Inspection Report Summary
Most inspections found no deficiencies, with the facility generally clean, safe, and compliant with regulations. However, some complaint investigations substantiated issues related to resident rights, including unlawful eviction procedures and staff opening a resident’s mail without permission, as well as a serious case in April 2022 where a resident sustained pressure injuries due to neglect and improper level of care, leading to a pending $10,000 civil penalty. Other deficiencies involved documentation lapses, incomplete health screenings, and maintenance concerns, but these were minor or isolated. Several complaint investigations were unsubstantiated, including allegations of staff neglect, medication errors, and inappropriate resident interactions. The most recent report from August 27, 2025, was a complaint investigation with no deficiencies found, indicating some improvement in compliance.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 48
Capacity: 120
Deficiencies: 0
Aug 27, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate the allegation that staff spoke to residents inappropriately.
Findings
The investigation included interviews with residents and staff, review of relevant documents, and facility observation. There was insufficient evidence to substantiate the allegation, and the complaint was determined to be unsubstantiated.
Complaint Details
The allegation was that staff spoke to residents inappropriately. Interviews with 6 residents and 6 staff members revealed denials of the allegation. An Unusual Incident Report showed no documented evidence of inappropriate staff communication. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Residents interviewed: 6
Staff interviewed: 6
Staff denying allegation: 5
Facility capacity: 120
Census: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Troy Watson | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Lorenzona Medina | Administrator | Facility administrator met with Licensing Program Analyst and participated in exit interview |
| Stephanie Cifuentes | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 120
Deficiencies: 0
Aug 26, 2025
Visit Reason
An office meeting was held to discuss Complaint 11-AS-20210226154939 regarding an allegation of neglect and lack of care and supervision involving a resident with a prohibited health condition requiring a higher level of care due to pressure injuries.
Findings
The Department substantiated the allegation of neglect and lack of care and supervision on April 8, 2022, and is reviewing the complaint for an enhanced civil penalty related to serious bodily injury. A civil penalty totaling $10,000 is pending.
Complaint Details
The complaint involved neglect and lack of care and supervision, specifically retaining a resident with a prohibited health condition needing a higher level of care due to pressure injuries. The Department substantiated the allegation on April 8, 2022, and is pursuing an enhanced civil penalty for serious bodily injury.
Report Facts
Civil penalty amount: 10000
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janae Hammond | Licensing Program Manager | Reviewed details of the complaint during the office meeting |
| Lizeth Villegas | Licensing Program Analyst | Present at the office meeting discussing the complaint |
| Rodrigo Ramos | Licensee | Present at the office meeting discussing the complaint |
| Elvie Medina Lorenzona | Administrator | Present at the office meeting discussing the complaint |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Aug 7, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2025-06-24 alleging that staff did not prevent a resident from engaging in inappropriate interactions with another resident.
Findings
The investigation found insufficient evidence to substantiate the allegation. Staff and most residents denied witnessing inappropriate interactions, and records reviewed did not support the complaint. The allegation was determined to be unsubstantiated and no citations were issued.
Complaint Details
The complaint alleged that a resident exposed themselves to another resident. Interviews with staff and residents, as well as review of medical and appraisal records, found no evidence to support the allegation. The resident involved was noted to have a mental condition causing paranoid delusions. The allegation was unsubstantiated.
Report Facts
Capacity: 120
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Perry Scott | Licensing Program Analyst | Conducted the complaint investigation |
| Janae Hammond | Licensing Program Manager | Oversaw the complaint investigation |
| Rodrigo Ramos | Licensee | Met with during inspection and participated in exit interview |
| Lorenzona Elvie Medina | Administrator | Facility administrator present during initial complaint visit |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Jul 3, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate an allegation that staff did not prevent a resident from engaging in inappropriate interactions with another resident in care.
Findings
The investigation found insufficient evidence to substantiate the allegation. Staff and most residents denied witnessing inappropriate sexual interactions, and the resident who made the allegation has a documented history of mental health issues including paranoid delusions. No citations were issued.
Complaint Details
The complaint alleged that a resident exposed themselves to another resident. Interviews with staff and residents, and review of medical and appraisal records for the resident who made the allegation, indicated the resident has schizoaffective behavior and psychosis. The allegation was determined to be unsubstantiated due to lack of evidence.
Report Facts
Capacity: 120
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elvie Lorenzona Medina | Administrator | Met with during investigation and exit interview |
| Rodrigo Ramos | Licensee | Joined during investigation visit |
| Perry Scott | Licensing Program Analyst | Conducted the complaint investigation |
| Janae Hammond | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 46
Capacity: 120
Deficiencies: 2
May 28, 2025
Visit Reason
An unannounced annual required visit was conducted using the CARE Inspection Tool to evaluate compliance with licensing requirements for Hacienda Grande Senior Assisted Living Facility.
Findings
The facility was found generally compliant with licensing requirements, including clean and operational kitchen, proper medication storage, and functional safety equipment. However, two Type B deficiencies were cited: incomplete health screenings for staff #2-4 and a missing smoke detector in bedroom #206.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff #2-4 do not have a completed and physician signed health screening. | Type B |
| Bedroom #206 was found without a smoke detector. | Type B |
Report Facts
Annual fee: 1982
Personnel records reviewed: 5
Resident records reviewed: 5
Medication reviews: 5
Resident bedrooms: 60
Resident bathrooms: 60
Common bathrooms: 6
Hospice waiver capacity: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rodrigo Ramos | Licensee | Met during inspection and discussed visit purpose |
| Shalani Ramos | Acting Administrator | Met during inspection and discussed visit purpose; provided pin and fee information |
| Janae Hammond | Licensing Program Manager | Named as Licensing Program Manager on report |
| Lizeth Villegas | Licensing Program Analyst | Conducted inspection and signed report |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 120
Deficiencies: 0
Jan 9, 2025
Visit Reason
The visit was an unannounced complaint investigation regarding allegations of staff neglect resulting in a resident being hospitalized and a resident not receiving medication as prescribed.
Findings
The investigation found that although there were allegations of medication mishandling and staff neglect leading to hospitalization, the evidence was insufficient to substantiate the claims. Resident medical records and interviews indicated the resident was admitted with kidney failure and that medication noncompliance was partly due to the resident's own actions. The allegations were ultimately unsubstantiated.
Complaint Details
The complaint involved allegations that staff neglect resulted in a resident being hospitalized due to missed high blood pressure medication, and that the resident was without medication for a few days. The investigation included interviews with staff, residents, and review of medical records and incident reports. The allegations were found unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 120
Census: 50
Medication missed days: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lorenzona Medina | Administrator | Met with during investigation and interviewed regarding allegations |
| Lizeth Villegas | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 120
Deficiencies: 4
Oct 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-10-14 regarding unlawful eviction, facility staff opening resident's mail without permission, and failure to provide a safe environment for residents.
Findings
The investigation substantiated two allegations: unlawful eviction due to improper eviction notice procedures and facility staff opening a resident's mail without permission. The allegation that the facility did not provide a safe environment was unsubstantiated based on interviews and evidence.
Complaint Details
The complaint included allegations of unlawful eviction, facility staff opening resident's mail without permission, and failure to provide a safe environment. The first two allegations were substantiated, citing violations of Title 22 regulations and personal rights. The third allegation was unsubstantiated due to insufficient evidence.
Severity Breakdown
Type B: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Eviction notice failed to include required information such as resources, referral services, complaint filing rights, and timely submission to Community Care Licensing. | Type B |
| Failure to serve resident with eviction notice in accordance with Title 22 regulations, posing a potential personal rights risk. | Type B |
| Inappropriate statements in eviction notice threatening resident removal from state funded program, violating personal rights. | Type B |
| Facility staff opened resident's mail without prior consent, violating personal rights. | Type B |
Report Facts
Capacity: 120
Census: 49
Plan of Correction Due Date: Oct 30, 2024
Fine Amount: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Perry Scott | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Janae Hammond | Licensing Program Manager | Oversaw the complaint investigation |
| Lorenzona Elvie Medina | Administrator | Facility administrator involved in investigation and cited in findings |
| Rodrigo Ramos | Licensee | Facility licensee involved in investigation and exit interview |
Inspection Report
Annual Inspection
Census: 46
Capacity: 120
Deficiencies: 3
Jun 20, 2024
Visit Reason
An unannounced annual required visit was conducted using the CARE Inspection Tool to evaluate compliance with licensing requirements.
Findings
The facility was generally clean, safe, and operational with proper maintenance of kitchen, resident rooms, and safety equipment. However, deficiencies were cited related to maintenance of the downstairs library wall, incomplete personnel records, and missing physician's signature on health screening forms.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Downstairs library wall is in disrepair and dirty, posing a potential health, safety, or personal rights risk to persons in care. | Type B |
| Personnel records lacked LIC 500 form and documentation detailing staff titles, work days, and hours, posing a potential health, safety, or personal rights risk. | Type B |
| LIC 503 health screening form was observed without physician's signature, posing a potential health, safety, or personal rights risk. | Type B |
Report Facts
Annual fee: 1982
Licensed capacity: 120
Current census: 46
Hospice waiver capacity: 10
Plan of Correction due date: Jun 27, 2024
Plan of Correction due date: Jul 4, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rodrigo Ramos | Licensee | Met with during inspection and provided information about annual fee |
| Shalani Ramos | Acting Administrator | Joined inspection visit |
| Lizeth Villegas | Licensing Program Analyst | Conducted inspection and authored report |
| Janae Hammond | Licensing Program Manager | Supervisor overseeing inspection |
Inspection Report
Census: 44
Capacity: 120
Deficiencies: 1
May 6, 2024
Visit Reason
The visit was a case management inspection conducted to issue a deficiency related to reporting requirements after the facility failed to submit unusual incident reports within the required 7-day timeframe.
Findings
The facility did not submit two unusual incident reports dated 04/17/24 and 04/19/24 to the licensing agency within 7 days as required by California code regulations, posing a potential health and safety risk to residents.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit unusual incident reports dated 4/17/24 and 4/19/24 to licensing within 7 days of occurrence as required by Title 22. | Type B |
Report Facts
Days late for incident report submission: 13
Days late for incident report submission: 11
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shalani Ramos | Administrator | Met with Licensing Program Analyst during the inspection and received a copy of the report |
| Lizeth Villegas | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Janae Hammond | Licensing Program Manager | Supervisor and Licensing Program Manager named in the report |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 2
May 6, 2024
Visit Reason
The visit was a case management inspection conducted to issue deficiencies observed during a complaint investigation (11-AS-20230811161937). The Licensing Program Analyst met with the Administrator to explain the purpose of the visit.
Findings
The investigation found that resident #1 had a change in condition that was not documented in the resident's record. Additionally, communication with the resident's physician regarding medication refusal was not documented, posing a health and safety risk.
Complaint Details
The visit was triggered by complaint investigation 11-AS-20230811161937. Deficiencies were substantiated related to failure to document changes in resident condition and failure to document communication with the physician regarding medication refusal.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to document changes in resident #1's physical and mental condition and failure to notify the resident's physician and responsible person. | Type B |
| Failure to document contact with resident #1's physician when resident refused medication and failure to document physician's directives. | Type B |
Report Facts
Deficiencies cited: 2
Plan of Correction Due Date: May 13, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shalani Ramos | Administrator | Met with Licensing Program Analyst during inspection and named in findings |
| Lizeth Villegas | Licensing Program Analyst | Conducted the case management visit and complaint investigation |
| Janae Hammond | Licensing Program Manager / Supervisor | Named as supervisor and licensing program manager |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 120
Deficiencies: 0
Mar 6, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that facility staff were opening residents' mail without consent and asking residents for money outside of monthly rent fees.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews with the administrator, licensee, staff, and residents denied the allegations, and residents reported no issues with mail or financial handling. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included facility staff opening residents' mail without consent and asking residents for money outside of monthly rent fees. Interviews and document reviews did not support these claims.
Report Facts
Facility capacity: 120
Resident census: 46
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lorenzona Elvie Medina | Administrator | Interviewed regarding allegations and investigation findings |
| Rodrigo Ramos | Licensee | Interviewed and participated in exit interview |
| Lizeth Villegas | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Sep 7, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that a resident developed a pressure injury due to staff neglect.
Findings
The investigation found no evidence to substantiate the allegation. Interviews and record reviews did not confirm the presence of the named resident or staff involved, and no supporting evidence was found during the facility tour and document review.
Complaint Details
The complaint alleged that due to staff neglect, a resident developed a pressure injury while in care. The allegation was unsubstantiated due to lack of evidence and inability to verify the resident or staff involved.
Report Facts
Capacity: 120
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lorenzona Elvie Medina | Administrator | Met with during investigation and exit interview |
| Rodrigo Ramos | Administrator/Licensee | Interviewed regarding complaint details |
| Janae Hammond | Licensing Program Manager | Conducted complaint investigation |
| Lizeth Villegas | Licensing Program Analyst | Conducted complaint investigation |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Sep 7, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2023-08-11 regarding medication administration, notification of medical condition changes, and proper addressing of resident condition changes.
Findings
The investigation found the allegations unsubstantiated after interviews with staff, residents, and review of records showed no evidence that staff failed to ensure medication intake, notify responsible parties of medical condition changes, or properly address resident condition changes.
Complaint Details
The complaint alleged that staff did not ensure a resident was taking prescribed medications, failed to notify the resident's responsible party of a change in medical condition, and failed to properly address the resident's change in condition. The investigation concluded these allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 120
Census: 47
Medication review: 8
Staff interviewed: 3
Residents interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizeth Villegas | Licensing Program Analyst | Conducted the complaint investigation |
| Lorenzona Medina | Administrator | Facility administrator interviewed during investigation |
| Shalani Ramos | Administrator | Administrator met during subsequent complaint visit |
| Janae Hammond | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 46
Capacity: 120
Deficiencies: 0
Jul 27, 2023
Visit Reason
The inspection was an unannounced annual inspection visit conducted to evaluate compliance with regulatory requirements at Hacienda Grande Senior Assisted Living Facility.
Findings
The facility was found to be clean, in good repair, and compliant with all applicable regulations. No deficiencies or citations were issued during this inspection.
Report Facts
Resident service records reviewed: 6
Resident medication records reviewed: 6
Residents interviewed: 6
Staff interviewed: 6
Resident bedrooms: 60
Resident bathrooms: 60
Common bathrooms: 6
Fire extinguishers: 20
Carbon monoxide detectors: 60
Smoke detectors: 60
Staff files reviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Calderon | Licensing Program Analyst | Conducted the inspection and authored the report |
| Rodrigo Ramos | Owner | Facility owner who allowed entry and participated in the inspection |
| Elvie Medina Lorenzona | Administrator | Facility administrator with valid certification noted during inspection |
| Eva M Alvarez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 48
Capacity: 120
Deficiencies: 0
Aug 9, 2022
Visit Reason
The inspection was an unannounced 1-year annual inspection visit conducted to evaluate compliance with licensing regulations at Hacienda Grande Senior Assisted Living Facility.
Findings
The Licensing Program Analyst found the facility to be clean, in good repair, and compliant with all applicable regulations. No deficiencies or citations were observed during the inspection.
Report Facts
Resident service records reviewed: 3
Resident medication records reviewed: 3
Resident bedrooms: 60
Resident bathrooms: 60
Common bathrooms: 6
Carbon Monoxide detectors: 60
Smoke detectors: 60
Fire extinguishers: 20
Staff files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Calderon | Licensing Program Analyst | Conducted the inspection and authored the report |
| Elvie Medina | Administrator | Facility administrator who allowed entry and participated in the inspection |
| Janae Hammond | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 45
Capacity: 120
Deficiencies: 0
May 26, 2022
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation that a resident was being threatened by another resident in care.
Findings
The investigation, including interviews with staff and residents and review of facility documents, found no evidence to support the allegation that a resident was being threatened by another resident. The allegation was determined to be unsubstantiated and no citations were issued.
Complaint Details
The complaint alleged that a resident was being threatened by another resident. After interviews with 5 staff members and 6 residents, and review of relevant documents, the Licensing Program Analyst found no reports or evidence supporting the allegation. The complaint was unsubstantiated.
Report Facts
Staff interviewed: 5
Residents interviewed: 6
Complaint investigation duration: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Susan Campos | Licensing Program Analyst | Conducted the complaint investigation |
| Rodrigo Ramos | Administrator | Facility administrator who allowed entry and participated in the investigation |
| Ulysses Coronel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 2
Apr 8, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that a resident sustained multiple pressure injuries while in care and that the facility retained a resident with a prohibited health condition.
Findings
The investigation substantiated that Resident #1 sustained multiple pressure injuries while in care and that the facility retained the resident despite a prohibited health condition requiring a higher level of care. The facility failed to transfer the resident promptly, resulting in civil penalties.
Complaint Details
The complaint investigation was substantiated. Resident #1 sustained multiple pressure injuries and was retained by the facility despite requiring a higher level of care. The allegations of neglect/lack of supervision and level of care were substantiated.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Persons who require health services or have a health condition including Stage 3 and 4 pressure sores (dermal ulcers) shall not be admitted or retained in a residential care facility for the elderly. | Type A |
| Licensee failed to observe or conduct an assessment of Resident #1’s level of care during which time the resident was receiving home health care services. | Type A |
Report Facts
Capacity: 120
Census: 44
Civil penalty amount: 0
Plan of Correction Due Date: Apr 11, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Cava | Licensing Program Manager | Oversaw the complaint investigation |
| Lorenzona Elvie Medina | Administrator | Facility administrator involved in the investigation and exit interview |
| Eddie Hector | Department of Social Service Investigator | Conducted a separate investigation including medical record review and interviews |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
Apr 7, 2022
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 01/21/2020 alleging lack of supervision resulting in a resident being assaulted by another resident.
Findings
The investigation found that an incident occurred on 01/14/20 where Resident 1 was assaulted by Resident 2 and sustained injuries requiring medical treatment. Staff responded by obtaining medical care and separating the residents. Interviews and record reviews did not reveal evidence of inadequate supervision or prior altercations. The allegation was determined to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint alleged lack of supervision resulting in Resident 1 being assaulted multiple times by Resident 2. The investigation included interviews with staff and residents, review of incident and medical reports, and law enforcement documentation. Resident 1 was treated for fractured fingers after being hit with a cane by Resident 2. Staff were not aware of the assaults prior to the incident. The allegation was unsubstantiated.
Report Facts
Complaint control number: 28-AS-20200121173041
Incident date: Jan 14, 2020
Law enforcement report number: 202887
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation report |
| Lorenzona Medina | Administrator | Met with Licensing Program Analyst during investigation and exit interview |
| Rodrigo E. Ramos | CEO | Met with Licensing Program Analyst during investigation and exit interview |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 120
Deficiencies: 0
Mar 24, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that lack of supervision resulted in a resident being assaulted on several occasions by another resident.
Findings
The investigation found insufficient evidence to substantiate the allegation. Interviews with staff, residents, and review of medical and incident reports showed that staff provided timely medical care and supervision, and there was no prior history of altercations between the residents involved. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that lack of supervision resulted in a resident being assaulted multiple times by another resident. The investigation included interviews with staff and residents, review of incident and medical reports, and law enforcement documentation. The allegation was found unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 120
Census: 46
Incident date: Jan 14, 2020
Law enforcement report number: 202887
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Rodrigo E. Ramos | CEO | Interviewed during the investigation and exit interview |
| Lorenzona Medina | Administrator | Interviewed during the investigation and exit interview |
| Marianne A Hodel | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 0
Dec 20, 2021
Visit Reason
An unannounced complaint investigation was conducted following allegations that a resident was spoken to inappropriately and was not provided assistance with eating while in care.
Findings
The investigation included interviews with staff and residents, record review, and a physical tour. Both allegations were found to be unsubstantiated due to lack of preponderance of evidence to prove the violations did or did not occur.
Complaint Details
The complaint involved allegations that a resident was spoken to inappropriately and was not provided assistance with eating. The investigation found no evidence to substantiate these allegations.
Report Facts
Residents needing assistance with eating: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Lorenzona Medina | Facility Administrator | Met with the Licensing Program Analyst during the investigation. |
| Michael Cava | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
Jul 15, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that a resident was found naked with no body covering with the air conditioning on, and that staff did not seek medical attention for the resident.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews and file reviews indicated uncertainty about how the resident became unclothed and confirmed that medical attention was sought appropriately. No citations were issued.
Complaint Details
The complaint was unsubstantiated. Allegations included a resident found naked without body covering and staff failing to seek medical attention. Investigation included interviews with staff and the resident, review of medical records, and observation. The resident was diagnosed with shingles and cellulitis and had been sent to the hospital as advised. The resident voluntarily discharged against medical advice but returned with medical diagnoses and advice. No preponderance of evidence was found to prove violations.
Report Facts
Capacity: 120
Census: 44
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Cava | Licensing Program Manager | Oversaw the complaint investigation |
| Elvie Medina | Administrator | Facility administrator met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 44
Capacity: 120
Deficiencies: 0
Jun 25, 2021
Visit Reason
An unannounced annual inspection control visit was conducted to evaluate the facility's compliance with safety, privacy, comfort, and regulatory requirements.
Findings
The facility was found to be in compliance with no citations issued. Minor technical advisories were given for cosmetic scuffs in the first-floor hallway and normal wear and tear on the second-floor carpet. Safety features such as smoke detectors, fire extinguishers, and medication storage were functioning properly.
Report Facts
Food supply: 2
Food supply: 7
PPE supply: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Michael Cava | Licensing Program Manager | Named in report header and signature |
| Lorenzona Medina | Facility Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 120
Deficiencies: 0
Jun 3, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on 2021-05-25 regarding a resident finding a cockroach in her bed.
Findings
The investigation found no evidence of cockroaches in resident rooms, kitchen, or common areas. Interviews with residents, staff, and the administrator confirmed no observations or complaints of cockroaches. Pest control invoices showed regular monthly treatments. The allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged a resident found a cockroach in her bed. The allegation was investigated and found unsubstantiated.
Report Facts
Capacity: 120
Census: 43
Number of staff interviewed: 6
Number of residents interviewed: 5
Pest control frequency: 1
Deep cleaning frequency: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Jones | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lorenzona Medina | Administrator | Facility administrator interviewed during the investigation |
| Michael Cava | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
May 21, 2021
Visit Reason
An unannounced complaint investigation was conducted due to allegations that facility showers were unsanitary and staff were not treating residents with dignity and respect.
Findings
After interviews with residents, staff, and the administrator, and inspection of shower drains and cleanliness, the allegations were found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included unsanitary showers and staff disrespect towards residents, but evidence did not support these claims.
Report Facts
Capacity: 120
Census: 44
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Cava | Licensing Program Manager | Named in report as Licensing Program Manager |
| Marianne A Hodel | Administrator | Facility Administrator during investigation |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 1
May 21, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation received on 08/27/2020 regarding the front door being padlocked at the facility.
Findings
The investigation found sufficient evidence to substantiate the allegation that the front door was padlocked by a night staff member, which violated residents' personal rights. The staff was spoken to and the issue did not recur. The deficiency was cited under CCR 87468.1(a)(6).
Complaint Details
The complaint was substantiated based on interviews with residents, staff, and the administrator, and review of documents. The allegation was that the front door was padlocked, which was confirmed by the investigation.
Deficiencies (1)
| Description |
|---|
| Front door was padlocked at night by a caregiver, restricting residents' right to leave the facility. |
Report Facts
Capacity: 120
Census: 44
Deficiency Type: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Cava | Licensing Program Manager | Oversaw the complaint investigation |
| Lorenzona Medina | Facility Administrator | Interviewed during the investigation and involved in exit interview |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 2
May 21, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including call lights being in disrepair and residents being left unattended for an extended period after a fall.
Findings
The investigation substantiated that call lights were not consistently working, including specific issues in rooms #127 and #116, and that some residents were left on the floor for up to 15 minutes after a fall, though no hospitalizations occurred. Both allegations were supported by evidence and interviews.
Complaint Details
The complaint investigation was substantiated. Allegations included call lights in disrepair and residents left unattended after falls. Interviews and observations confirmed these issues, with no hospitalizations resulting from falls.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Call light system was not consistently working, including intermittent intercom in room #127 and missing pull cord and call button in room #116. | Type B |
| Residents were left unattended on the floor for an unspecified amount of time after a fall, posing potential health, safety, and personal rights risks. | Type B |
Report Facts
Capacity: 120
Census: 44
Deficiencies cited: 2
Plan of Correction Due Date: Jun 11, 2021
Time to respond to call after fall: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Cava | Licensing Program Manager | Oversaw the complaint investigation |
| Lorenzona Elvie Medina | Facility Administrator | Facility administrator present during investigation and named in findings |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 2
May 21, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations received on 09/23/2020 regarding call light disrepair and residents being left unattended after a fall.
Findings
The investigation substantiated both allegations: the call light system was found to be inconsistently working with missing components in some rooms, and residents were left unattended for periods generally not exceeding 15 minutes after falls, with no hospitalizations reported.
Complaint Details
The complaint investigation was substantiated based on evidence gathered and interviews. Allegations included call light disrepair and residents left unattended after falls. The preponderance of evidence standard was met for both allegations.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Call light system not consistently working; room #127 intercom intermittent and room #116 missing pull chord and call button. | Type B |
| Residents left unattended for unspecified amount of time after falls, posing potential health, safety, and personal rights risks. | Type B |
Report Facts
Capacity: 120
Census: 44
Plan of Correction Due Date: Jun 11, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Cava | Licensing Program Manager | Oversaw the complaint investigation |
| Marianne A Hodel | Administrator | Facility administrator involved in investigation |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
May 20, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 12/15/2020 regarding residents not having access to water and being isolated in their rooms.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Observations and interviews indicated residents had access to water and were not isolated except for protective measures against COVID-19. The complaint was determined to be unsubstantiated.
Complaint Details
Complaint allegations included residents not having access to water and residents being isolated in their rooms. The complaint was unsubstantiated based on interviews and observations.
Report Facts
Capacity: 120
Census: 44
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Brown | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Elvie Medina | Administrator | Facility administrator who met with the investigator and participated in the exit interview |
| Michael Cava | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 120
Deficiencies: 0
May 20, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that residents did not have access to water and were isolated in their rooms.
Findings
Based on interviews with residents and staff, and observations during the visit, there was no evidence to substantiate the allegations. Residents had access to water and were not isolated except for protective reasons related to COVID-19.
Complaint Details
The complaint was unsubstantiated as there was not a preponderance of evidence to prove the alleged violations occurred.
Report Facts
Capacity: 120
Census: 44
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elvie Medina | Administrator | Met with Licensing Program Analyst during the complaint investigation |
| Erik Brown | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lourdes Montoya | Licensing Program Analyst | Conducted initial complaint intake and signed report |
| Angela J Kendrick | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
May 19, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that a resident sustained multiple unwitnessed falls at the facility resulting in hospitalization.
Findings
The investigation included resident and staff interviews and record reviews related to falls. The allegation was found to be unsubstantiated due to lack of preponderance of evidence to prove the violation occurred.
Complaint Details
The complaint alleged that a resident sustained multiple unwitnessed falls resulting in hospitalization. Interviews revealed the resident had issues with methamphetamine use contributing to falls. Other residents reported no issues with falls. The allegation was unsubstantiated.
Report Facts
Complaint Control Number: 11
Complaint Received Date: Jan 4, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Evaluator | Conducted the complaint investigation |
| Elvie Medina | Met with during the investigation, Administrator | |
| Marianne A Hodel | Administrator | Facility Administrator |
| Ulysses Coronel | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 120
Deficiencies: 0
Apr 15, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 2020-01-21 alleging lack of supervision resulting in a resident being assaulted by another resident.
Findings
The investigation included interviews with staff, residents, and review of records. The statements were inconsistent and there was insufficient evidence to substantiate the allegation of assault due to lack of supervision. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged lack of supervision resulting in a resident being assaulted on several occasions by another resident. The investigation found inconsistent statements and insufficient evidence to support the allegation. The complaint was unsubstantiated.
Report Facts
Complaint Control Number: 28-AS-20200121173041
Number of staff interviewed: 6
Number of residents interviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Wei Siew Ho | Licensing Program Manager | Named in report as Licensing Program Manager |
| Marianne A Hodel | Administrator | Facility Administrator involved in investigation |
| Rodrigo E. Ramos | Licensee | Facility Licensee met during investigation |
Inspection Report
Complaint Investigation
Capacity: 120
Deficiencies: 0
Apr 7, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 07/09/2020 alleging that a resident was forced to take unknown medications.
Findings
The investigation found that residents generally stated they take their medications voluntarily and are not forced. The administrator confirmed that only trained staff pass out medications and residents have the right to refuse medications, which is documented. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that a resident was forced to take unknown medications. The allegation was investigated through resident interviews and discussion with the administrator. The complaint was found to be unsubstantiated.
Report Facts
Facility capacity: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Cava | Licensing Program Manager | Named in report as Licensing Program Manager |
| Marianne A Hodel | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 120
Deficiencies: 0
Feb 3, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations that staff were not providing appropriate care and supervision to residents and that residents' personal items had gone missing.
Findings
The investigation included interviews with residents and the administrator conducted via virtual video call due to COVID-19. Residents generally reported satisfaction with care and supervision and denied missing personal items. The allegations were found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was initiated based on allegations of inadequate care and missing personal items. After interviews and document review, the allegations were determined to be unsubstantiated.
Report Facts
Capacity: 120
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jade Jordan | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Michael Cava | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Lorenzona Medina | Administrator | Facility administrator interviewed during the investigation |
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