Administrator | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 100
Deficiencies: 1
Mar 3, 2022
Visit Reason
The visit was conducted to investigate complaints alleging that a former staff member sexually abused a resident and that facility staff did not notify appropriate parties of the resident's incident.
Findings
The allegation of sexual abuse by a former staff member was found to be unsubstantiated based on interviews and evidence reviewed. However, the allegation that facility staff failed to notify appropriate parties of the resident's incident was substantiated, resulting in a citation for failure to comply with mandated reporting requirements.
Complaint Details
The complaint investigation was triggered by an allegation that former staff member S1 sexually abused resident #1 (R1) by performing oral sex. The allegation was unsubstantiated after interviews with involved parties and review of police reports. Another complaint alleged that facility staff did not notify appropriate parties of the resident's incident, which was substantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87211(c) Reporting Requirements. Any suspected physical abuse that does not result in serious bodily injury shall be reported to the local ombudsman, the licensing agency, and the local law enforcement agency within twenty-four (24) hours. Facility staff did not fulfill reporting requirements including Mandated Reporter requirements by reporting suspected abuse, posing an immediate health and safety risk to residents. | Type A |
Report Facts
Capacity: 100
Census: 37
Deficiencies cited: 1
Plan of Correction Due Date: Mar 4, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Janice Pink | Facility representative met with during investigation | |
| Elizabeth Flores | Assistant Administrator | Toured facility with investigator during initial complaint visit |
| Pink Tillman | Administrator | Facility administrator named in report header |
| Philippe Ryan Miles | Investigator | Conducted interviews and investigation related to complaint |
Inspection Report
Annual Inspection
Census: 36
Capacity: 100
Deficiencies: 5
Jan 26, 2022
Visit Reason
The visit was a required annual unannounced inspection with a specific emphasis on infection control practices and procedures.
Findings
The facility was found to have deficiencies including insufficient 30-day supply of PPE, failure to report multiple COVID-19 positive cases within 24 hours, non-association of certain staff members, and issues with hot water temperature due to a broken water heater. Additionally, the facility restricted visitation contrary to updated guidance.
Severity Breakdown
Type A: 1
Type A (Dismissed): 1
Type B: 3
Deficiencies (5)
| Description | Severity |
|---|---|
| Facility does not currently have a sufficient 30-Day supply of PPE gear, posing a potential personal rights risk. | Type B |
| Facility failed to report between five (5) to six (6) COVID cases within 24 hours to the licensing agency, posing a potential health and safety risk. | Type B |
| Staff #3 and Staff #4 have not been associated to the facility, posing an immediate health and safety risk to residents. | Type A |
| Facility failed to ensure hot water temperature measured within 105 to 120 degrees Fahrenheit due to water heater needing repairs, posing an immediate health, safety or personal rights risk. | Type A (Dismissed) |
| Facility failed to ensure residents were allowed visitors with restrictions in accordance with updated visitation guidance, posing a potential health and safety risk. | Type B |
Report Facts
COVID-19 Positive cases unreported: 5
COVID-19 Positive cases unreported: 6
Facility capacity: 100
Resident census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tillman Pink | Executive Director | Named in relation to infection control findings and refusal to sign report. |
| Janyce Pink | Assistant Administrator | Named in relation to infection control findings and visitation restrictions. |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 1
Dec 21, 2021
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation of illegal eviction received on 2021-12-17.
Findings
The investigation substantiated that Resident #1 was served an eviction notice that did not comply with legal requirements, including insufficient notice time and missing required language, posing an immediate health and safety risk.
Complaint Details
The complaint alleged illegal eviction. The investigation found that Resident #1 was served an eviction notice on 12/16/2021 dated 12/2/2021 with an effective date of 1/2/2022, which did not provide the required full 30 days' notice nor include required language per Health and Safety Code Section 1569.683(a)(4). The allegation was substantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87224(a) Eviction Procedures. The licensee did not provide a valid 30-day written eviction notice as required, and the issued eviction notice was invalid, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 100
Census: 34
Plan of Correction Due Date: Dec 22, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation |
| Pink Tillman | Administrator | Facility administrator who agreed to plan of correction |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 0
Dec 21, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 12/08/2021 regarding allegations about resident admission agreement signing and staff providing a comfortable environment.
Findings
The investigation found that Resident 1 had signed and initialed all required areas of the admissions agreement, and staff were acting professionally and respectfully when issuing invoices. Both allegations were deemed unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint alleged that the facility did not ensure a resident signed an Admission Agreement and that staff were not providing a comfortable environment for the resident. Both allegations were investigated and found unsubstantiated.
Report Facts
Capacity: 100
Census: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation |
| Ashley Smith | Licensing Program Analyst | Arrived unannounced for the complaint visit |
| Elizabeth Flores | Office Manager | Met with LPAs during the investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report signature and oversight |
| Pink Tillman | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 2
Dec 21, 2021
Visit Reason
An unannounced Case Management-Deficiencies inspection visit was conducted due to deficiencies observed during the investigation of complaint control #29-AS-20211217161220.
Findings
The inspection found that Staff #1 (S1) and Staff #2 (S2) were working at the facility without being properly associated as required by the Caregiver Background Check System, posing an immediate health and safety risk. Additionally, the posted Administrator Certificate for Pink Tillman was expired, and S2 was not officially designated as an Administrator.
Complaint Details
The visit was triggered by deficiencies observed during the investigation of complaint control #29-AS-20211217161220. The complaint was substantiated by findings of staff working without proper association and expired administrator certification.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to request a transfer of a criminal record clearance for S1 and S2 prior to working at the facility, posing an immediate health and safety risk to residents. | Type A |
| The current Administrator Certificate for the Administrator on file is expired, posing a potential health and safety risk to residents. | Type B |
Report Facts
Capacity: 100
Census: 34
Civil penalties: Civil penalties were assessed but exact amounts are not stated
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pink Tillman | Administrator | Administrator certificate was expired |
| Janyce Pink | Assistant Administrator | Not associated to the facility and no paperwork designating as Administrator |
| Elizabeth Flores | Met with during the inspection | |
| Ashley Smith | Licensing Program Analyst | Conducted the inspection |
| Elsie Campos | Licensing Program Analyst | Conducted the inspection |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor of the inspection |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 1
Dec 16, 2021
Visit Reason
The inspection visit was conducted due to deficiencies observed during the investigation of complaint control #29-AS-20211208140455.
Findings
The licensee did not comply with criminal record clearance requirements as two staff members (S1 and S2) were not associated with the facility despite having background check clearance, posing an immediate health and safety risk to residents.
Complaint Details
The visit was complaint-related based on complaint control #29-AS-20211208140455. Civil penalties were assessed. The deficiency was substantiated as the staff were not properly associated with the facility.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to request a transfer of a criminal record clearance for Staff #1 and Staff #2 as required by Health and Safety Code Section 1569.17(b), posing an immediate health and safety risk to residents. | Type A |
Report Facts
Capacity: 100
Census: 34
Plan of Correction Due Date: Dec 17, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pink Tillman | Administrator | Facility administrator present during inspection |
| Elsie Campos | Licensing Program Analyst | Conducted the inspection and signed the report |
| Teresa Camara | Licensing Program Analyst | Conducted the inspection |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 0
Dec 4, 2021
Visit Reason
This was an unannounced complaint investigation visit conducted to investigate multiple allegations received on 02/19/2020 regarding resident care and facility practices.
Findings
All allegations including resident having scabies, inadequate food service, untimely diaper changes, rough handling by staff, and failure to report changes in resident condition were investigated and deemed unsubstantiated based on interviews, observations, and prior investigations.
Complaint Details
The complaint included allegations of a resident having scabies, inadequate food service, residents' diapers not changed timely, rough handling by staff, and failure to report changes in resident condition to responsible parties. All allegations were found unsubstantiated.
Report Facts
Capacity: 100
Census: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cassandra Harris | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 0
Dec 3, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2020-02-25 regarding multiple allegations including inadequate food service, insufficient staffing, lack of staff training, failure to assist residents timely, and staff threatening residents.
Findings
All allegations investigated were deemed unsubstantiated based on interviews with residents and staff, review of staff training records, observation of food supply, and staff schedules. No deficiencies or violations were found during the investigation.
Complaint Details
The complaint included allegations that facility staff failed to provide adequate food service, were not trained to meet residents' needs, had insufficient staffing, failed to assist residents timely, and threatened a resident. All allegations were investigated and found unsubstantiated.
Report Facts
Capacity: 100
Census: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation |
| Jose Gary Tan | Licensing Program Analyst | Conducted the complaint investigation |
| Cassandra Harris | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 33
Capacity: 100
Deficiencies: 1
Nov 9, 2021
Visit Reason
The visit was a Case Management visit to issue a civil penalty related to a medication error incident that led to the hospitalization and death of a resident.
Findings
The investigation revealed that untrained staff allowed a resident to ingest another resident's medications, resulting in adverse effects and the resident's death. The facility failed to ensure staff completed required medication training and failed to immediately notify emergency services, leading to citations and a civil penalty.
Complaint Details
The visit was complaint-related due to incident reports about a medication error involving an 83-year-old male resident who was hospitalized and later died. The medication technician admitted to the error. The complaint was substantiated with citations issued for personnel training deficiencies and failure to notify emergency services.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to complete all required medication training prior to assisting residents with self-administration of medication, posing an immediate health and safety risk. | Type A |
Report Facts
Civil penalty amount: 15000
Number of medications prescribed to Resident 2: 12
Medication training hours required: 24
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tillman Pink | Executive Director | Met during the visit and acknowledged appeal rights. |
| Ashley Smith | Licensing Program Analyst | Conducted the investigation and authored the report. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the licensing evaluation. |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 0
Oct 19, 2021
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 06/15/2020 regarding staff hitting a resident and residents not being afforded privacy while in care.
Findings
The investigation found insufficient evidence to substantiate the allegations that staff hit a resident or that residents were not afforded privacy. Interviews with staff, residents, and regional center representatives, as well as documentation review, supported these conclusions. No citations were issued.
Complaint Details
The complaint involved allegations that staff hit a resident on 04/28/2020 and that residents were not afforded privacy due to staff entering rooms without notification and recording residents. Both allegations were deemed unsubstantiated based on interviews and documentation.
Report Facts
Capacity: 100
Census: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martha Guzman-Chavez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Elizabeth Torres | Assistant Administrator | Met with Licensing Program Analyst during the visit and provided information |
| Tillman Pink Jr | Administrator | Facility Administrator mentioned in the report and interviewed |
Inspection Report
Complaint Investigation
Census: 34
Capacity: 100
Deficiencies: 1
Oct 19, 2021
Visit Reason
The visit was an unannounced complaint investigation initiated due to an allegation that facility staff failed to provide a resident's records to the resident's authorized representative.
Findings
The investigation substantiated that the facility staff did not provide the requested resident records to the authorized representative within the regulatory timeframe, despite the representative submitting all necessary documentation. This failure was found to be a violation of Title 22, California Code of Regulations.
Complaint Details
The complaint alleged that on 03/20/2020, facility staff failed to provide resident's records to the resident's authorized representative. The allegation was substantiated based on interviews and documentation review.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide residents prompt access to review all of their records and photocopied records within two business days at a cost not exceeding the community standard. | Type B |
Report Facts
Capacity: 100
Census: 34
Deficiency citation due date: Oct 29, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martha Guzman-Chavez | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Desaree Perera | Licensing Program Manager | Oversaw the complaint investigation and signed the report |
| Elizabeth Torres | Assistant Administrator | Met with the Licensing Program Analyst during the inspection |
| Tillman Pink Jr | Administrator | Facility Administrator mentioned in the investigation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Sep 15, 2021
Visit Reason
Unannounced complaint investigation visit conducted to gather more information related to allegations that staff denied residents phone calls and did not provide a resident with his mail.
Findings
After interviews with residents and observation of mail being placed in mailboxes, both allegations were found to be unsubstantiated. No deficiencies were cited.
Complaint Details
The complaint investigation was unsubstantiated regarding allegations that staff denied residents phone calls and did not provide resident mail.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the unannounced complaint investigation visit. |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Jul 1, 2021
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation of illegal eviction at the facility.
Findings
The investigation found no evidence that the facility illegally evicted the resident; the allegation was determined to be unsubstantiated.
Complaint Details
The allegation of illegal eviction was investigated and found to be unsubstantiated based on staff interviews and document review.
Report Facts
Capacity: 100
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation |
| Pink Tillman | Administrator | Facility administrator met during the investigation |
| Elizabeth Flores | Assistant Administrator | Interviewed during the investigation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 100
Deficiencies: 0
Jul 1, 2021
Visit Reason
Unannounced complaint investigation conducted due to an allegation of illegal eviction received on 03/19/2021.
Findings
The investigation found no evidence that the facility illegally evicted the resident. Interviews and records showed the resident was never given eviction notice and is currently at a skilled nursing facility due to an incident involving police. The allegation was unsubstantiated.
Complaint Details
Allegation of illegal eviction was investigated and found unsubstantiated based on interviews with resident and facility staff and review of documentation.
Report Facts
Capacity: 100
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted complaint investigation and interviews |
| Pink Tillman | Assistant Administrator | Met with Licensing Program Analyst during investigation |
| Desaree Perera | Licensing Program Manager | Oversaw complaint investigation |
| Flores | Assistant Administrator | Interviewed regarding eviction allegation |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 100
Deficiencies: 0
May 22, 2021
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 2019-04-18 regarding unsafe environment causing resident falls, poor room maintenance, and unmet hygiene needs of a resident.
Findings
The investigation found all allegations unsubstantiated. Resident falls were linked to resident's own actions, room repairs were completed with residents relocated during repairs, and hygiene refusals were documented with staff efforts to motivate the resident.
Complaint Details
The complaint involved allegations that staff failed to provide a safe environment resulting in resident falls, failed to keep resident's room in good repair, and did not meet the hygiene needs of a resident. All allegations were found unsubstantiated based on interviews and documentation reviewed.
Report Facts
Facility capacity: 100
Resident census: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yelena Avetisyan | Licensing Program Analyst | Conducted the complaint investigation |
| Jessyca Munoz | Med-Tech | Met with Licensing Program Analyst during investigation |
| Priscilla Pinedo | Office Manager | Spoke with Licensing Program Analyst and designated med-tech to sign report |
| Alin Astrvazadrian | Administrator | Interviewed regarding room repairs and resident relocation |
| Cassandra Harris | Licensing Program Manager | Named as Licensing Program Manager on report |
| Mr. Silva | Provided information about maintenance procedures |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 100
Deficiencies: 0
Feb 17, 2021
Visit Reason
The inspection was conducted as a complaint investigation following a complaint received on 01/24/2020 alleging that staff did not properly dispose of expired medication.
Findings
The investigation found that the allegation was unsubstantiated. Interviews and record reviews showed that the resident takes medication regularly and there was no need to destroy medication. No deficiencies were cited.
Complaint Details
The complaint was unsubstantiated based on interviews with staff and the resident, and review of medication logs and destruction records. No deficiencies were cited.
Report Facts
Capacity: 100
Census: 45
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martina Berry | Licensing Program Analyst | Conducted the complaint investigation |
| Elizabeth Flores | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 100
Deficiencies: 0
Feb 5, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2020-01-24 regarding allegations that staff denied residents phone calls and did not provide a resident with his mail.
Findings
The investigation found insufficient evidence to substantiate the allegations that resident #1 was denied phone calls or was not provided with his mail. The allegations were deemed unsubstantiated based on interviews and information gathered.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff denying residents phone calls and not providing resident #1 with his mail. Interviews and attempts to interview the resident did not provide enough information to confirm the allegations.
Report Facts
Capacity: 100
Census: 43
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation |
| Elizabeth Flores | Assistant Administrator | Met with the investigator during the complaint investigation |
| Tillman Pink Jr | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 100
Deficiencies: 2
Feb 4, 2021
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation that a resident contracted a communicable disease while in care.
Findings
The investigation substantiated the allegation that Resident #1 contracted a communicable disease while in the facility, posing an immediate health and safety risk. The facility failed to ensure proper care and supervision, resulting in the resident's illness. A deficiency and civil penalty were assessed.
Complaint Details
The complaint was substantiated. Resident #1 was diagnosed with a communicable disease on 02/11/2020, which was determined by medical experts to have been acquired during the resident's stay at the facility. The investigation included interviews with residents, staff, family members, medical professionals, and review of medical and police records.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to ensure that health and safety of Resident #1 was protected, resulting in contracting a communicable disease while in care. | Type A |
| Facility failed to provide care and supervision as defined in regulations, resulting in Resident #1 contracting a communicable disease. | Type A |
Report Facts
Capacity: 100
Census: 40
Plan of Correction Due Date: Feb 8, 2021
Plan of Correction Due Date: Feb 6, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Gary Tan | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Tillman Pink III | Administrator | Facility administrator met during the investigation and named in findings |
| Denis Seng | Investigator | Conducted interviews and reviewed records during the investigation |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 100
Deficiencies: 0
Feb 4, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the facility was not providing services agreed to in the admissions agreement.
Findings
The investigation found that the allegation was unsubstantiated. The facility's policy on transportation, including a $25 charge for an attendant accompanying a resident to medical appointments, was included in the admission agreement and signed by the resident's responsible person.
Complaint Details
The complaint alleged that the facility charged resident #1 to accompany them to medical appointments without agreement in the admission contract. The allegation was found unsubstantiated after review of records, interviews, and the admission agreement.
Report Facts
Capacity: 100
Census: 43
Charge amount: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation |
| Elizabeth Flores | Assistant Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 100
Deficiencies: 0
Feb 4, 2021
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to a complaint received on 2020-02-19 regarding the facility's alleged failure to follow the admission agreement concerning the use of third-party services.
Findings
The investigation found that emergency services made the decision regarding the hospital to which resident #1 was taken, not the facility. Based on interviews and information gathered, the allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that the facility did not follow the admission agreement regarding the use of third-party services, specifically that resident #1 was taken to Sherman Oaks hospital instead of Kaiser hospital despite being covered by Kaiser. The allegation was found unsubstantiated.
Report Facts
Capacity: 100
Census: 43
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation |
| Tillman Pink Jr | Administrator | Facility administrator named in the report |
| Elizabeth Flores | Assistant Administrator | Met with the investigator during the complaint investigation |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 100
Deficiencies: 1
Feb 4, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident sustained pressure injuries while in care, the facility had scabies, and there was insufficient staffing to meet residents' needs.
Findings
The allegation that a resident sustained pressure injuries was substantiated, with a deficiency and civil penalty assessed for failure to provide proper care and supervision. The allegations regarding scabies outbreaks and insufficient staffing were deemed unsubstantiated based on investigation findings and interviews.
Complaint Details
The complaint was received on 2020-02-18 and investigated due to allegations that Resident #1 sustained pressure injuries while in care, the facility had scabies, and insufficient staffing to meet residents' needs. The pressure injury allegation was substantiated, while the scabies and staffing allegations were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure that Resident #1 was properly provided care and supervision resulting in pressure injuries, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 100
Census: 40
Plan of Correction Due Date: Feb 8, 2021
Care Staff Count Morning Shift: 4
Care Staff Count Afternoon Shift: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tillman Pink III | Administrator | Met with during inspection and named in findings |
| Jose Gary Tan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Dennis Seng | Investigator | Conducted interviews with facility staff during investigation |
| Nichelle Gillyard | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 100
Deficiencies: 0
Jan 31, 2021
Visit Reason
This was an unannounced complaint investigation visit triggered by a complaint received on 01/24/2020 regarding staff notification of resident's authorized representative and prevention of inappropriate behaviors.
Findings
The investigation found that staff did notify the resident's authorized representative about the hospital transport, and the allegation was deemed unsubstantiated. The allegation that staff did not prevent inappropriate behaviors was also unsubstantiated as the behaviors did not violate personal rights and occurred in the resident's personal room.
Complaint Details
The complaint involved two allegations: 1) Staff did not notify resident’s authorized representative of resident being transported to the hospital, and 2) Staff did not prevent inappropriate behaviors. Both allegations were investigated and found to be unsubstantiated.
Report Facts
Capacity: 100
Census: 45
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation |
| Cassandra Harris | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 100
Deficiencies: 0
Jan 30, 2021
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to an allegation of illegal eviction of resident #1 at the facility.
Findings
The investigation found insufficient evidence to substantiate the allegation of illegal eviction. The eviction was reviewed and deemed lawful by the Woodland Hills Regional Office, and it was concluded that there is not enough information to state that resident #1 was illegally evicted.
Complaint Details
The complaint alleged illegal eviction of resident #1. The investigation included interviews with the administrator, staff, and resident's conservator, and review of eviction documentation. The allegation was deemed unsubstantiated.
Report Facts
Complaint Control Number: 31-AS-20200123160902
Facility Capacity: 100
Census: 45
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wendell Smith | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Cassandra Harris | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
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