Inspection Reports for Lake Park Senior Living
1850 Alice St, Oakland, CA 94612, United States, CA
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally good compliance with regulations. However, some substantiated issues have occurred, primarily related to facility maintenance, staffing, security, and adherence to contractual obligations. Notably, the facility was fined $250 in June 2025 for failing to maintain an elevator in good repair, which posed an immediate health and safety risk, and earlier reports cited inadequate staff training and insufficient night shift staffing. Other substantiated deficiencies included failure to provide 24-hour security as required by contracts, illegal eviction of a resident, and failure to obtain building permits for renovations. The most recent report from July 22, 2025, was clean with no deficiencies, showing some improvement after prior issues.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
5.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
45% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
44% occupied
Based on a July 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Census: 122
Capacity: 275
Deficiencies: 0
Date: Jul 22, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations received on 2025-07-08 regarding staff supplies, training, reporting, resident condition evaluation, pest control, food service, and facility maintenance.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included insufficient supplies for resident hygiene and infection control, inadequate staff training, failure to follow reporting requirements, failure to evaluate changes in resident condition, pest issues, inadequate food service, and poor facility maintenance. None of these allegations were substantiated based on evidence gathered.
Findings
All allegations were found to be unsubstantiated based on staff interviews, record reviews, observations, and documentation. The facility was found to have sufficient supplies, adequate staff training, proper reporting procedures, resident assessments, pest control measures, adequate food service, and proper facility maintenance.
Report Facts
Capacity: 275
Census: 122
Number of staff interviewed: 5
Number of resident appraisals reviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during investigation and named in reporting requirements finding |
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 275
Deficiencies: 1
Date: Jun 19, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the licensee is not ensuring that the facility elevator is maintained in good repair.
Complaint Details
The allegation that the licensee is not ensuring the facility elevator is maintained in good repair was substantiated. An immediate civil penalty of $250 was assessed for a repeat violation. Failure to submit proof of correction by the plan of correction due date and any repeat violation within 12 months may result in further civil penalties.
Findings
The investigation found that elevator two has been out of service since November and remains nonoperational despite management's efforts to repair it. The allegation was substantiated, posing an immediate health and safety risk to persons in care.
Deficiencies (1)
Failure to maintain the facility elevator in good repair, posing an immediate health and safety risk to persons in care.
Report Facts
Civil Penalty: 250
Capacity: 275
Census: 121
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during investigation and discussed deficiency plan and proof of correction. |
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation and delivered findings. |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation report. |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 0
Date: Apr 22, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that the facility does not have sufficient staff to meet residents' needs in the provision of food services.
Complaint Details
The complaint alleged insufficient staffing for food services. The investigation included interviews and record reviews, concluding the allegation was unsubstantiated.
Findings
The investigation found that there is sufficient staff for food service and no resident requires assistance with feeding. The allegation was determined to be unsubstantiated due to lack of evidence.
Report Facts
Capacity: 275
Census: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Fouzia Yaagoub | Business Office Manager | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 0
Date: Apr 22, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that the facility does not employ a qualified food service consultant and that disaster drills are not being conducted as required.
Complaint Details
The complaint investigation was unannounced and conducted based on allegations received on 2025-04-17. Both allegations were found unsubstantiated after interviews and record reviews.
Findings
The investigation found that the facility employs a qualified full-time food service employee and a dietician, and disaster drills are conducted monthly and properly logged. Both allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 275
Census: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Fouzia Yaagoub | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Kirsten Korfhage | Administrator | Facility Administrator named in report |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 1
Date: Apr 22, 2025
Visit Reason
This was an unannounced complaint investigation visit triggered by a complaint received on 2025-03-25 regarding the facility elevator maintenance.
Complaint Details
The allegation that the licensee is not ensuring that the facility elevator is maintained in good repair was substantiated.
Findings
The investigation substantiated that elevator two has been out of service since November and remains nonoperational despite management efforts to repair it.
Deficiencies (1)
Facility elevator two has been inoperational since November, violating maintenance and operation requirements.
Report Facts
Capacity: 275
Census: 100
Deficiency Plan of Correction Due Date: Apr 29, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Fouzia Yaagoub | Business Office Manager | Met with Licensing Program Analyst during inspection |
Inspection Report
Census: 110
Capacity: 275
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was an unannounced office meeting conducted to verify a Chapter 7 Bankruptcy Report filed by Pacifica Senior Living as reported by the media.
Findings
The meeting confirmed multiple lawsuits involving Pacifica Senior Living management companies, including a $25M lawsuit in Bakersfield and others related to photography and a Skilled Nursing Facility. It was stated that these lawsuits had no financial impact on the properties, residents, or staff, and there were no vendor issues. Management communicated changes to staff and residents, and the bankruptcy did not affect the communities as Pacifica Senior Living was no longer the management company.
Report Facts
Lawsuit amount: 25000000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Carl Knepler | Chief Executive Officer | Provided information regarding lawsuits and financial impact during the meeting |
| Stacy Barlow | Assistant Program Administrator | Conducted the meeting to verify bankruptcy report |
| Shelley Grace | Assistant Branch Chief, CCLD | Present during the meeting |
| Craig Lundgren | Legal Counsel, CCLD | Present during the meeting |
| Marlene Nelson | Director, Quality Assurance and Risk Management | Present during the meeting |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 275
Deficiencies: 0
Date: Mar 11, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff did not ensure the facility elevator was properly operating.
Complaint Details
The complaint alleged that the facility elevator was in disrepair. Interviews with residents and staff, and observation of the elevator repair technician were conducted. The allegation was found unsubstantiated.
Findings
The investigation found that although the elevator had been closing on residents, no injuries were reported and the elevator was being repaired at the time of the visit. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 275
Census: 102
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report signature |
| Fouzia Yaagoub | Business Office Manager | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 1
Date: Feb 21, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the facility elevator is in disrepair.
Complaint Details
The complaint alleged that the facility elevator was in disrepair. The investigation included interviews with the Executive Director and residents, and review of service and maintenance logs. It was determined the elevator was being repaired and there was no preponderance of evidence to substantiate the allegation.
Findings
The investigation found the allegation unsubstantiated as the elevator was in the process of being repaired with documented plans and a reasonable timeline for completion.
Deficiencies (1)
Facility elevator is in disrepair.
Report Facts
Facility capacity: 275
Census: 100
Number of repair companies contacted: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during investigation and involved in elevator repair discussions |
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 275
Deficiencies: 0
Date: Jan 23, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff mismanaged a resident's medication.
Complaint Details
The complaint alleged that staff mismanaged a resident's medication. The investigation reviewed R1's MAR, medication count sheet, physician report, care plan, and medication staff communication log. Medication was removed from the facility before verification. The allegation was unsubstantiated.
Findings
The investigation included interviews and review of medication records and logs. The allegation of medication mismanagement was found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 275
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report signature |
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analysts during investigation |
| Roza Medini | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 99
Capacity: 275
Deficiencies: 0
Date: Jan 23, 2025
Visit Reason
The inspection was conducted as a 10-day initial complaint investigation regarding an allegation that the facility's Disaster Plan does not meet Regulation Requirements.
Complaint Details
The complaint alleged that the facility’s Disaster Plan was out of compliance, specifically that the Evacuation component had an expired date. The investigation found no evidence to substantiate this claim.
Findings
The investigation found the allegation unsubstantiated after review and interview, confirming that the Disaster Plan was current and met regulatory requirements.
Report Facts
Complaint Control Number: 15-AS-20250117120802
Capacity: 275
Census: 99
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analysts during the investigation |
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 99
Capacity: 275
Deficiencies: 2
Date: Jan 9, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2024-04-26 concerning resident rights and care at Lake Park Senior Living Facility.
Complaint Details
The complaint investigation was substantiated for allegations that staff did not provide resident’s authorized representative with records and did not provide resident with privacy. Other allegations were unsubstantiated. The investigation included interviews, record reviews, and observations conducted by Licensing Program Analyst Laura Hall.
Findings
The investigation substantiated allegations that staff did not provide the resident's authorized representative with records in a timely manner and did not provide the resident with privacy. Other allegations including falsification of appraisal documentation, lack of assistance with hygiene and laundry, and an uncomfortable environment were found unsubstantiated.
Deficiencies (2)
Failure to provide prompt access to resident's records to authorized representative.
Failure to provide resident with a reasonable level of personal privacy.
Report Facts
Capacity: 275
Census: 99
Plan of Correction Due Date: Jan 24, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Kirsten Korfhage | Executive Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 275
Deficiencies: 1
Date: Dec 12, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2024-02-20 regarding allegations including the facility being in financial distress and plumbing disrepair.
Complaint Details
The complaint investigation was substantiated for the allegation of financial distress, with evidence including past due utility bills from PG&E and Waste Management, unpaid contractor invoices totaling $42,800 for sewer lateral repairs, and non-payment for pest and caregiver services. The plumbing disrepair allegation was unsubstantiated after interviews and review of maintenance work completed in 2023.
Findings
The allegation that the facility is in financial distress was substantiated based on interviews, document reviews, and observations showing unpaid utility bills and contractor invoices. The plumbing disrepair allegation was unsubstantiated due to lack of sufficient evidence. No deficiencies were cited for plumbing, but a financial deficiency was cited related to failure to maintain sufficient resources to meet operating costs.
Deficiencies (1)
The licensee shall have a financial plan that assures sufficient resources to meet operating costs for care of residents.
Report Facts
Capacity: 275
Census: 94
Unpaid contractor invoice amount: 42800
Unpaid contractor invoice amount: 8514.99
POC Due Date: Jan 17, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analysts during investigation and exit interview |
| Lori Alexander-Washington | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Bennett Fong | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 275
Deficiencies: 0
Date: Dec 10, 2024
Visit Reason
The inspection was an unannounced continuing complaint investigation visit conducted due to allegations that the facility was not complying with its approved plan of operation and that staff mismanaged a resident's medication.
Complaint Details
The complaint investigation included two allegations: 1) Facility not complying with approved plan of operation, which was substantiated; 2) Staff mismanaged resident's medication, which was unsubstantiated. The investigation involved interviews with staff and review of relevant documentation. The medication mismanagement allegation could not be substantiated because the medication was removed from the facility and exact pill counts could not be verified.
Findings
The allegation that the facility was not complying with the approved plan of operation was substantiated due to conflicting language in the electronic admission agreement. The allegation of staff mismanaging a resident's medication was unsubstantiated due to lack of sufficient evidence. No new deficiencies were issued during this visit due to previous substantiation and deficiencies cited on 7/25/2024.
Report Facts
Facility capacity: 275
Census: 98
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Doidge | Licensing Program Analyst | Conducted the complaint investigation visit |
| Bennett Fong | Licensing Program Manager | Accompanied the Licensing Program Analyst during the investigation |
| Kirsten Korfhage | Executive Director | Met with investigators during the visit |
| Roza Medini | Administrator | Facility administrator named in the report |
Inspection Report
Annual Inspection
Census: 97
Capacity: 275
Deficiencies: 0
Date: Dec 4, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted by Licensing Program Analysts to evaluate compliance with regulatory standards.
Findings
The facility was toured and inspected, including resident and staff records review. No deficiencies were observed or cited during the visit. Safety equipment and environmental conditions were found to be in proper working order.
Report Facts
Resident records reviewed: 5
Staff records reviewed: 5
Fire extinguisher last serviced: Aug 12, 2024
Emergency disaster drill last conducted: Nov 26, 2024
Hot water temperature: 112.2
Hallway temperature: 72
Food supply: 7
Food supply: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analysts during inspection |
| David Doidge | Licensing Program Analyst | Conducted the inspection |
| C. Fowler | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 2
Date: Dec 4, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including inadequate staff training and insufficient staffing at the facility.
Complaint Details
The complaint investigation was substantiated for allegations of inadequate staff training and insufficient staffing. The allegations regarding failure to perform required annual re-appraisals and lack of a required dietician were unsubstantiated.
Findings
The investigation substantiated allegations that facility staff were inadequately trained and that there was insufficient staffing during the night shift, posing health and safety risks. Two other allegations regarding failure to perform required annual re-appraisals and lack of a required dietician were found unsubstantiated.
Deficiencies (2)
Facility staff training was not current, posing an immediate health and safety risk to persons in care.
Facility did not have sufficient staff to meet residents' needs such as assistance with two-person transfers and diapering during night shift, posing potential health and personal rights risks.
Report Facts
Facility capacity: 275
Census: 97
Deficiency count: 2
Plan of Correction due date: Jan 6, 2025
Staff on night shift: 2
Resident files sampled: 7
Resident files with expired re-appraisal: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Carol Fowler | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| David Doidge | Licensing Program Analyst | Participated in the complaint investigation visit |
| Kirsten Korfhage | Executive Director | Met with LPAs during the investigation and was involved in discussions regarding findings |
| Roza Medini | Administrator | Facility administrator named in the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 1
Date: Nov 22, 2024
Visit Reason
An unannounced Case Management visit was conducted on 11/22/2024 to follow up on a complaint investigation (#15-AS-20240503094454) regarding visitor sign-in procedures and resident safety.
Complaint Details
The visit was complaint-related, investigating complaint #15-AS-20240503094454. The complaint was substantiated as the facility was found not requiring visitor sign-in, exposing residents to personal rights violations.
Findings
The facility was found not requiring visitors to sign in and allowing them to access residents' apartments without signing in, posing a potential safety and personal rights risk to residents.
Deficiencies (1)
Residents of residential care facilities for the elderly were not protected as the facility failed to monitor individuals entering or require visitors to sign in, posing a safety and personal rights risk.
Report Facts
Capacity: 275
Census: 97
Deficiency count: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during the inspection |
| Alona Gomez | Licensing Program Analyst | Conducted the unannounced Case Management visit and complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor and Licensing Program Manager named in the report |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 0
Date: Nov 22, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation that staff interfered with the designation of a responsible person for a resident.
Complaint Details
The complaint alleged staff interference with the designation of a responsible person for a resident. The investigation included interviews, record reviews, and document analysis. The allegation was found to be unsubstantiated due to lack of evidence.
Findings
The investigation found insufficient evidence to substantiate the allegation. The previous Executive Director followed appropriate procedures by contacting the resident's emergency contact and other relevant parties, and did not interfere with the designation of the responsible person. The allegation was determined to be unsubstantiated.
Report Facts
Capacity: 275
Census: 97
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during investigation |
| Roza Medini | Administrator | Facility administrator named in report header |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 221
Capacity: 275
Deficiencies: 1
Date: Nov 8, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility was overcharging a resident.
Complaint Details
The complaint was substantiated based on interviews and records review. The resident stated they had sufficient funds and no bank charge for NSF. The facility was found to have improperly charged the resident $50.00 for NSF. The deficiency is cited under Title 22 California Code of Regulations section 87468.2(a)(8).
Findings
The investigation substantiated the allegation that the facility charged a resident a $50.00 fee for insufficient funds (NSF) which was not reversed, despite the resident having sufficient funds and no bank charge for NSF. The facility reversed a $250.00 late payment charge but refused to reverse the $50.00 NSF fee.
Deficiencies (1)
Facility charged resident $50.00 for NSF fee which was not reversed, violating Additional Personal Rights of Residents in Privately Operated Facilities under CCR 87468.2(a)(8).
Report Facts
Late payment charge reversed: 250
NSF fee charged: 50
Facility capacity: 275
Resident census: 221
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Fouzia Yaagoub | Business Office Manager | Interviewed during investigation regarding the charges |
| Kirsten Korfhage | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 275
Deficiencies: 0
Date: Oct 9, 2024
Visit Reason
The visit was an unannounced Case Management inspection conducted as part of a complaint investigation regarding the facility's surety bond status and resident cash management.
Complaint Details
The complaint investigation was triggered by information received on 09/17/2024 that the management and ownership did not have a surety bond.
Findings
No deficiencies were issued during the visit. The Executive Director confirmed the facility does not hold residents' cash, which may be managed by fiduciaries or bankers.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Interviewed during the complaint investigation regarding surety bond and resident cash management. |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 275
Deficiencies: 0
Date: Sep 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-02-12 regarding staff not ensuring a healthful environment and inadequate food services for residents.
Complaint Details
The complaint alleged that staff were not ensuring a healthful environment and that the licensee did not provide adequate food services. The investigation included interviews with the reporting party and residents, who stated the food issue had been resolved. The allegations were unsubstantiated due to lack of sufficient evidence.
Findings
The investigation found no preponderance of evidence to substantiate the allegations; the complaint was determined to be unsubstantiated after interviews and review.
Report Facts
Capacity: 275
Census: 92
Employees mentioned
| Name | Title | Context |
|---|---|---|
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kirsten Korfhage | Executive Director | Met with the Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 114
Capacity: 275
Deficiencies: 0
Date: Aug 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate an allegation that staff did not provide safe transportation for a resident.
Complaint Details
The complaint alleged that staff did not provide safe transportation for a resident. The complaint was investigated and found to be unsubstantiated.
Findings
The investigation found that residents who are wheelchair-bound were not transported by facility staff using the facility's vans because it was impossible to accommodate wheelchairs in the vans. Transportation for wheelchair-bound residents was arranged through a sister facility or a private company. The allegation was closed as unsubstantiated due to insufficient evidence to prove the violation occurred.
Report Facts
Capacity: 275
Census: 114
Staff interviewed: 5
Residents interviewed: 3
Residents stating no transportation: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kenia Tobete | Activity Director | Met with Licensing Program Analyst during investigation |
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 275
Deficiencies: 1
Date: Jul 25, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation regarding allegations that the facility changed its Plan of Operation without Community Care Licensing Division (CCLD) approval.
Complaint Details
The complaint alleged that the facility changed the Plan of Operation without CCLD approval. The allegation was substantiated based on interviews, observations, and record reviews.
Findings
The investigation substantiated that the facility changed its Plan of Operation to lease units to 55+ independent renters and Section 8 recipients without CCLD approval, which is a significant change affecting resident services and poses potential health, safety, or personal rights risks.
Deficiencies (1)
The licensee did not comply with the requirement to submit any significant changes in the plan of operation to the licensing agency for approval by changing the plan of operation without CCLD approval.
Report Facts
Capacity: 275
Census: 92
Deficiency Type Count: 1
Plan of Correction Due Date: Aug 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 275
Deficiencies: 1
Date: Jul 25, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the licensee did not adhere to the terms and conditions of the Admission Agreement, specifically regarding the provision of 24-hour security service.
Complaint Details
The complaint was substantiated. The allegation was that the licensee did not adhere to the terms and conditions of the Admission Agreement, specifically the provision of 24-hour security service. Interviews with staff, residents, and witnesses confirmed the lack of dedicated security personnel, non-operational security cameras, and unsecured facility entrances, which violated the terms of the CCRC contracts.
Findings
The investigation substantiated the allegation that the facility failed to provide the 24-hour security service as required by existing Continuing Care Retirement Community (CCRC) contracts, posing a potential health, safety, and personal rights risk to residents. The facility had discontinued dedicated security guard services and non-operational security cameras due to non-payment since Spring 2023.
Deficiencies (1)
Failure to provide adequate 24-hour security as specified in existing CCRC contracts, violating HSC 1793.2(s).
Report Facts
Capacity: 275
Census: 92
Plan of Correction Due Date: Aug 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Kirsten Korfhage | Executive Director | Facility representative met during the investigation and exit interview |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 275
Deficiencies: 0
Date: Jun 21, 2024
Visit Reason
The visit was conducted as a Case Management visit and complaint investigation regarding concerns about food availability for residents reported on 05/26/2024.
Complaint Details
The complaint investigation was related to questionable food availability for residents. The complaint was not substantiated as adequate food was found during the visit.
Findings
During the complaint investigation, it was observed that adequate food was available for residents, and no deficiencies were issued during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kirsten Korfhage | Executive Director | Met with Licensing Program Analyst during the visit. |
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the complaint investigation and Case Management visit. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 275
Deficiencies: 1
Date: Jun 21, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff did not get the proper permits for renovation in the facility.
Complaint Details
The complaint was substantiated based on evidence that the facility did not obtain the required permits for renovation involving gas line changes and equipment replacement.
Findings
The allegation was substantiated. The investigation found that the facility replaced kitchen equipment and moved gas lines without obtaining the required building permit, posing a potential health and safety risk to residents.
Deficiencies (1)
Failure to obtain a building permit prior to construction or alterations in the kitchen.
Report Facts
Capacity: 275
Census: 89
Plan of Correction Due Date: Jul 5, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Kirsten Korfhage | Executive Director | Met with the Licensing Program Analyst during the investigation. |
| Bennett Fong | Licensing Program Manager | Named in relation to the deficiency citation and report. |
Inspection Report
Complaint Investigation
Census: 17
Capacity: 275
Deficiencies: 0
Date: May 29, 2024
Visit Reason
An unannounced complaint investigation was conducted to investigate allegations that staff did not adhere to a resident's admissions agreement, specifically regarding the failure to replace a broken refrigerator in a resident's unit.
Complaint Details
The complaint alleged that the facility failed to replace a broken refrigerator as required by the admissions agreement. The complaint was investigated and found unsubstantiated.
Findings
The investigation found that four out of five residents interviewed had refrigerators in their units in working condition, and one resident whose refrigerator was not working had it replaced immediately without charge. The refrigerators inspected were observed to be operating. The allegation was closed as unsubstantiated due to lack of preponderance of evidence.
Report Facts
Residents interviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during investigation |
| Aryanna Henry | Business Office Manager | Met with Licensing Program Analyst during investigation and signed report |
| Roza Medini | Administrator | Facility administrator named in report header |
| Bennett Fong | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 275
Deficiencies: 0
Date: Apr 15, 2024
Visit Reason
An unannounced complaint investigation visit was conducted regarding an allegation that the facility has pests.
Complaint Details
The complaint was unsubstantiated after investigation. Pest presence was acknowledged but addressed with pest control company Clark, which recommended weekly visits to eliminate the issue. The Executive Director approved the recommendation.
Findings
The investigation found that although pests were present in the kitchen, the issue had been addressed with pest control services. Multiple traps were observed and pest control visits had recently resumed. The allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 275
Census: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Plan of Correction
Census: 105
Capacity: 275
Deficiencies: 1
Date: Apr 11, 2024
Visit Reason
The visit was an unannounced Proof of Correction (POC) inspection to verify correction of previously cited deficiencies related to billing and payment status for PG&E and Waste Management accounts.
Findings
The deficiencies related to unpaid accounts were cleared as the facility demonstrated that PG&E and Waste Management accounts were current and paid through March 2024. An exit interview was conducted and a Letter of Deficiency Citations Cleared was provided.
Deficiencies (1)
87755(b) - PG&E and Waste Management accounts are current and paid up through March 2024.
Report Facts
Capacity: 275
Census: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during the inspection and discussed deficiencies and proof of correction |
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the unannounced Proof of Correction visit |
Inspection Report
Census: 105
Capacity: 275
Deficiencies: 0
Date: Apr 9, 2024
Visit Reason
The visit was a Case Management conducted while at the facility for another matter, related to a prior complaint investigation.
Complaint Details
The visit referenced a prior complaint investigation (#15-AS-20240220153014) conducted on 2024-02-21 involving non-payment for caregiver services and related invoices.
Findings
No citations were issued during this visit. The Licensing Program Analyst reviewed documents related to non-payment for caregiver services and other accounts, and conducted an exit interview.
Report Facts
Facility capacity: 275
Census: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during visit |
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the Case Management visit |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Census: 103
Capacity: 275
Deficiencies: 1
Date: Mar 28, 2024
Visit Reason
The visit was an unannounced Case Management visit related to complaint 15-AS-2024 0220153014, focusing on obtaining documents and information about the payment history for utility accounts and service vendors.
Complaint Details
The visit was related to complaint 15-AS-2024 0220153014. The facility did not provide requested documents despite multiple requests on 2/21/24, 2/28/24, 2/29/24, 3/1/24, 3/11/24, 3/12/24, and 3/13/24.
Findings
The facility failed to provide requested accounting documents related to gas, electricity, and waste collection services, resulting in cited deficiencies for noncompliance with California Code of Regulation, Title 22, posing an immediate health and safety risk.
Deficiencies (1)
Failure to provide requested account documents for utilities, vendors accounts, and status of outstanding payments, posing an immediate health and safety risk to persons in care.
Report Facts
Capacity: 275
Census: 103
Plan of Correction Due Date: Apr 4, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
| Annemarie Domizio | Executive Director | Facility representative met during the visit |
Inspection Report
Census: 3
Capacity: 275
Deficiencies: 0
Date: Mar 28, 2024
Visit Reason
An unannounced Health and Safety check was conducted to assess utilities operation, cleanliness, garbage buildup, and resident well-being.
Findings
The facility was found to be clean with no imminent health and safety concerns. Residents appeared safe and no deficiencies were cited during the visit.
Report Facts
Staff observed: 3
Residents observed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during the visit |
| Lori Alexander | Licensing Program Analyst | Conducted the unannounced Health and Safety check |
| Bennett Fong | Licensing Program Manager | Named in the report header |
Inspection Report
Census: 103
Capacity: 275
Deficiencies: 0
Date: Mar 28, 2024
Visit Reason
An unannounced Case Management visit was conducted to gather information regarding the facility's intent to rent units to independent 55+ individuals and persons with Section 8 Vouchers, and to clarify policies about Physician’s Reports and Tuberculosis tests for these residents.
Findings
No citations were issued during this visit. The Licensing Program Analyst met with the Executive Director and obtained relevant documents including lease agreements and rental applications. An exit interview was conducted and a copy of the report was provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during the visit to provide information. |
| Lori Alexander | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Bennett Fong | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 0
Date: Feb 16, 2024
Visit Reason
An unannounced complaint investigation visit was conducted on 02/16/2024 concerning allegations that staff did not ensure the facility restrooms were equipped with grab bars, had toiletries, and were kept clean.
Complaint Details
The complaint investigation was unsubstantiated as there was not a preponderance of evidence to prove the allegations regarding restroom grab bars, toiletries, and cleanliness.
Findings
The investigation found that although there were no ADA-compliant grab bars currently in the public restrooms due to supply delays, the facility planned to complete updates by the end of February 2024. The restrooms did have toiletries and were kept clean. There was insufficient evidence to substantiate the allegations, and the complaint was unsubstantiated.
Report Facts
Census: 100
Total Capacity: 275
Employees mentioned
| Name | Title | Context |
|---|---|---|
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation |
| Annemarie Domizio | Executive Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 0
Date: Feb 9, 2024
Visit Reason
An unannounced complaint investigation visit was conducted on 02/09/2024 concerning allegations that staff were not following a resident's care plan and that the facility was in disrepair.
Complaint Details
The complaint investigation was unsubstantiated based on evidence gathered, including staff interviews and documentation review. Allegations included staff not following resident's care plan and facility disrepair.
Findings
The investigation found both allegations to be unsubstantiated. Staff interviews and review of shower logs showed no disruption in resident care or facility services during renovations.
Report Facts
Capacity: 275
Census: 100
Renovation duration: 4
Shower frequency: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation |
| Annemarie Domizio | Executive Director | Facility representative met during investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 1
Date: Feb 9, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to allegations received on 2024-01-29 regarding facility disrepair, cleanliness, and safety concerns for residents.
Complaint Details
The complaint investigation was substantiated for the allegation of facility disrepair related to security doors. The allegations of uncleanliness and unsafe environment were unsubstantiated based on interviews and observations.
Findings
The allegation that the facility is in disrepair was substantiated due to unrepaired security doors posing a safety risk. Allegations that the facility was unclean and that staff did not provide a safe environment were unsubstantiated after interviews and facility tours.
Deficiencies (1)
The facility had not repaired the front door for over a month and the basement door for more than four months, posing a potential health and safety risk to residents.
Report Facts
Capacity: 275
Census: 100
Plan of Correction Due Date: Mar 1, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Annemarie Domizio | Executive Director | Facility representative met during investigation |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 1
Date: Feb 5, 2024
Visit Reason
An unannounced initial 10-day complaint investigation was conducted to assess compliance with emergency drill requirements.
Complaint Details
The visit was complaint-related and involved an unannounced initial 10-day complaint investigation. The deficiency was substantiated based on evidence and statements.
Findings
The facility was found not to be conducting required quarterly emergency drills for each shift, as evidenced by lack of documentation and statements from residents and staff.
Deficiencies (1)
Failure to conduct quarterly emergency drills for each shift as required, including documentation of date, type of emergency, and staff participation.
Report Facts
Capacity: 275
Census: 97
Deficiencies cited: 1
Plan of Correction Due Date: Feb 20, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Annemarie Domizio | Executive Director | Informed of the reason for the visit and involved in the inspection |
| Aryana Henry | Business Office Manager | Participated in exit interview |
| James Sampair | Licensing Program Analyst | Conducted the inspection and signed the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 4
Date: Feb 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations including insufficient food service, failure to provide security personnel per admission agreements, staff not according residents dignity, and interference with residents exercising rights.
Complaint Details
The complaint investigation was substantiated. Allegations included insufficient food service, failure to provide security personnel, lack of dignity accorded to residents by staff, and interference with residents exercising rights. One allegation of insufficient activities was unsubstantiated.
Findings
The investigation substantiated several allegations: the facility changed food service without proper notice, failed to provide security personnel as required by admission agreements, staff did not accord residents dignity, and the facility interfered with residents exercising their rights by requiring new agreements improperly. One allegation of insufficient activities was unsubstantiated.
Deficiencies (4)
Provider failed to fulfill obligations under continuing care contracts by changing and eliminating food service components without proper notice.
Provider failed to provide security personnel as required by Residence and Services Agreement.
Facility staff did not accord residents with dignity, violating residents' rights to an environment that enhances personal dignity.
Facility interfered with residents exercising rights by requiring new agreements improperly and moving a resident to assisted living without proper agreement.
Report Facts
Capacity: 275
Census: 97
Deficiency count: 4
Plan of Correction Due Date: Feb 16, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during inspection and provided information |
| Roza Medini | Administrator | Interviewed regarding facility status and agreements |
| Aryanna Henry | Business Office Manager | Participated in exit interview |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 2
Date: Feb 1, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that the facility illegally evicted a resident and hired an aide for a resident without obtaining consent.
Complaint Details
The complaint investigation was substantiated. Allegations included illegal eviction of a resident and hiring an aide without consent. The facility was found to have violated continuing care contract obligations and failed to issue required notices.
Findings
The investigation substantiated that the facility illegally evicted a resident who developed memory care needs despite contracts stating such residents should be retained. Additionally, the facility failed to provide required advance written notice regarding the need and costs for a 24-hour 1:1 aide.
Deficiencies (2)
Facility illegally evicted resident who developed memory care needs contrary to continuing care contracts.
Facility failed to provide advance 30-day written notice of new need and associated costs for 24-hour 1:1 aide.
Report Facts
Capacity: 275
Census: 97
Plan of Correction Due Date: Feb 16, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during investigation |
| Aryanna Henry | Business Office Manager | Participated in exit interview |
| Roza Medini | Administrator | Confirmed eviction letter issuance and family responsibilities |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 275
Deficiencies: 0
Date: Feb 1, 2024
Visit Reason
Unannounced complaint investigation visit conducted in response to an allegation that a staff person entered a resident's unit by force without authorization.
Complaint Details
Allegation: Staff person entered resident's unit by force without authorization. Investigation included interviews with resident R1, staff S1 and S2, and resident R2. All evidence indicated no forced entry occurred; the resident had made an appointment and welcomed staff into the unit.
Findings
The allegation was found to be unsubstantiated after interviews with involved parties and witnesses. No deficiencies were cited during the visit.
Report Facts
Capacity: 275
Census: 97
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during the visit and involved in the investigation |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 275
Deficiencies: 0
Date: Dec 13, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-12-05 regarding staff not maintaining the facility in good repair.
Complaint Details
The complaint alleged that staff did not maintain the facility in good repair. The investigation included interviews and document review. The heating issue was acknowledged but was being addressed. The allegations were unsubstantiated due to insufficient evidence.
Findings
The investigation found that there was a known heating issue in the building with repairs scheduled, but the complaint was unsubstantiated due to lack of preponderance of evidence to prove the alleged violations occurred.
Report Facts
Capacity: 275
Census: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the complaint investigation visit |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during investigation |
| Aryanna Henry | Business Office Manager | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 275
Deficiencies: 0
Date: Oct 24, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that facility staff does not ensure planned activities are posted in a readily accessible location for residents.
Complaint Details
The complaint allegation that facility staff does not ensure planned activities are posted in a readily accessible location for residents was investigated and found to be unsubstantiated.
Findings
The investigation found the allegation to be unsubstantiated after touring the facility, reviewing records, and interviewing staff. Planned activities were observed to be posted in accessible locations and additional copies were available for residents.
Report Facts
Capacity: 275
Census: 109
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Roza Medini | Administrator | Facility administrator mentioned in the report |
| Annmarie Dominici | Executive Director | Met with during the investigation and provided information |
Inspection Report
Census: 109
Capacity: 275
Deficiencies: 0
Date: Oct 24, 2023
Visit Reason
The visit occurred as a Case Management - Other type of visit, during which the Licensing Program Analyst toured the facility with the Executive Director to observe renovations and verify compliance with permit requirements.
Findings
The facility was observed to be clean, bright, and in good repair with no deficiencies cited during the inspection. Remodelled areas were sectioned off to ensure residents were not impacted by renovations, and a permit was secured for new bathroom tiles.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Roza Medini | Administrator | Named as facility administrator. |
| Annmarie Dominici | Executive Director | Met with Licensing Program Analyst during the visit and provided information about renovations. |
| Bennett Fong | Licensing Program Manager | Named in report header. |
| Daisy Panlilio | Licensing Program Analyst | Conducted the facility tour and inspection. |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 275
Deficiencies: 0
Date: Jul 18, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations received on 2023-01-30 regarding facility disrepair, transportation, nutrition, temperature comfort, and adherence to residents' admission agreements.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included facility disrepair, failure to provide appropriate transportation, failure to provide nutrition food service to meet residents' needs, failure to provide a comfortable temperature, and failure to adhere to residents' admission agreement. Each allegation was investigated and found unsubstantiated.
Findings
All allegations investigated were found to be unsubstantiated due to lack of preponderance of evidence proving violations. The facility was found to have operational elevators (except one broken since November 2022), available transportation options, adherence to nutritional guidelines, temperature issues resolved, and compliance with residents' admission agreements.
Report Facts
Facility capacity: 275
Census: 100
Number of elevators: 3
Broken elevators: 1
Vehicles: 3
Nutritionally balanced meals: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
| Roza Medini | Administrator | Facility administrator involved in investigation findings |
| Annemarie Domizio | Executive Director | Met with Licensing Program Analyst during visit |
Inspection Report
Census: 98
Capacity: 275
Deficiencies: 0
Date: Feb 24, 2023
Visit Reason
An unannounced case management health and safety check was conducted to assess the facility's conditions and compliance.
Findings
The facility was undergoing renovations but maintained safety and cleanliness. Adequate food supplies, PPE, staffing, and safe environment were observed. No deficiencies were cited during the inspection.
Report Facts
Temperature: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the unannounced case management health and safety check |
| Bennett Fong | Licensing Program Manager | Named in report header |
| Candice Moses | Executive Director | Met with Licensing Program Analyst during visit |
Inspection Report
Census: 99
Capacity: 275
Deficiencies: 0
Date: Feb 6, 2023
Visit Reason
The inspection visit was a Post-Licensing unannounced inspection conducted to evaluate the facility's compliance following licensing.
Findings
The facility was found to be in compliance with no deficiencies cited. Observations included proper COVID-19 screening and infection control measures, adequate food and PPE supplies, and the presence of required plans and records.
Report Facts
Food supply duration: 2
Food supply duration: 7
Supply duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Catherine Lin | Licensing Program Analyst | Conducted the Post-Licensing inspection visit |
| Candice Moses | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Census: 100
Capacity: 275
Deficiencies: 0
Date: Dec 21, 2022
Visit Reason
The visit was an unannounced case management health and safety check conducted by the Licensing Program Analyst.
Findings
The facility was found to have adequate food, PPE, and emergency supplies, sufficient staffing, and no imminent health or safety concerns. Staff were observed wearing surgical masks and infection control posters were posted.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Candice Moses | Executive Director | Met with Licensing Program Analyst during the visit. |
| Catherine Lin | Licensing Program Analyst | Conducted the unannounced case management health and safety check. |
| Bennett Fong | Licensing Program Manager | Named in the report header. |
Inspection Report
Census: 114
Capacity: 275
Deficiencies: 0
Date: Dec 7, 2022
Visit Reason
An unannounced case management health and safety check was conducted to assess the facility's compliance with health and safety standards.
Findings
The inspection found adequate food, PPE, and staffing levels, proper COVID-19 symptom screening, and no imminent health or safety concerns. Staff and residents reported no noticeable changes in service or schedules.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Candice Moses | Executive Director | Met with Licensing Program Analyst during the visit |
| Tammy Hauck | Met with Licensing Program Analyst during the visit | |
| Catherine Lin | Licensing Program Analyst | Conducted the unannounced case management health and safety check |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Census: 121
Capacity: 275
Deficiencies: 0
Date: Sep 15, 2022
Visit Reason
The visit was an office evaluation related to a Change of Ownership application for the Residential Care Facility for the Elderly with Continuing Care Retirement Community.
Findings
The applicant/administrator participated in a COMP II telephone interview to verify identification and confirm understanding of California Code Title 22 regulations, including facility operation, admission policies, staffing, health conditions, emergency preparedness, complaints, and pre-licensing readiness.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Roza Medini | Administrator | Applicant/administrator who participated in COMP II and confirmed understanding of regulations. |
| Jude De La Concepcion | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Bethany Hunter | Licensing Program Analyst | Named as Licensing Program Analyst on the report. |
Inspection Report
Original Licensing
Capacity: 275
Deficiencies: 0
Date: Sep 15, 2022
Visit Reason
A virtual meeting was conducted pertaining to the licensure application pending for Lake Park Senior Living and Pacific Grove Senior Living to review licensing expectations and requirements.
Findings
The Department reviewed expectations including staffing, facility oversight, and quality assurance audits with the applicants. The applicant agreed to the listed conditions and acknowledged licensing appeal rights.
Report Facts
Facility capacity: 275
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Pam Gill | Assistant Program Administrator | Explained Department expectations and licensing process |
| Bennett Fong | Licensing Program Analyst | Signed licensing report |
| Deepak Israni | President & Managing Partner | Participant representing Pacifica Senior Living |
| Carl Knepler | Senior Vice President of Operations | Participant representing Pacifica Senior Living |
Inspection Report
Census: 120
Capacity: 275
Deficiencies: 0
Date: Sep 12, 2022
Visit Reason
The visit was conducted as a case management inspection and included a pre-licensing inspection due to a change of ownership.
Findings
The Licensing Program Analysts conducted an unannounced case management visit and pre-licensing inspection, noting that the pre-licensing inspection was initially conducted under the old facility number and corrected to the new facility number. An exit interview was conducted and a copy of the report was provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tammy Hauck | Executive Director | Met with Licensing Program Analysts during the visit |
| Kelly Nguyen | Licensing Program Analyst | Conducted the inspection and case management visit |
| Bennett Fong | Licensing Program Manager | Named in the report header |
Inspection Report
Original Licensing
Census: 120
Capacity: 275
Deficiencies: 0
Date: Sep 9, 2022
Visit Reason
The inspection was conducted as a pre-licensing visit due to a change of ownership at the facility.
Findings
No issues were noted during the inspection. The Licensing Program Analysts observed that the facility is ready to be licensed, subject to final approval by the Central Applications Unit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tammy Hauck | Executive Director | Met with Licensing Program Analysts during the inspection. |
| Kelly Nguyen | Licensing Program Analyst | Conducted the pre-licensing inspection. |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager. |
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