Inspection Report Summary
Most inspections found deficiencies, though the facility has shown improvement over time. The most recent report from June 26, 2025, was clean with no deficiencies noted. Earlier issues included immediate health and safety risks such as missing evacuation chairs, staff lacking valid first aid/CPR certification, expired and moldy food, water damage, and hot water temperature violations. Several complaint investigations were unsubstantiated, including allegations about resident supervision and room temperature. Enforcement actions included civil penalties in 2023, but no fines or license suspensions were listed in the available reports.
Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 87
Capacity: 145
Deficiencies: 0
Jun 26, 2025
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with Title 22 regulations and ensure there are no health and safety hazards.
Findings
The facility was found to be in compliance with all applicable regulations, including fire safety, infection control, emergency disaster planning, medication management, and record keeping. No deficiencies or citations were issued during the inspection.
Report Facts
Residents interviewed: 8
Staff interviewed: 10
Family visitors interviewed: 1
Bedrooms inspected: 10
Personnel files reviewed: 8
Resident files reviewed: 9
Medication review: 6
Fire extinguisher last serviced: Feb 14, 2025
Last fire inspection date: Jun 10, 2025
Last emergency disaster drill: Jun 24, 2025
Hot water temperature range: 114.1-117.7
Perishable food supply: 2
Non-perishable food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Rubinstein | Administrator | Met with Licensing Program Analyst during inspection |
| Erica Mosley | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Monitoring
Census: 82
Capacity: 145
Deficiencies: 0
Feb 14, 2025
Visit Reason
Unannounced case management visit to check the health and safety of residents following a reported smoke/fire incident at the facility on 2025-02-13.
Findings
The fire was electrical in nature with no foul play suspected. Residents were evacuated safely, only one resident was relocated, and no additional residents were affected. The facility was inspected by fire department and fire alarm system representatives with no concerns observed during the visit.
Report Facts
Incident time: 1245
Incident report date: Feb 13, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the unannounced case management visit |
| Kristin Heffernan | Licensing Program Manager | Named in report header |
| Michelle Gubbay | Facility Designee | Met with Licensing Program Analyst during visit |
| Marian Rubenstein | Facility Designee | Arrived during visit related to incident |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 145
Deficiencies: 0
Feb 5, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation of lack of care and/or supervision resulting in a physical altercation and injury between residents.
Findings
The investigation found that a physical altercation occurred between two residents resulting in injury, but both residents were independent and did not require constant supervision. The allegation was deemed unsubstantiated due to insufficient evidence to prove the alleged violation.
Complaint Details
The complaint alleged that due to lack of care and/or supervision, residents engaged in a physical altercation resulting in injury. The investigation included interviews, document reviews, and a facility tour. The allegation was unsubstantiated as evidence was insufficient to confirm the violation.
Report Facts
Staff response count: 5
Complaint received date: Dec 9, 2024
Incident date: Dec 7, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the complaint investigation and visits |
| Michael Sokolowski | Executive Director | Met with Licensing Program Analyst during investigation |
| Veronica Padilla | Investigations Branch Investigator | Interviewed residents during investigation |
| Kristin Heffernan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 145
Deficiencies: 0
Aug 29, 2024
Visit Reason
The visit was conducted as a complaint investigation following an allegation that staff does not provide a comfortable room temperature for residents due to a malfunctioning heater.
Findings
The investigation found that the facility was undergoing renovations to install a new heating and air conditioning system, residents and family were notified, and portable heaters and air conditioners were provided to affected residents. Interviews with nine residents revealed no concerns about room temperature. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that staff did not provide a comfortable room temperature for residents because the facility's heater had been in disrepair for months. The allegation was found unsubstantiated based on interviews, records, and observations.
Report Facts
Capacity: 145
Census: 89
Residents interviewed: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michelle Gubbay | Director of Services | Met with the Licensing Program Analyst during the investigation |
| Desaree Perera | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 84
Capacity: 145
Deficiencies: 2
Jun 24, 2024
Visit Reason
The inspection was an unannounced required annual visit to ensure the facility's compliance with health and safety regulations and Title 22 requirements.
Findings
The facility was generally found to be in compliance with health and safety standards, including proper food storage, clean and furnished resident rooms, operational safety equipment, and adequate infection control measures. However, deficiencies were cited related to the absence of evacuation chairs in stairwells and lack of valid first aid/CPR certification for most staff files reviewed.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| No evacuation chair at each stairwell as required, posing an immediate health, safety or personal rights risk to persons in care. | Type A |
| Seven out of eight staff files reviewed did not have a valid first aid/CPR certification on file, posing a potential health, safety or personal rights risk to persons in care. | Type B |
Report Facts
Civil Penalty: 500
Personnel records reviewed: 8
Staff files lacking valid first aid/CPR certification: 7
Resident records reviewed: 8
Bedrooms inspected: 8
Fire extinguishers last serviced: Nov 28, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Desaree Perera | Licensing Program Manager | Supervisor overseeing the inspection. |
| Miriam Rubinstein | Administrator | Facility administrator met with LPAs during the inspection. |
Inspection Report
Annual Inspection
Census: 87
Capacity: 145
Deficiencies: 2
Aug 2, 2023
Visit Reason
The visit was an unannounced continuation of a required annual inspection that began on 2023-06-19, conducted to review compliance with licensing regulations including personnel records, resident care, medication administration, and infection control.
Findings
The inspection found seven staff members not properly associated with the facility posing an immediate health and safety risk, and one instance of a missed medication administration for a resident. Resident records and infection control measures were found to be in order. Civil penalties were assessed for the deficiencies.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Seven staff members (S1, S2, S3, S4, S5, S6, S7) were not associated with the facility as required, posing an immediate health and safety risk. | Type A |
| One morning dose of Digoxin for Resident #1 on 08/01/2023 was not administered as prescribed, posing an immediate health and safety risk. | Type A |
Report Facts
Staff not associated: 7
Resident files audited: 5
Missed medication dose: 1
Facility capacity: 145
Census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Inga Jakobovich | Administrator | Named in relation to staff association deficiencies and facility management. |
| Elsie Campos | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Annual Inspection
Census: 87
Capacity: 145
Deficiencies: 0
Aug 1, 2023
Visit Reason
The visit was an unannounced continuation of a required annual inspection that began on 2023-06-19, conducted to review staff records and compliance.
Findings
The Licensing Program Analyst began a records review focusing on staff associations and personnel reports, identifying 7 staff members needing further record review. Due to time constraints, the inspection was not completed and will continue at a later date.
Report Facts
Staff requiring further record review: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the inspection and records review |
| Inga Jakobovich | Administrator | Facility administrator met with Licensing Program Analyst during inspection |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 85
Capacity: 145
Deficiencies: 3
Jun 19, 2023
Visit Reason
The Licensing Program Analyst conducted an unannounced required annual visit to evaluate the facility's compliance with Title 22 Regulations and ensure there are no health and safety hazards.
Findings
The inspection found expired and moldy food items in the kitchen, water damage on the ceiling of bedroom 204, and taps delivering hot water above the regulated temperature, all posing health and safety risks. The facility was otherwise clean, with no obstructions or tripping hazards observed in common areas.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Ceiling in bedroom 204 observed to have water damage posing an immediate health and safety risk. | Type A |
| Moldy lettuce, moldy tomatoes, and expired prune juice discovered in the kitchen posing an immediate health and safety risk. | Type A |
| Taps throughout the facility delivering hot water up to 125.4 degrees F, exceeding the maximum allowed temperature and posing a potential health and safety risk. | Type B |
Report Facts
Hot water temperature: 125.4
Deficiency due date: Jun 20, 2023
Deficiency due date: Jun 23, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Inga Jakobovich | Administrator | Met with Licensing Program Analyst during inspection and responsible for discarding expired food items |
| Elsie Campos | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 94
Capacity: 145
Deficiencies: 3
Jun 18, 2022
Visit Reason
The visit was an unannounced required annual inspection with a specific emphasis on infection control practices and procedures.
Findings
The inspection found deficiencies related to hot water temperature in resident faucets, staff not wearing masks in common areas, and the medication room door lock being non-functional, posing immediate health and safety risks. The facility was otherwise compliant with infection control signage, PPE supply, and visitation requirements.
Severity Breakdown
Type A: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Level 2 resident's restroom faucets deliver hot water measured at 100 and 104 degrees Fahrenheit, below the required minimum of 105 degrees Fahrenheit. | Type A |
| Four staff were observed not wearing masks/face coverings in common areas. | Type A |
| The medication room door lock did not lock, making medication accessible to residents. | Type A |
Report Facts
Census: 94
Total Capacity: 145
Hot water temperature: 100
Hot water temperature: 104
Hot water temperature: 116.6
Hot water temperature: 105.8
Fire extinguisher last serviced: Nov 21, 2021
Plan of Correction Due Date: Jun 24, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Inga Jakobovich | Administrator | Named in relation to findings and corrective actions |
| Martha Arroyo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Desaree Perera | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 145
Deficiencies: 2
Apr 23, 2021
Visit Reason
The visit was a Case Management-Incident investigation initiated to conclude a previous investigation regarding a resident with a pressure injury and related incident reports.
Findings
The facility retained a resident with a prohibited health condition (Stage 3 or higher pressure injury) and failed to submit an incident report for an urgent care visit, posing health and safety risks to residents.
Complaint Details
The investigation was complaint-related, initiated due to an Unusual Incident Report about a resident's pressure injury worsening and failure to report an urgent care visit. The complaint was substantiated based on evidence of prohibited health condition retention and reporting failures.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Retained Resident #1 with a prohibited health condition, a Stage 3 or 4 pressure injury. | Type A |
| Failed to submit an incident report when Resident #1 went to the emergency room on 3/16/2021. | Type B |
Report Facts
Facility capacity: 145
Resident census: 72
Plan of Correction due date: Apr 26, 2021
Plan of Correction due date: Apr 28, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted the Case Management-Incident visit and investigation |
| Inga Jakobovich | Administrator | Interviewed during the investigation and discussed findings |
| Marian Rubenstein | Administrator | Interviewed telephonically during the complaint investigation |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 145
Deficiencies: 0
Apr 1, 2021
Visit Reason
The inspection was conducted as a Case Management-Incident visit triggered by a complaint investigation related to an unusual incident report about a resident's pressure injury.
Findings
The facility reported a resident with a Stage 4 pressure injury that was initially observed as redness and progressed despite care. No immediate health and safety concerns were observed during the virtual physical plant tour. Further investigation is required prior to issuing findings.
Complaint Details
The complaint investigation was initiated due to an Unusual Incident Report submitted on 04/01/2021 regarding Resident #1 who developed a Stage 4 pressure injury after initial redness was observed on 03/16/2021. The resident was taken to urgent care and later hospitalized. The Administrator reported leaving a message for the On-Duty Worker about the incident on approximately 03/19/2021.
Report Facts
Facility capacity: 145
Resident census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Initiated the Case Management-Incident visit and conducted the virtual inspection |
| Inga Jakobovich | Administrator | Facility Administrator involved in the incident and virtual inspection |
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