Inspection Reports for The Hampshire – A Provincial Senior Living Community
3460 R St, Merced, CA 95348, United States, CA, 95348
Back to Facility ProfileInspection Report Summary
Most inspections found deficiencies related primarily to resident care, medication management, timely staff response, and environmental safety issues. The facility has faced several substantiated complaints over the years, including medication errors that resulted in civil penalties, delayed responses to resident calls posing health risks, and incidents of residents going absent without leave due to inadequate supervision, with a $500 fine assessed in 2021. The most recent report from August 18, 2025, was a complaint investigation that found no deficiencies and all allegations unsubstantiated, indicating improvement in complaint-related issues. Earlier reports showed ongoing challenges with timely staff assistance and documentation, but recent complaint investigations were consistently unsubstantiated. Overall, the facility’s record shows some serious past issues but signs of progress in addressing them.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
6.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
55% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
90% occupied
Based on a August 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Census: 84
Capacity: 93
Deficiencies: 0
Date: Aug 18, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2025-05-14 regarding multiple allegations including unqualified staff providing care, inappropriate rent increases, delayed call button responses, and acceptance of residents not in the plan of operation.
Complaint Details
The complaint included allegations of unqualified staff providing care, inappropriate rent increases, delayed response to resident call buttons, and acceptance of residents not in the plan of operation. All allegations were investigated and found to be unsubstantiated.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations. Personnel records met requirements, the facility's plan of operation addressed resident care types, call response concerns were not supported by resident interviews, and an overcharge in rent was credited back to the resident. All allegations were determined to be unsubstantiated.
Report Facts
Capacity: 93
Census: 84
Rent overcharge amount: 50
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lisa Baricevic | Administrator | Facility administrator present during the investigation |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 93
Deficiencies: 0
Date: Jun 27, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that facility staff do not ensure residents are accorded the ability to receive personal phone calls.
Complaint Details
The allegation that facility staff do not ensure residents can receive personal phone calls was unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation found that the facility does have a landline phone and a cell phone that residents can use to contact family, and staff assist residents upon request. There was insufficient evidence to substantiate the allegation, and no deficiencies were cited.
Report Facts
Capacity: 93
Census: 84
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Baricevic | Administrator | Facility Administrator met during the investigation and named in findings |
| Sarah Hurt | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Date: Apr 17, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff do not follow infection control requirements.
Complaint Details
The allegation that staff do not follow infection control requirements was investigated and found to be unsubstantiated.
Findings
The investigation found that the facility is following infection control requirements. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 93
Census: 75
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lisa Baricevic | Administrator | Met with the Licensing Program Analyst during the investigation |
Inspection Report
Annual Inspection
Census: 75
Capacity: 93
Deficiencies: 1
Date: Apr 17, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean, in good repair, and compliant with safety and health standards including proper food storage, medication management, and resident room safety features. One deficiency was cited related to failure to obtain and evaluate a recent medical assessment prior to accepting a resident for care.
Deficiencies (1)
Failure to obtain and evaluate a recent medical assessment prior to accepting a resident for care.
Report Facts
Capacity: 93
Census: 75
Deficiencies cited: 1
Plan of Correction Due Date: Due date for correction is 2025-04-27
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Baricevic | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection and signed the report |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 75
Capacity: 93
Deficiencies: 2
Date: Apr 17, 2025
Visit Reason
The visit was conducted as a follow-up on a previous complaint investigation and residents' interviews regarding staff not responding to residents' calls in a timely manner.
Complaint Details
The visit was complaint-related, following up on previous complaint investigation about staff not responding to residents' calls in a timely manner.
Findings
The inspection found that residents' calls were not answered for over 20 minutes and in some cases over an hour. Additionally, one resident's physician report had not been updated since 2018, posing potential health and safety risks.
Deficiencies (2)
Facility did not respond to residents calls in a timely manner resulting in at least 3 out of 75 residents waiting from 30 minutes to over an hour for assistance in January 2025.
One out of 75 residents had not had an updated physician report since 2018.
Report Facts
Residents affected: 3
Total residents: 75
Facility capacity: 93
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Baricevic | Administrator | Met with Licensing Program Analyst during inspection |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection visit |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 78
Capacity: 93
Deficiencies: 0
Date: Mar 20, 2025
Visit Reason
An unannounced Case Management visit was conducted to review facility operations, amend a previous deficiency report, request administrator certification, and update the facility hospice waiver.
Findings
The Licensing Program Analyst toured the facility, observed residents, and amended a deficiency report from 3/12/25. The facility currently has 20 residents receiving hospice services. Facility files were requested to be provided by 03/21/2025.
Report Facts
Residents receiving hospice services: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Administrator/Director | Facility administrator named in the report |
| Lisa Baricevic | Administrator | Met with Licensing Program Analyst during the visit |
| Vadim Gorban | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 93
Deficiencies: 1
Date: Mar 12, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-03-10 regarding failure to provide resident reappraisal upon change in condition.
Complaint Details
Complaint was substantiated that facility staff did not provide resident reappraisal upon change in condition.
Findings
The investigation found that resident R1 did not receive updated reappraisal documents after a change in level of care, substantiating the complaint. The facility was cited for failure to provide updated admission agreements and reappraisal documentation, posing potential health and safety risks.
Deficiencies (1)
Facility staff failed to provide the resident with updated re-appraisal for resident knowledge and records, posing potential health and safety risk.
Report Facts
Capacity: 93
Census: 84
Deficiencies cited: 1
Plan of Correction Due Date: Due date is 03/14/2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lisa Baricevic | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Capacity: 93
Deficiencies: 1
Date: Nov 26, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff do not ensure the insect issue is being properly addressed for residents in care.
Complaint Details
The complaint was substantiated based on observations, interviews, and record reviews. The allegation was that staff did not properly address an insect issue affecting residents.
Findings
The investigation found a substantiated cockroach infestation in a resident's room, posing an immediate health, safety, and personal rights risk. The facility was cited for failure to maintain a clean, safe, sanitary environment as required by regulations.
Deficiencies (1)
Facility failed to maintain clean, safe, sanitary conditions as evidenced by cockroach infestation in resident's room.
Report Facts
Total licensed capacity: 93
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brianna Miranda | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Emily Venegas | Administrator | Facility administrator not available during visit |
| Tracy Gaddess | Wellness Director | Met with Licensing Program Analyst during the investigation |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 71
Capacity: 93
Deficiencies: 0
Date: Oct 17, 2024
Visit Reason
The visit was an unannounced Case Management visit conducted by the Licensing Program Analyst to review compliance and address a Decision and Order excluding a staff member from the facility.
Findings
No deficiencies were observed or cited during the visit. The Licensing Program Analyst served a Decision and Order excluding a staff member from the facility and ensured the facility updated its personnel records accordingly.
Report Facts
Capacity: 93
Census: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Executive Director | Met with Licensing Program Analyst during the visit and was informed about the exclusion order for Staff 1 |
| Martin Vega | Licensing Program Analyst | Conducted the unannounced Case Management visit and served the Decision and Order |
Inspection Report
Annual Inspection
Census: 70
Capacity: 93
Deficiencies: 2
Date: Apr 23, 2024
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing regulations.
Findings
The facility was generally clean, well-maintained, and compliant with emergency preparedness and resident care standards. However, two type-B deficiencies were cited related to expired medication storage and solid waste containers lacking tight-fitting covers in resident bathrooms.
Deficiencies (2)
Expired medication was found stored in the medication cart with other resident medications.
At least three storage bins in resident bathrooms and one in a common bathroom were not fitted with tight-fitting covers.
Report Facts
Residents present: 70
Total licensed capacity: 93
Deficiencies cited: 2
Storage bins without tight-fitting covers: 4
Residents affected by expired medication deficiency: 1
Residents affected by waste container deficiency: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Executive Director | Met with Licensing Program Analyst during inspection |
| Daniel Gormley | Administrator/Director | Facility administrator named in report and plan of correction |
| David Ayers | Licensing Program Analyst | Conducted the inspection and authored the report |
| Brenda Chan | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 93
Deficiencies: 5
Date: Mar 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted due to multiple allegations including lack of timely staff response to calls for assistance, missed medications, failure to follow residents' care plans, multiple resident falls due to neglect, and failure to provide authorized representatives with care plan copies.
Complaint Details
The complaint investigation was substantiated. Allegations included untimely staff response to calls for assistance, missed medications, failure to follow care plans, multiple falls due to neglect, and failure to provide care plan copies to authorized representatives. Evidence met the preponderance of evidence standard for all allegations.
Findings
All allegations were substantiated based on interviews, record reviews, and observations. Significant deficiencies included excessive wait times for staff assistance, missed medications, failure to follow care plans, multiple falls due to neglect, and failure to provide required documentation to residents' representatives.
Deficiencies (5)
Facility personnel were insufficient in numbers and competence to meet resident needs, resulting in Resident 1 waiting over 60 minutes for assistance.
Resident 1 was not provided medications as listed on the medication list.
Resident 1 was not correctly assisted with medications or transfers as listed on pre-admission, posing health and safety risks.
Resident 1 was not assisted by staff with transfers resulting in several falls.
Resident 1's Responsible Party was not provided and did not sign Resident Assessment or Needs and Services plan.
Report Facts
Census: 68
Total Capacity: 93
Response Time: 80
Response Time: 61
Response Time: 55
Deficiency Count: 5
Plan of Correction Due Dates: Mar 21, 2024
Plan of Correction Due Dates: Apr 3, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Hurt | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Emily Venegas | Administrator | Facility administrator met with Licensing Program Analyst during investigation and exit interview |
| Daniel Gormley | Administrator | Named as facility administrator in report header |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Census: 70
Capacity: 93
Deficiencies: 0
Date: Dec 28, 2023
Visit Reason
The inspection was an unannounced case management visit to conduct health checks and review an incident that occurred on 12/19/2023.
Findings
No deficiencies were cited during the inspection. The Licensing Program Analyst conducted a tour to ensure no immediate health or safety concerns were present.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Executive Director | Met with Licensing Program Analyst during the inspection. |
| David Ayers | Licensing Program Analyst | Conducted the inspection and requested additional information regarding an incident. |
| Brenda Chan | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 67
Capacity: 93
Deficiencies: 4
Date: May 4, 2023
Visit Reason
The visit was an unannounced required annual inspection conducted by a Licensing Program Analyst to evaluate compliance with regulations at Pacifica Senior Living Merced.
Findings
The inspection found the facility generally maintained safety and emergency preparedness, but noted deficiencies including debris and dead bugs in common areas and resident bedrooms, lack of non-skid mats in one resident shower, unsecured cleaning chemicals in the memory care kitchen, and inadequate documentation of emergency drills.
Deficiencies (4)
One resident shower lacked a non-skid mat, posing a potential safety risk.
Cleaning solutions and disinfectants were stored in an unsecured cabinet in the memory care kitchen.
Facility staff did not maintain adequate records of disaster/emergency drills; last recorded fire drill was in 2019.
Common areas and some resident bedrooms had debris and dead bugs on floors and window sills.
Report Facts
Deficiencies cited: 4
Census: 67
Total Capacity: 93
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Seibert | Memory Care Director | Met with Licensing Program Analyst during inspection. |
| Daniel Gormley | Administrator | Facility administrator named in report header. |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
Date: May 3, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 2023-01-06 regarding staff response times to call bells, adequacy of food service, and notification of authorized representatives of incidents.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included untimely call bell response, inadequate food service, and failure to notify authorized representatives. The evidence did not support these allegations.
Findings
The investigation found that although call bell logs showed extended response times due to technical issues, staff generally responded within 5 minutes. Food service was adequate with meals sometimes reheated per resident request. The facility did not fail to notify authorized representatives as none were on record for the resident in question. All allegations were unsubstantiated or unfounded.
Report Facts
Capacity: 93
Census: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Malia Thao | Licensing Program Analyst | Conducted the complaint investigation |
| Shelly Randel | Executive Director (Administrator) | Met with Licensing Program Analyst during inspection |
Inspection Report
Follow-Up
Census: 65
Capacity: 93
Deficiencies: 1
Date: May 3, 2023
Visit Reason
The inspection was a case management - deficiencies visit conducted to address observations made during a prior complaint inspection #24-AS-20230106152902.
Complaint Details
This visit was conducted as a follow-up to a complaint inspection #24-AS-20230106152902. The deficiency cited was based on observations made during that complaint inspection.
Findings
The inspection found that signal system devices installed at bedside and in bathrooms of sampled Memory Care bedrooms were inoperable, and staff conducted 30-minute resident checks without using pagers to receive signal alerts, posing a potential health and safety risk.
Deficiencies (1)
Signal system devices installed at bedside and in bathrooms of sampled Memory Care bedrooms (#306, 308, 314, 317) were inoperable, and staff did not use pagers to receive alerts.
Report Facts
Capacity: 93
Census: 65
Deficiencies cited: 1
Plan of Correction Due Date: May 10, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shelly Randel | Executive Director (Administrator) | Met with Licensing Program Analyst during inspection |
| Malia Thao | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 2
Date: Mar 2, 2023
Visit Reason
Unannounced complaint investigation visit conducted in response to multiple allegations received on 12/15/2022 regarding expired foods, insect infestation, elevator maintenance, resident injury, staffing adequacy, refrigerator condition, and theft of resident funds.
Complaint Details
The complaint investigation was substantiated for expired foods and insect infestation. Other allegations including elevator maintenance, resident injury, staffing adequacy, refrigerator condition, and theft of resident funds were found to be unfounded or unsubstantiated.
Findings
The investigation substantiated allegations of expired foods and insect infestation in resident rooms. Other allegations including elevator maintenance, resident injury, staffing adequacy, refrigerator condition, and theft of resident funds were found to be unfounded or unsubstantiated based on observations, interviews, and records review.
Deficiencies (2)
Facility did not keep foods of good quality; refrigerator observed to store moldy fruit.
Facility did not keep the facility free of insects; ants observed in resident rooms 103, 105, and 208.
Report Facts
Capacity: 93
Census: 70
Deficiencies cited: 2
Plan of Correction Due Date: Mar 2, 2023
Plan of Correction Due Date: Mar 17, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kamaldeep Kaur | Licensing Program Analyst | Conducted complaint investigation and delivered findings |
| Daniel Gormley | Administrator | Named in relation to facility administration and findings |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 93
Deficiencies: 1
Date: Sep 29, 2022
Visit Reason
Unannounced Case Management visit to follow up on multiple Unusual Incident/Injury Reports involving residents, including medication administration concerns, wound care, health and safety, and a resident going absent without leave (AWOL).
Complaint Details
The visit was complaint-related following multiple Unusual Incident/Injury Reports. The substantiation includes a confirmed incident of resident R4 going AWOL due to lack of supervision, confirmed by Merced Police Department and supported by R4's Physician’s Report indicating mild cognitive impairment and inability to leave unassisted.
Findings
The facility failed to provide adequate supervision resulting in a Memory Care resident (R4) going AWOL, posing an immediate risk to health and safety. Other incidents involved medication administration and wound care follow-ups. A civil penalty was cited due to the supervision deficiency.
Deficiencies (1)
The incident on 09/04/2022 resulted in Memory Care resident R4 going AWOL from the facility due to no supervision in the common area, posing an immediate risk to health, safety, or personal rights of clients in care.
Report Facts
Capacity: 93
Census: 77
Deficiencies cited: 1
Plan of Correction Due Date: Sep 30, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the unannounced Case Management visit and authored the report |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor overseeing the inspection |
| Shelly Randel | Executive Director | Facility representative who met with Licensing Program Analyst during the visit |
| Daniel Gormley | Administrator | Facility Administrator unavailable during visit |
Inspection Report
Annual Inspection
Census: 77
Capacity: 93
Deficiencies: 2
Date: Apr 26, 2022
Visit Reason
The inspection was an unannounced Annual Required Inspection conducted to evaluate compliance with regulations, including follow-up on Special Incident Reports submitted earlier in the year.
Findings
Deficiencies were cited related to unsecured hazardous areas such as unlocked laundry and housekeeping rooms, and maintenance issues including clutter in hallways, dried tree branches in the parking lot, and strong urine odor in a memory care resident's room. Plans of correction were initiated during the visit for some deficiencies.
Deficiencies (2)
Laundry room and memory care housekeeping room were unlocked, posing an immediate health, safety or personal rights risk to persons in care.
Several unused wheelchairs, boxes, and various items were observed in the hallway by the service entrance; dried tree/branches were on top of a metal storage container in the back parking lot; a memory care resident's room had a strong odor of urine.
Report Facts
Capacity: 93
Census: 77
Plan of Correction Due Date: Apr 26, 2022
Plan of Correction Due Date: May 3, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daniel Gormley | Administrator | Named as facility administrator; unavailable during inspection |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst and gave facility tour during inspection |
| Lady Cabrera | Licensing Program Analyst | Conducted the inspection and authored the report |
| Sergiy Pidgirny | Licensing Program Manager / Supervisor | Supervisor overseeing the inspection |
Inspection Report
Census: 79
Capacity: 93
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
Licensing Program Analyst conducted a case management visit due to the unavailability of the Administrator and to follow up on a death report for a resident, requesting records to be submitted.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst will follow up once records and interviews have been conducted.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daniel Gormley | Administrator | Mentioned as unavailable during the visit. |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the visit. |
| Lady Cabrera | Licensing Program Analyst | Conducted the case management visit. |
| Sergiy Pidgirny | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 1
Date: Apr 20, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations including a resident fall resulting in injury, unmet care needs, inadequate food service, pest issues, and delayed staff response to call buttons.
Complaint Details
The complaint investigation was triggered by allegations including a resident fall with injury, unmet care needs, inadequate food service, pest issues, and delayed staff response. The fall and delayed response allegations were substantiated, while others were unsubstantiated.
Findings
The investigation found some allegations unsubstantiated, such as unmet care needs, laundry, food service, and pest presence. However, the complaint that a resident was left on the floor for an extended period and staff did not respond timely to call buttons was substantiated, resulting in a deficiency citation.
Deficiencies (1)
Resident calls for assistance were not responded to in a timely manner, and a resident was left on the floor for an extended period after an unwitnessed fall.
Report Facts
Resident call button presses: 15
Staff response time: 21
Facility capacity: 93
Resident census: 79
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Sergiy Pidgirny | Licensing Program Manager | Oversaw the complaint investigation. |
| Tyler Wilds | Administrator | Facility administrator named in the report. |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the investigation. |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2021-12-29 regarding resident care and facility conditions.
Complaint Details
The complaint investigation was unsubstantiated as there was insufficient evidence to prove the alleged violations occurred.
Findings
The investigation found no substantiated evidence supporting the allegations that bedridden residents were not turned every two hours, residents were not receiving timely assistance with incontinence needs, or that the facility had roaches. The facility does have monthly pest control service but occasional pests were noted.
Report Facts
Capacity: 93
Census: 79
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the visit |
| Tyler Wilds | Administrator | Facility Administrator mentioned in report |
| Daniel Gormley | Administrator | Unavailable Administrator referenced in report |
| Sergiy Pidgirny | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 01/07/2022 regarding staff behaviors posing risks to residents, residents sustaining falls, residents being left soiled for extended periods, and staff stealing residents' medications.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff behaviors posing risks, residents sustaining falls, residents left soiled, and staff stealing medications. Interviews and record reviews did not confirm these allegations.
Findings
The investigation found no substantiated evidence to support the allegations. Medication counts and administration were reviewed with no errors found, and interviews and records indicated no concerns regarding residents being left soiled or staff misconduct. The allegations were deemed unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 93
Census: 79
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Sergiy Pidgirny | Licensing Program Manager | Oversaw the complaint investigation |
| Tyler Wilds | Administrator | Facility administrator named in the report |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation of inadequate staffing to meet residents' needs.
Complaint Details
The complaint alleging inadequate staffing to meet residents' needs was investigated and found to be unfounded; the complaint was dismissed.
Findings
The investigation found the allegation of inadequate staffing to be unfounded. Despite a COVID-19 outbreak causing staffing challenges, the facility continued hiring and focused on resident care.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the investigation. |
| Tyler Wilds | Administrator | Named as facility administrator; unavailable during visit. |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 0
Date: Apr 20, 2022
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 01/25/2022 alleging that the facility was not following COVID-19 protocol.
Complaint Details
The complaint alleging that the facility was not following COVID-19 protocol was investigated and found to be unsubstantiated due to lack of preponderance of evidence.
Findings
Based on interviews and records review, the allegations that the facility was not following COVID-19 protocol were found to be unsubstantiated. COVID precautionary measures were observed at the point of entry on the date of the visit and on 02/02/2022.
Report Facts
Complaint Control Number: 24
Complaint Control Number Suffix: 20220125094342
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings. |
| Shelly Randel | Executive Director | Met with Licensing Program Analyst during the investigation visit. |
| Tyler Wilds | Administrator | Named as facility administrator; was unavailable during the visit. |
Inspection Report
Census: 84
Capacity: 93
Deficiencies: 0
Date: Feb 8, 2022
Visit Reason
An informal office meeting was held to discuss recently identified issues and concerns associated with the operation of the facility.
Findings
The meeting addressed multiple operational concerns including accountability of the licensee governing body, administrator qualifications and duties, personnel requirements and operations, basic services, incidental medical and dental care, personal rights, and maintenance and operation.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shelly Randel | Business Office Director | Attended meeting discussing facility operational concerns |
| Daniel Gormley | Operations Specialist, Licensee Representative | Attended meeting discussing facility operational concerns |
| Brenda White | Regional Manager | Attended meeting discussing facility operational concerns |
| Sergiy Pidgirny | Licensing Program Manager | Attended meeting discussing facility operational concerns |
| Lady Cabrera | Licensing Program Analyst | Attended meeting discussing facility operational concerns |
Inspection Report
Follow-Up
Census: 84
Capacity: 93
Deficiencies: 2
Date: Feb 2, 2022
Visit Reason
The visit was an unannounced Case Management follow-up to assess the administration of the facility, including review of prior incidents and compliance with reporting requirements.
Findings
The inspection found deficiencies related to a resident going absent without leave (AWOL) despite being unable to leave unassisted, and failure to notify the Department in writing of a new facility administrator, posing health, safety, and personal rights risks.
Deficiencies (2)
Failure to provide required care and supervision as evidenced by resident R1 going AWOL despite being unable to leave unassisted per physician report.
Failure to notify the Department in writing within 30 days of hiring a new administrator.
Report Facts
Capacity: 93
Census: 84
Plan of Correction Due Date: Feb 3, 2022
Plan of Correction Due Date: Feb 15, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Named as former administrator transferred out of state |
| Daniel Gormley | Acting Administrator | Met with Licensing Program Analyst during visit |
| Shelly Randel | Business Manager | Met with Licensing Program Analyst during visit |
| Lady Cabrera | Licensing Program Analyst | Conducted the inspection visit |
| Sergiy Pidgirny | Licensing Program Manager | Named as supervisor and licensing program manager |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 93
Deficiencies: 0
Date: Dec 28, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to complaints alleging residents sustaining pressure injuries while in care and staff not keeping the facility free from odor.
Complaint Details
The complaint investigation addressed two allegations: 1) Residents sustaining pressure injuries while in care, which was found to be unfounded; 2) Staff do not keep the facility free from odor, which was unsubstantiated. The investigation included interviews with Memory Care Director Tracy Seibert and review of facility records. The facility had a resident with stage 2 pressure injuries receiving appropriate care. Odor was noted on a prior date but was not substantiated during the visit.
Findings
The complaint alleging residents sustaining pressure injuries was found to be unfounded after review of relevant facility files and interviews. The complaint alleging staff do not keep the facility free from odor was unsubstantiated due to lack of preponderance of evidence despite an odor observed on a prior date.
Report Facts
Capacity: 93
Census: 80
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Seibert | Memory Care Director | Met with during the complaint investigation |
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation |
| Kamaldeep Kaur | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 93
Deficiencies: 2
Date: Oct 1, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations including failure to communicate with resident's responsible party, unclean resident room, failure to follow physician orders, presence of pests, and medication administration issues.
Complaint Details
The complaint investigation was substantiated for failure to communicate with the resident's responsible party and failure to maintain a clean resident room. The allegation that staff did not follow physician orders was unfounded. The allegations of pests and failure to ensure resident took medications were unsubstantiated.
Findings
The investigation substantiated that facility staff did not effectively communicate with the resident's responsible party and did not ensure the resident's room was clean. The allegation that staff did not follow physician orders was found to be unfounded. The allegations regarding pests and medication administration were unsubstantiated based on evidence and interviews.
Deficiencies (2)
Licensee did not communicate with the resident's responsible party as required by regulation CCR 87468.1(a)(8).
Facility did not ensure the resident's room was clean, violating CCR 87303(a).
Report Facts
Facility capacity: 93
Census: 83
Deficiencies cited: 2
Plan of Correction Due Date: Oct 15, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Tyler Wilds | Administrator | Facility administrator unavailable during investigation |
| Tracy Seibert | Director (Designated Representative) | Met with Licensing Program Analyst and signed report on behalf of administrator |
| Sergiy Pidgirny | Licensing Program Manager | Oversaw licensing program and acknowledged report |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 93
Deficiencies: 2
Date: Aug 9, 2021
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 07/14/2021 regarding resident participation in pre-admission appraisal and resident sleeping in her chair.
Complaint Details
The complaint was substantiated based on interviews, observations, and records review. The allegations that the resident was not given the opportunity to participate in the pre-admission appraisal and that the resident was sleeping in her chair due to lack of assistance were both substantiated.
Findings
The investigation substantiated that the resident did not participate in the development of the pre-admission appraisal and that the resident sleeps on her recliner at night due to not receiving appropriate assistance.
Deficiencies (2)
Licensee did not ensure that the resident participated in the development of the pre-admission appraisal, posing a potential health and safety risk.
Licensee did not ensure the resident was regularly observed for changes and was not provided with appropriate assistance, posing a potential health and safety risk.
Report Facts
Deficiencies cited: 2
Plan of Correction Due Date: Aug 23, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Tyler Wilds | Administrator | Facility administrator met during the investigation |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Census: 72
Capacity: 93
Deficiencies: 0
Date: Jul 14, 2021
Visit Reason
Licensing Program Analyst Lady Cabrera conducted a case management visit to offer technical assistance to the Licensee.
Findings
The analyst recommended that the facility should provide residents' personal belongings and immediate items such as dentures, glasses, hearing aids, medication list, and/or medications when residents are transported to the hospital.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the case management visit and made recommendations regarding resident belongings. |
| Tyler Wilds | Administrator | Facility administrator met during the visit. |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 93
Deficiencies: 1
Date: Jul 14, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff were not answering call buttons in a timely manner.
Complaint Details
The complaint alleged that staff were not answering call buttons in a timely manner. The allegation was substantiated based on interviews and review of call button records showing delayed responses.
Findings
The investigation found substantiated evidence that staff response times to call buttons were delayed, sometimes taking 30 to 45 minutes, due to short staffing and other duties. This posed an immediate health and safety risk to residents.
Deficiencies (1)
Facility personnel were not sufficient in numbers and competent to provide necessary services, evidenced by delayed response times to call buttons.
Report Facts
Capacity: 93
Census: 72
Plan of Correction Due Date: Jul 15, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Tyler Wilds | Administrator | Facility administrator involved in the investigation and plan of correction |
| Sergiy Pidgirny | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 93
Deficiencies: 1
Date: Jul 14, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including resident falls and medication administration issues.
Complaint Details
The complaint investigation was triggered by allegations that a resident fell multiple times while in care, staff did not administer resident's medication, and staff did not send the resident's medication list with her to the hospital. The fall allegation was found unsubstantiated, the medication administration allegation was substantiated, and the medication list allegation was unsubstantiated.
Findings
The investigation found one allegation substantiated regarding failure to administer resident medication, resulting in a deficiency citation and a civil penalty. Another allegation about failure to send medication list to hospital was unsubstantiated, and the resident fall allegation was also unsubstantiated.
Deficiencies (1)
Licensee did not meet California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465(c)(2) Incidental Medical and Dental Care due to failure to administer resident's prescribed medication on 04/22/2021.
Report Facts
Civil Penalty: 250
Deficiency Type: 1
Capacity: 93
Census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with Licensing Program Analyst during complaint investigation and involved in Plan of Correction discussions. |
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Date: Jun 23, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-05-19 regarding allegations that the facility did not obtain a medical assessment signed by a physician prior to resident acceptance and did not maintain current resident records.
Complaint Details
The complaint alleged that the facility failed to obtain a medical assessment signed by a physician prior to resident acceptance and failed to maintain current resident records. The complaint was investigated and found to be unfounded.
Findings
The investigation found that the resident's physician report was completed prior to admission and included all required health and care information. Based on the physician's report and resident assessment, the complaint was found to be unfounded and dismissed.
Report Facts
Capacity: 93
Census: 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with during complaint investigation and informed of findings |
| Lady Cabrera | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Census: 70
Capacity: 93
Deficiencies: 0
Date: Jun 9, 2021
Visit Reason
The visit was a subsequent Case Management visit to discuss information obtained from a prior visit on 05/05/2021 and to address an incident that occurred on 04/25/2021 involving a resident striking another resident.
Findings
The incident involved one resident striking another on the jaw, with staff intervening immediately and transporting the injured resident to the hospital for evaluation. Both residents are reported to be doing well, and no other incidents were reported. Technical advisory was provided for reassessment and care needs.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Facility administrator met during the visit. |
| Lady Cabrera | Licensing Program Analyst | Conducted the Case Management visit. |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Follow-Up
Census: 70
Capacity: 93
Deficiencies: 1
Date: Jun 9, 2021
Visit Reason
The visit was a subsequent Case Management visit to address an incident on 03/23/2021 where resident R1 went absent without leave (AWOL) from the facility.
Findings
The facility was found deficient for failing to provide required basic services, as evidenced by the incident where resident R1, who has dementia and was unable to leave unassisted, went AWOL, presenting an immediate risk to health, safety, and personal rights of clients.
Deficiencies (1)
Failure to meet basic services requirements as resident R1 went AWOL despite being unable to leave unassisted due to dementia diagnosis.
Report Facts
Capacity: 93
Census: 70
Plan of Correction Due Date: Jun 10, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met during the visit and involved in exit interview |
| Lady Cabrera | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor overseeing the licensing evaluation |
Inspection Report
Follow-Up
Census: 70
Capacity: 93
Deficiencies: 1
Date: Jun 9, 2021
Visit Reason
The visit was conducted as a subsequent Case Management visit to address incidents on 03/23/2021 and 05/16/2021 where a resident went absent without leave (AWOL), which was reported by facility staff.
Findings
The facility failed to meet the basic services requirement as resident R1, who was unable to leave unassisted per physician report, went AWOL twice, presenting an immediate risk to health and safety. A civil penalty of $500 was assessed as this was a second violation within twelve months.
Deficiencies (1)
Failure to provide required basic services resulting in resident R1 going AWOL on 03/23/2021 and 05/16/2021 despite being unable to leave unassisted.
Report Facts
Civil Penalty Amount: 500
Deficiency Count: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met during visit and involved in exit interview |
| Lady Cabrera | Licensing Program Analyst | Conducted the Case Management visit and authored the report |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor named in the report |
Inspection Report
Census: 70
Capacity: 93
Deficiencies: 0
Date: May 26, 2021
Visit Reason
The visit was an unannounced case management visit to address an incident that occurred on 03/21/2021, following up on the health and safety check of Resident 1 (R1).
Findings
Licensing Program Analysts conducted the visit and requested documents including the Most Physician Report 602, Reappraisal/Assessment, and Admission Agreement from the facility.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with Licensing Program Analysts during the visit |
| Lady Cabrera | Licensing Program Analyst | Conducted the unannounced case management visit |
| Les Xiong | Licensing Program Analyst | Conducted the unannounced case management visit |
| Sergiy Pidgirny | Licensing Program Manager | Named in the report header |
Inspection Report
Census: 70
Capacity: 93
Deficiencies: 0
Date: May 26, 2021
Visit Reason
The visit was an unannounced case management visit to address incidents that occurred on 03/23/2021 and 05/16/2021, following up on the health and safety check of Resident 1 (R1).
Findings
Licensing Program Analysts conducted the visit and requested specific documents from the facility including the Most Physician Report 602, Reappraisal/Assessment, and Admission Agreement to follow up on the unusual incident reports submitted by facility staff.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with Licensing Program Analysts during the case management visit. |
Inspection Report
Follow-Up
Census: 69
Capacity: 93
Deficiencies: 1
Date: May 5, 2021
Visit Reason
Subsequent Case Management visit to discuss information obtained from the initial visit conducted on 04/23/2021, focusing on deficiencies related to medication administration.
Findings
The Licensee did not meet California Code of Regulations Title 22, Division 6, Chapter 8, Section 87465(c)(2) regarding Incidental Medical and Dental Care due to a medication error where a resident missed a prescribed dose. This is the third violation within twelve months, resulting in a civil penalty of $250.
Deficiencies (1)
Failure to meet Incidental Medical Care requirements as a resident missed a prescribed medication dose due to medication being misplaced.
Report Facts
Civil Penalty Amount: 250
Violation Count: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Facility administrator mentioned in relation to the visit. |
| Tracy Seibert | Memory Care Director | Met with Licensing Program Analyst during the visit and involved in exit interview. |
| Lady Cabrera | Licensing Program Analyst | Conducted the Case Management visit and investigation. |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor mentioned in the report. |
Inspection Report
Census: 69
Capacity: 93
Deficiencies: 0
Date: May 5, 2021
Visit Reason
The visit was a case management follow-up conducted by phone due to COVID-19 precautionary measures, to follow up on the health and safety check of two residents and to obtain additional information related to an Unusual Incident/Injury Report received on 04/30/2021.
Findings
The Licensing Program Analyst contacted the Memory Care Director by phone to request several documents including the Resident’s Admission Agreement, Physician's Report, Facility Narratives, and Staff contact information, which were to be submitted by 05/07/2021.
Report Facts
Capacity: 93
Census: 69
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Facility Administrator mentioned in relation to the visit |
| Tracy Seibert | Memory Care Director | Met with Licensing Program Analyst during the visit |
| Lady Cabrera | Licensing Program Analyst | Conducted the phone contact and follow-up |
| Sergiy Pidgirny | Licensing Program Manager | Named in the report header |
Inspection Report
Census: 69
Capacity: 93
Deficiencies: 0
Date: May 5, 2021
Visit Reason
The visit was a case management follow-up conducted by phone due to COVID-19 precautionary measures, following receipt of an Unusual Incident/Injury Report to check on the health and safety of two residents and to obtain additional information.
Findings
The Licensing Program Analyst contacted the Memory Care Director by phone to discuss the incident and requested several documents including the Resident’s Admission Agreement, Physician's Report, Facility Narratives, and Staff contact information to be submitted by 5/7/2021.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Named as the facility administrator who designated the Memory Care Director to meet with the Licensing Program Analyst. |
| Tracy Seibert | Memory Care Director | Met with the Licensing Program Analyst by phone to discuss the incident and provide information. |
| Lady Cabrera | Licensing Program Analyst | Conducted the phone follow-up and requested documents related to the incident. |
| Sergiy Pidgirny | Licensing Program Manager | Named as the Licensing Program Manager on the report. |
Inspection Report
Census: 72
Capacity: 93
Deficiencies: 0
Date: Apr 23, 2021
Visit Reason
The visit was a case management follow-up conducted by phone due to COVID-19 precautionary measures and to follow up on an Unusual Incident/Injury Report received on 03/18/2021, focusing on the health and safety check of a resident and obtaining additional information regarding the resident's change of condition.
Findings
The Licensing Program Analyst requested several documents including the resident’s admission agreement, physician's report and orders, facility assessments, medication lists, and staff contact information to be submitted by 4/27/2021. No deficiencies or violations were explicitly stated in the report.
Report Facts
Capacity: 93
Census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Facility administrator named in the report header |
| Tracy Seibert | Memory Care Director | Met with Licensing Program Analyst during the visit |
| Lady Cabrera | Licensing Program Analyst | Conducted the phone contact and follow-up |
| Sergiy Pidgirny | Licensing Program Manager | Named in the report |
Inspection Report
Census: 72
Capacity: 93
Deficiencies: 0
Date: Apr 23, 2021
Visit Reason
The visit was a case management follow-up conducted by phone due to COVID-19 precautionary measures and to follow up on an unusual incident/injury report related to a medication error that occurred on 03/23/2021.
Findings
The Memory Care Director reported that staff involved in the medication error were immediately retrained. Licensing Program Analyst requested several documents related to the incident to be submitted by 04/27/2021.
Report Facts
Capacity: 93
Census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Seibert | Memory Care Director | Contacted by Licensing Program Analyst regarding medication error and follow-up |
| Lady Cabrera | Licensing Program Analyst | Conducted the follow-up phone call and requested documents |
| Sergiy Pidgirny | Licensing Program Manager | Named in the report header |
Inspection Report
Complaint Investigation
Capacity: 93
Deficiencies: 1
Date: Mar 25, 2021
Visit Reason
The visit was a Case Management follow-up conducted to discuss information obtained from an initial visit on 03/04/2021, specifically regarding medication administration errors.
Complaint Details
This was a complaint-related visit triggered by a medication error incident. It was the second violation within twelve months, with the first violation occurring on 11/17/2020. A civil penalty of $250.00 was assessed.
Findings
During the investigation, it was found that staff administered the wrong medication to a resident, resulting in a double dose. The resident was monitored with no adverse reactions. The licensee did not meet California Code of Regulations related to Incidental Medical and Dental Care, resulting in a cited deficiency and a civil penalty.
Deficiencies (1)
Failure to meet Incidental Medical Care requirements as staff administered wrong medication causing a double dose to a resident.
Report Facts
Civil Penalty: 250
Capacity: 93
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with Licensing Program Analyst during the visit and involved in exit interview |
| Lady Cabrera | Licensing Program Analyst | Conducted the Case Management visit and investigation |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 93
Deficiencies: 1
Date: Mar 4, 2021
Visit Reason
The inspection was an unannounced Case Management - Deficiencies visit conducted via telephone due to COVID-19 precautions, triggered by staff reports of Unusual Incident/Injury Reports submitted to the licensing agency.
Complaint Details
The complaint was substantiated based on the preponderance of evidence standard after review of staff statements and incident reports related to an event on 1/21/2020.
Findings
The Licensee was found to have not met the California Code of Regulations regarding Personal Rights of Residents, specifically failing to ensure residents were free from punishment, humiliation, intimidation, abuse, or other actions interfering with daily living functions. The allegation was substantiated based on interviews and records review.
Deficiencies (1)
Failure to meet Personal Rights of residents, including freedom from punishment, humiliation, intimidation, abuse, or other actions interfering with daily living functions such as eating and sleeping.
Report Facts
Capacity: 93
Census: 66
Deficiency count: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Met with Licensing Program Analyst during inspection and involved in exit interview |
| Lady Cabrera | Licensing Program Analyst | Conducted the unannounced Case Management - Deficiencies visit and authored the report |
| Sergiy Pidgirny | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 69
Capacity: 93
Deficiencies: 0
Date: Jan 28, 2021
Visit Reason
The visit was a case management incident follow-up conducted by phone to check on the health and safety of residents and to obtain additional information related to an unusual incident/injury report received by Community Care Licensing.
Findings
The Licensing Program Analyst contacted the facility administrator due to COVID-19 precautionary measures and requested several documents including the Resident’s Admission Agreement, LIC602A, staff contact information, and police report case number. An exit interview was conducted and a copy of the report was provided via email.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Wilds | Administrator | Facility administrator contacted during the incident follow-up and exit interview. |
| Lady Cabrera | Licensing Program Analyst | Conducted the phone follow-up and requested documents. |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
Date: Nov 17, 2020
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that staff were mismanaging residents' medications.
Complaint Details
The complaint was substantiated. The investigation was conducted via telephone due to COVID-19 precautions. The allegation involved mismanagement of residents' medications. The preponderance of evidence standard was met, confirming the allegation.
Findings
The investigation found the allegation substantiated based on records review and interviews. Medications had not been dispensed correctly according to physician directions, posing an immediate risk to residents.
Deficiencies (1)
Incidental Medical and Dental Care: Licensee failed to administer medications according to physician's directions, posing an immediate risk to residents.
Report Facts
Capacity: 93
Census: 75
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dixie Marie Wright | Licensing Program Analyst | Conducted the complaint investigation |
| Tyler Wilds | Facility representative met during investigation | |
| Melinda Hoffmann | Licensing Program Manager | Named in report as Licensing Program Manager |
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