Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Jul 25, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2025-03-04 regarding resident care, staff training, staffing levels, food supply, medication availability, and adult briefs/diapers supply.
Findings
All allegations were found to be unfounded after interviews with staff and administrator, review of training records, observation of the facility and supplies, and medication logs. The facility was found to have adequate staffing, training, food, medications, and supplies.
Complaint Details
The complaint included allegations that residents' briefs were not changed often enough, staff did not receive adequate training, there was insufficient staffing, insufficient food supply, residents might run out of medications, and residents might run out of adult briefs/diapers. All allegations were investigated and found to be unfounded.
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Todd Tryon | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Troy Ordonez | Licensing Program Manager | Oversaw the complaint investigation |
| Cathy Dustin | Administrator | Facility administrator interviewed by phone during investigation |
| Kim Bao Tram Tran | Staff | Staff member interviewed during the investigation visit |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
May 28, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that facility staff did not ensure a resident was hydrated resulting in hospitalization and that staff did not dispense medications as prescribed.
Findings
The investigation found the hydration allegation to be unfounded with no evidence of staff neglect. The medication dispensing allegation was unsubstantiated, with findings indicating resident behavior caused medication issues rather than staff error. No deficiencies were cited.
Complaint Details
The complaint included two main allegations: 1) Facility staff did not ensure resident hydration resulting in hospitalization, which was found to be unfounded. 2) Facility staff did not dispense medications as prescribed, which was found to be unsubstantiated due to lack of evidence of staff error and resident non-compliance with medication intake.
Report Facts
Facility capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with during investigation and referenced in findings |
| Todd Tryon | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Troy Ordonez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 0
May 28, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2024-08-29 regarding multiple allegations about staff conduct and facility operations at Hampshire Manor Inc.
Findings
The investigation found no credible evidence to support any of the allegations, including inappropriate staff behavior, failure to report incidents, delayed medical attention, leaving residents soiled, lack of planned activities, staff working without criminal clearance, and inadequate staff training. All allegations were determined to be unfounded and no deficiencies were cited.
Complaint Details
The complaint included nine allegations related to staff speaking inappropriately to residents, failure to report incidents, delayed medical care, residents left soiled, lack of planned activities, staff working without criminal clearance, and insufficient staff training. All allegations were found to be unfounded after investigation.
Report Facts
Capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with during investigation and named in report |
| Todd Tryon | Licensing Program Analyst | Conducted the complaint investigation |
| Troy Ordonez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Dec 30, 2024
Visit Reason
The inspection was an unannounced annual visit conducted to evaluate the facility's compliance with regulations.
Findings
The facility was found to be clean, well-furnished, and in good repair with adequate food supplies and secured medications. Documentation was appropriate and the facility appeared to be in substantial compliance with regulations.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with during the inspection and involved in review of CARE Tool. |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Aug 22, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation into allegations that facility staff were not providing incontinence care to a resident.
Findings
The Licensing Program Analyst investigated the allegation by interviewing staff, witnesses, and reviewing resident documentation. The allegation was found to be unsubstantiated as staff reported providing incontinence care, hospice staff had no concerns, and documentation supported care was provided.
Complaint Details
The complaint alleged that facility staff were not providing incontinence care to a resident. After investigation, including interviews and documentation review, the allegation was found to be unsubstantiated.
Report Facts
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Cathy Dustin | Administrator | Met with Licensing Program Analyst during inspection and provided information |
| Troy Ordonez | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Dec 6, 2023
Visit Reason
The inspection was an unannounced Required-1 Year Inspection conducted to evaluate the health and safety conditions of the facility and ensure compliance with licensing regulations.
Findings
The inspection found the facility to be in good condition with no deficiencies cited. Observations included clean and sanitary resident bathrooms, proper food storage, locked medications, operable fire safety equipment, and adequate staff training.
Report Facts
Residents observed: 6
Staff observed: 1
Resident files reviewed: 3
Staff records reviewed: 1
Fire extinguishers: 2
Fire extinguisher last service date: Sep 1, 2023
Fire drill last conducted: Oct 23, 2023
Hot water temperature: 105
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Executive Director | Met with Licensing Program Analyst during inspection and named in report |
| Sarena Keosavang | Licensing Program Analyst | Conducted the inspection |
| Troy Ordonez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 31, 2023
Visit Reason
The inspection was an unannounced Required-1 Year Inspection focusing on the infection control domain to ensure health and safety compliance at the facility.
Findings
The facility was found to be in substantial compliance with no immediate health, safety, or personal rights violations observed. No deficiencies were cited as a result of the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with Licensing Program Analyst during inspection and involved in infection control domain completion. |
| Sarena Keosavang | Licensing Program Analyst | Conducted the Required-1 Year Inspection and infection control domain evaluation. |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Jan 11, 2022
Visit Reason
The Licensing Program Analyst conducted a required 1-year annual inspection utilizing the infection control domain to ensure compliance with health and safety standards.
Findings
The facility was found to be in substantial compliance with no immediate health, safety, or personal rights violations observed. No deficiencies were cited as a result of the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with Licensing Program Analyst during inspection |
| Jacob Williams | Licensing Program Analyst | Conducted the inspection |
| Anthony Perez | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Sep 29, 2021
Visit Reason
The inspection was an unannounced Required-1 Year Inspection focusing on infection control protocols and overall health and safety compliance.
Findings
The facility was found to be in substantial compliance with no immediate health, safety, or personal rights violations observed. No deficiencies were cited as a result of the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Dustin | Administrator | Met with Licensing Program Analyst during inspection and involved in infection control domain completion. |
| Sarena Keosavang | Licensing Program Analyst | Conducted the Required-1 Year Inspection and infection control domain evaluation. |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on the report. |
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