Inspection Reports for Marymount Villa
345 Davis St #2795, San Leandro, CA 94577, CA, 94577
Back to Facility ProfileInspection Report Summary
Most inspections at Marymount Villa Retirement Center found no deficiencies, with the latest report dated October 14, 2025, citing only a minor issue of missing first aid training for some staff. Several complaint investigations were substantiated, primarily involving safety concerns such as blocking emergency exit doors, insufficient staffing and supervision, and failures in medication administration and wound care. The facility received a $500 fine in July 2025 for repeated fire safety violations related to blocked exits. Some investigations found immediate health and safety risks, including retaining a resident with unstageable wounds without proper authorization and lapses in wound treatment and diabetic care. While there have been serious findings in the past, recent reports show some improvement, though isolated deficiencies persist.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 96
Capacity: 99
Deficiencies: 1
Oct 14, 2025
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements at Marymount Villa Retirement Center.
Findings
The facility was toured and found to have adequate lighting, proper hot water temperatures, and safety features such as grab bars and non-skid mats. Centrally stored medications and safety equipment were secured and operational. However, a deficiency was cited for missing first aid training for all five staff members reviewed.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Missing first aid training from 0/5 staff members. | Type B |
Report Facts
Staff reviewed: 6
Resident records reviewed: 7
Hot water temperature: 112.1
Hot water temperature: 113.1
Hot water temperature: 110.6
Fire extinguisher last serviced: Oct 16, 2024
Staff missing first aid training: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during inspection and named in plan of correction |
| Yasamin Brown | Licensing Program Analyst | Conducted the inspection and signed the report |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 99
Deficiencies: 1
Oct 14, 2025
Visit Reason
An unannounced Case Management visit was conducted regarding an incident reported to the Community Care Licensing Division on 2025-09-18 involving a resident who became non-responsive and had unstageable wounds.
Findings
The licensee failed to obtain an approved exception request prior to retaining a resident with unstageable wounds back to the facility, posing an immediate health and safety risk. The deficiency was cited under California Code of Regulation, Title 22.
Complaint Details
The visit was triggered by a complaint regarding an incident where resident R1 became non-responsive and had unstageable wounds. The complaint was substantiated by the finding that the licensee failed to obtain the required exception request.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with Section 87612 by retaining a resident with unstageable wounds in the facility, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 99
Census: 96
Plan of Correction Due Date: Oct 15, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during the visit and involved in the incident discussion |
| Yasamin Brown | Licensing Program Analyst | Conducted the unannounced Case Management visit and authored the report |
| Harpreet Humpal | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 99
Deficiencies: 1
Jul 17, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that facility staff blocked exit doors, presenting a hazard to residents.
Findings
The investigation substantiated that emergency exit doors on the 3rd, 4th, and 5th floors were blocked with a bench and a potted plant to prevent dementia residents from seeking an exit. This was a repeat violation of Title 22 Section 87203 Fire Safety. An immediate civil penalty of $500 was assessed due to the fire clearance violation.
Complaint Details
The complaint was substantiated. Facility staff blocked emergency exit doors on multiple floors, confirmed by interviews and record reviews. This was a repeat violation with an immediate civil penalty assessed.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff failed to keep emergency exit doors unobstructed, posing an immediate health and safety risk to residents. | Type A |
Report Facts
Civil penalty amount: 500
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and interviews. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Dolly Rizvi | Executive Director/Administrator | Met with investigators and involved in findings regarding blocked exit doors. |
Inspection Report
Census: 93
Capacity: 99
Deficiencies: 1
Jul 17, 2025
Visit Reason
The visit was a case management inspection conducted to discuss administrator duties, reporting requirements, and emergency/disaster plans with the Executive Director.
Findings
The inspection found that no incident reports were submitted to the licensing agency for emergency exit blockages on the 3rd, 4th, and 5th floors, resulting in a cited deficiency under Title 22 California Code of Regulations.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| No incident reports were submitted to CCLD for emergency exit blockages on the 3rd, 4th, and 5th floors of the facility. | Type B |
Report Facts
Capacity: 99
Census: 93
Plan of Correction Due Date: Aug 11, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Discussed administrator duties and reporting requirements during the visit |
| Yasamin Brown | Licensing Program Analyst | Conducted the case management visit |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 99
Deficiencies: 0
Apr 24, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 07/20/2022 regarding staff refusal to accept a resident back after an emergency visit, bed condition issues, and inadequate feeding of the resident.
Findings
The investigation found that the allegations were unsubstantiated due to insufficient evidence. The resident's bed was confirmed to be working at the time of inspection, and staff reported following proper feeding protocols. The facility administrator denied refusing admission and explained efforts to arrange a replacement bed.
Complaint Details
The complaint involved allegations that staff refused to accept resident R1 back after an emergency visit, did not ensure the resident's bed was in working condition, and did not adequately feed the resident. After interviews and document review, the allegations were found unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 99
Census: 94
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Named in allegations and investigation regarding refusal to admit resident and bed issues |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 99
Deficiencies: 1
Apr 4, 2025
Visit Reason
Unannounced visit to investigate a complaint received on 2021-10-08 regarding alleged failure to clean a resident's room and other care concerns.
Findings
The investigation substantiated that the resident's room was not cleaned, posing a personal rights risk. Other allegations including severe dehydration, failure to notify family of health changes, COVID-19 isolation, missing dentures, and missing personal property were unsubstantiated. A deficiency was cited for failure to maintain a clean and sanitary environment.
Complaint Details
Complaint received on 2021-10-08 alleging staff did not clean resident's room, resident was severely dehydrated, staff failed to notify responsible party of health changes, COVID-19 positive residents were not isolated, resident missing teeth from dentures, and missing personal property. The allegation regarding the unclean room was substantiated; all other allegations were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Resident's room was not cleaned, violating maintenance and operation requirements for cleanliness and safety. | Type B |
Report Facts
Capacity: 99
Census: 91
Plan of Correction Due Date: Apr 18, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Duncan Agyemang | Staff | Met with Licensing Program Analyst during investigation |
| Ernesto Buendia | Staff | Met with Licensing Program Analyst and authorized to sign report |
| Dolly Rizvi | Administrator / Executive Director | Informed of investigation reason and discussed findings |
| Alicia Delmundo | Licensing Program Analyst | Conducted complaint investigation |
| Bennett Fong | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 99
Deficiencies: 1
Feb 21, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that facility staff blocked exit doors, presenting a hazard to residents.
Findings
The investigation found that on February 7, 2025, the facility temporarily blocked fire exits with a bench and other objects to prevent residents from exiting. The administrator confirmed the blockage and stated that the obstacles were removed after being informed that blocking exits was not allowed. All exits were observed to be clear at the time of inspection.
Complaint Details
The complaint was substantiated based on the preponderance of evidence standard. The allegation that facility staff blocked exit doors presenting a hazard to residents was confirmed.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility temporarily blocked fire exits with a bench and other objects, posing a potential safety violation to residents. | Type B |
Report Facts
Capacity: 99
Census: 96
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Duncan Agyemang | Care Coordinator | Met with Licensing Program Analyst during investigation |
| Dolly Rizvi | Administrator | Spoke with Licensing Program Analyst over the phone regarding the blocked exits |
| Alona Gomez | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 95
Capacity: 99
Deficiencies: 0
Dec 6, 2024
Visit Reason
The inspection visit was conducted unannounced in response to an Unusual Incident Report received regarding a resident who was found to have a broken wrist after a family outing.
Findings
The Licensing Program Analyst reviewed the resident's records, conducted interviews, and found no deficiencies during the visit.
Complaint Details
The complaint involved a resident who was reported to have pain in the left wrist and was taken to the hospital where a broken wrist was confirmed. The investigation included review of relevant medical and facility documents and interviews. No deficiencies were cited and the complaint was effectively investigated.
Report Facts
Capacity: 99
Census: 95
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristinia Morgan | Wellness Coordinator | Met with Licensing Program Analyst during the inspection |
| Bessy John | Care Coordinator | Met with Licensing Program Analyst and signed report on behalf of Wellness Coordinator |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection visit |
| Dolly Rizvi | Administrator/Director | Facility administrator named in the report header |
Inspection Report
Census: 95
Capacity: 99
Deficiencies: 1
Dec 6, 2024
Visit Reason
The visit was a Case Management - Deficiencies inspection conducted unannounced to review facility compliance and address identified deficiencies.
Findings
The Licensing Program Analyst found that a staff member (S1) was not associated with the facility despite being fingerprinted and cleared, which poses a potential safety risk. A deficiency was cited under Title 22 California Code of Regulations section 809D.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to have staff member S1 associated with the facility as required by criminal record clearance regulations. | Type B |
Report Facts
Plan of Correction Due Date: Dec 20, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Discussed deficiency and plan of correction |
| Bessy John | Care Coordinator | Present during discussion of deficiency and received report copy |
| Alicia Delmundo | Licensing Program Analyst | Conducted inspection and cited deficiency |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Capacity: 99
Deficiencies: 0
Nov 19, 2024
Visit Reason
The visit was an unannounced case management visit to deliver an amended report from a prior visit on 10/01/24.
Findings
No deficiencies were cited during the visit. An exit interview was conducted and a copy of the report was provided to the facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gregory Clark | Licensing Program Analyst | Arrived unannounced to deliver amended report and conducted the visit. |
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during the visit. |
Inspection Report
Annual Inspection
Census: 92
Capacity: 99
Deficiencies: 0
Nov 18, 2024
Visit Reason
The visit was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements.
Findings
The inspection found no deficiencies. The facility's fire clearance was approved for 99 non-ambulatory residents, including 9 bedridden and 18 hospice residents. Safety features such as smoke detectors, carbon monoxide detectors, fire extinguishers, and adequate lighting were all in proper condition. Resident and staff records were reviewed and found compliant.
Report Facts
Residents records reviewed: 9
Staff records reviewed: 4
Fire extinguisher last serviced: Oct 15, 2024
Hot water temperature: 110.3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during inspection |
| Kristinia Morgan | Wellness Coordinator | Accompanied Licensing Program Analyst during facility tour |
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 99
Deficiencies: 0
Oct 1, 2024
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation of financial abuse of a resident by staff.
Findings
The investigation found that the complaint was unsubstantiated due to lack of preponderance of evidence. The resident admitted giving money to a staff member but stated the staff never asked for it, and the staff was reassigned. The money given was a fake $100 bill.
Complaint Details
The complaint alleged staff was financially abusing a resident. The investigation included interviews with the resident and staff, and review of the resident's file. The complaint was found unsubstantiated.
Report Facts
Capacity: 99
Census: 88
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gregory Clark | Licensing Program Analyst | Conducted the complaint investigation |
| Dolly Rizvi | Administrator | Facility administrator met during investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 99
Deficiencies: 0
Sep 27, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident (R1) sustained a fractured finger while in care and that facility staff hit the resident.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews with residents, staff, and family members, as well as review of medical and incident records, indicated that the resident had dementia and behavioral disturbances and that the injury was likely self-inflicted. No staff were observed or reported to have hit the resident. The complaint was closed as unsubstantiated with no deficiencies cited.
Complaint Details
The complaint involved two allegations: 1) Resident (R1) sustained a fractured finger while in care, and 2) Facility staff hit resident (R1). The complaint was investigated through interviews with residents, staff, and family members, and review of resident records and incident reports. The complaint was determined to be unsubstantiated due to lack of evidence proving the alleged violations occurred.
Report Facts
Capacity: 99
Census: 89
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Dolly Rizvi | Administrator | Facility administrator who communicated with Licensing Program Analyst |
| Kristinia Morgan | Wellness Coordinator | Facility staff member who met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 99
Deficiencies: 1
Sep 27, 2024
Visit Reason
The inspection was conducted as a case management visit resulting from an investigation of a complaint regarding a resident's wound that was not properly attended to or reported by staff.
Findings
The facility failed to comply with personnel requirements when staff did not attend to a resident's wound nor report it to the nurse, posing immediate health and safety risks. A deficiency was cited under Title 22 California Code of Regulations.
Complaint Details
Investigation of complaint Control # 15-AS-20211026093939 regarding a resident's wound that was not properly treated or reported. The complaint was substantiated by observation and staff interviews.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility personnel did not attend to resident R1's wound nor report it to the facility nurse, posing immediate health, safety, and personal rights risks. | Type A |
Report Facts
Census: 89
Total Capacity: 99
Plan of Correction Due Date: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the investigation and inspection |
| Dolly Rizvi | Executive Director | Facility administrator involved in discussion of deficiency and plan of correction |
| Kristinia Morgan | Wellness Coordinator | Met with Licensing Program Analyst during inspection |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 99
Deficiencies: 0
Sep 18, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff handled a resident roughly.
Findings
The investigation included interviews with residents, staff, and family members, and a review of relevant documents. No evidence was found to substantiate the allegation, and the complaint was determined to be unsubstantiated.
Complaint Details
The allegation that staff handled a resident roughly was unsubstantiated after interviews with residents, staff, and family members revealed no witnesses or evidence of rough handling or residents falling.
Report Facts
Capacity: 99
Census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analysts during the investigation |
| Lori Alexander-Washington | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 99
Deficiencies: 0
Sep 18, 2024
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations including illegal eviction and staff refusal to accept a resident back from hospital discharge.
Findings
The investigation found that the eviction notice was issued appropriately due to the resident's conservator no longer being responsible for medical and financial matters, and the resident was sent to a skilled nursing facility after hospital discharge. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included illegal eviction and refusal to accept resident back from hospital discharge. Evidence showed the eviction notice was properly issued and the resident was transferred to a skilled nursing facility due to health concerns.
Report Facts
Capacity: 99
Census: 87
Complaint control number: 15-AS-20230707150358
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analysts during investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 86
Capacity: 99
Deficiencies: 0
Jun 20, 2023
Visit Reason
The visit was an unannounced case management follow-up to check on six residents who needed immediate transfer from Montgomery Springs Manor.
Findings
Based on interviews with the six residents, no immediate health and safety concerns were noted during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during the visit. |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 99
Deficiencies: 0
Apr 19, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including unexplained rapid weight loss of a resident, staff not responding to resident's calls for help, and failure to call 911.
Findings
The investigation found that residents are weighed monthly with no drastic weight changes for the resident in question, staff respond to calls for help within five minutes, and staff call 911 when needed. The allegations were closed as unsubstantiated with no deficiencies cited.
Complaint Details
The complaint involved three allegations: unexplained rapid weight loss of a resident, staff not responding to calls for help, and failure to call 911. Interviews with staff, residents, and family members, as well as record reviews, led to the conclusion that the allegations were unsubstantiated.
Report Facts
Capacity: 99
Census: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation and provided information |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 0
Apr 6, 2023
Visit Reason
An unannounced complaint investigation was conducted based on allegations that a resident sustained a head injury while in care, staff did not seek medical attention in a timely manner, and staff did not inform the resident's authorized representative of the injury in a timely manner.
Findings
The investigation included interviews, record reviews, and document collection. It was found that the resident did sustain a head injury and staff initially applied an ice pack and monitored the resident. The resident refused hospital transport initially but was later transported after swelling was observed. The resident's conservator and family were notified of the incident. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint involved allegations of a resident sustaining a head injury, delayed medical attention, and delayed notification to the resident's authorized representative. The investigation found no sufficient evidence to substantiate the allegations; therefore, the complaint was unsubstantiated.
Report Facts
Facility capacity: 99
Resident census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizette Francisco | Licensing Program Analyst | Conducted the complaint investigation |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 0
Apr 6, 2023
Visit Reason
Unannounced complaint investigation conducted due to allegations that the facility did not provide adequate care resulting in unexplained pressure sores, did not observe resident's changes in condition resulting in infections, and did not safeguard resident's dentures.
Findings
The investigation found insufficient evidence to substantiate the allegations. Records showed some care was provided for pressure sores, staff reported conducting body checks during showers, and the denture issue could not be proven or disproven. Therefore, the allegations were unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated as there was not a preponderance of evidence to prove the alleged violations occurred.
Report Facts
Facility capacity: 99
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizette Francisco | Licensing Program Analyst | Conducted the complaint investigation |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 99
Deficiencies: 2
Mar 7, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that facility staff were not dispensing resident's medication as prescribed, not ensuring the resident was following a prescribed diet, not seeking medical attention in a timely manner, and not arranging transportation for resident's medical appointments.
Findings
The investigation substantiated that facility staff did not administer medication according to doctor's orders and did not ensure the resident followed the prescribed renal and diabetic diet, posing potential health and safety risks. Allegations regarding failure to seek timely medical attention and arranging transportation were found to be unsubstantiated.
Complaint Details
The complaint investigation was substantiated for medication administration and diet adherence violations, but unsubstantiated for allegations related to timely medical attention and transportation arrangements.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not administer medication according to physician's directions. | Type B |
| Facility did not ensure resident followed prescribed modified diet. | Type B |
Report Facts
Capacity: 99
Census: 73
Deficiencies cited: 2
Plan of Correction Due Date: Mar 24, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
| Grace Luk | Licensing Program Analyst | Conducted complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 0
Feb 8, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-10-31 regarding allegations that staff were not performing residents' ADLs and that a resident was paying for his own meals.
Findings
The investigation found that the facility is providing alternative meals to residents with special dietary needs and accommodating meal preferences. The facility is conducting and evaluating residents' ADLs with schedules and logs in place. There was insufficient evidence to substantiate the allegations, and therefore the complaint was unsubstantiated.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included staff not performing residents' ADLs and a resident paying for his own meals. Interviews and record reviews did not support the allegations.
Report Facts
Capacity: 99
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 0
Feb 3, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that the facility was not observing changes in a resident's health, staff did not notify the responsible party of the resident's health changes, and staff did not check the resident every 2 hours.
Findings
The investigation found that staff routinely conducted checks every 1 to 2 hours and documented observations. Records showed no changes in the resident's condition from October 2019 through January 2020. Communication records indicated that the responsible party was notified of concerns and incidents. The allegations were unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to observe changes in resident's health, failure to notify responsible party, and failure to check resident every 2 hours. Evidence did not support these claims.
Report Facts
Capacity: 99
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Bessy John | Care Coordinator | Met with Licensing Program Analysts during investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 1
Feb 2, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that the facility did not issue a refund to an authorized representative.
Findings
The investigation substantiated the allegation that the facility failed to provide a 60% refund of the preadmission fee to the resident who left within 60 days, violating California Code of Regulations, Title 22.
Complaint Details
The complaint was substantiated based on evidence including interviews with staff and complainant, review of admission agreement, correspondence, and care notes. The resident moved in on 10/4/2021 and moved out on 11/27/2021. The facility did not issue the required refund.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide a refund of at least 60 percent of the preadmission fee when the resident left within 60 days of residency. | Type B |
Report Facts
Capacity: 99
Census: 74
Plan of Correction Due Date: Feb 17, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bessy John | Care Coordinator | Met with Licensing Program Analyst during investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 1
Feb 2, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff were not monitoring a resident's blood glucose levels while in care.
Findings
The investigation found that the resident's blood sugar log was incomplete, with most days only having one blood sugar check instead of the required two. The allegation was substantiated based on the preponderance of evidence.
Complaint Details
The complaint was substantiated. The allegation was that staff were not monitoring a resident's blood glucose levels while in care. The investigation included interviews, review of physician's report, care plan, care notes, blood sugar log, and doctor's orders.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to document resident's blood sugar levels as required, posing a potential health and safety risk. | Type B |
Report Facts
Capacity: 99
Census: 74
Deficiencies cited: 1
Plan of Correction Due Date: Feb 17, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bessy John | Care Coordinator | Met with Licensing Program Analyst during investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 99
Deficiencies: 1
Jan 12, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations that staff did not send records to an authorized representative and that the facility did not provide a correct refund to a resident's authorized representative.
Findings
The allegation regarding failure to provide requested records was substantiated as the facility initially did not provide records for 2021 but later the resident's complete file including 2021 records was observed. The allegation regarding incorrect refund was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not send records to the authorized representative. The allegation that the facility did not provide a correct refund was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Additional Personal Rights of Residents in Privately Operated Facilities. To have prompt access to review all of their records and records shall be provided within two (2) business days. Facility did not comply by not providing requested records which poses a potential personal rights violation. | Type B |
Report Facts
Capacity: 99
Census: 74
Deficiencies cited: 1
Plan of Correction Due Date: Jan 23, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Bessy John | Care Coordinator | Met with Licensing Program Analyst during investigation |
| Dolly Rizvi | Administrator | Facility Administrator named in report |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 99
Deficiencies: 0
Dec 20, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 06/29/2022 regarding spoiled food, mismanagement of resident's medication, and inadequate assistance with dressing at Marymount Villa Retirement Center.
Findings
All allegations were investigated and found to be unsubstantiated based on interviews and records review. No deficiencies were cited during the investigation.
Complaint Details
The complaint investigation addressed three allegations: resident served spoiled food, facility mismanaged resident's medication, and failure to provide adequate assistance with dressing. All allegations were found unsubstantiated after interviews with staff and residents and review of records.
Report Facts
Capacity: 99
Census: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Catherine Lin | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Dolly Rizvi | Administrator | Facility Administrator met during investigation |
Inspection Report
Annual Inspection
Census: 74
Capacity: 99
Deficiencies: 0
Oct 31, 2022
Visit Reason
The visit was an unannounced annual Infection Control Inspection conducted to assess the facility's compliance with infection control standards.
Findings
The inspection found the facility to be in compliance with infection control requirements, including proper PPE use, adequate food supply, visitor screening, and maintenance of safety equipment. No deficiencies were cited during the visit.
Report Facts
Capacity: 99
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during inspection |
| Paris Watson | Licensing Program Analyst | Conducted the annual Infection Control Inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report header |
Inspection Report
Census: 71
Capacity: 99
Deficiencies: 0
Sep 6, 2022
Visit Reason
The visit was an unannounced case management health and safety check conducted by Licensing Program Analysts to assess the facility's compliance with health and safety standards.
Findings
The facility was found to have sufficient food supplies, adequate PPE, proper medication and chemical storage, unobstructed pathways, and sufficient staffing. Residents appeared well-groomed and comfortable, and no imminent health or safety concerns were observed. No deficiencies were cited during the inspection.
Report Facts
Staff present: 14
Residents assisted: 33
Freezer temperature: 0
Refrigerator temperature: 40
Facility temperature: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analysts during the visit |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 99
Deficiencies: 2
Aug 26, 2022
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to multiple allegations including inadequate staff supervision, insufficient staffing, suspicious bruising on a resident, and visitation restrictions.
Findings
The investigation substantiated allegations of inadequate supervision and insufficient staffing, finding that staff did not follow the care plan requiring two-person assist and that staffing levels were sometimes insufficient, especially during night shifts. Allegations regarding suspicious bruising and visitation restrictions were unsubstantiated.
Complaint Details
The complaint investigation was substantiated for inadequate supervision and insufficient staffing. The allegations of suspicious bruising and visitation restrictions were unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to follow the resident's care plan requiring two-person assist during transfer, bathing, and toileting. | Type B |
| Insufficient staffing to support residents' care needs as identified in their current appraisal. | Type B |
Report Facts
Capacity: 99
Census: 75
Plan of Correction Due Date: Sep 12, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Bessy John | Care Coordinator | Met with Licensing Program Analyst during investigation |
| Dolly Rizvi | Administrator | Facility administrator named in report |
Inspection Report
Census: 72
Capacity: 99
Deficiencies: 0
Jul 21, 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 facility was found to have sufficient food supplies, adequate PPE, sufficient staffing, and no obstructions or fire hazards. Residents appeared well-groomed and comfortable, and no deficiencies were cited during the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analysts during the inspection and explained the purpose of the visit. |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 99
Deficiencies: 0
Jul 13, 2022
Visit Reason
The visit was an unannounced Case Management investigation regarding an incident reported on 07/10/2022 involving a resident who jumped from the 3rd floor of the facility.
Findings
During the visit, Licensing Program Analysts interviewed the administrator and staff, reviewed documents, and toured memory care rooms. The administrator stated she was unaware of the resident's suicidal ideations prior to admission. Further investigation is needed.
Complaint Details
The visit was triggered by a complaint incident report dated 07/10/2022 about Resident 1 jumping from the 3rd floor. The investigation is ongoing with further investigation needed.
Report Facts
Census: 73
Total Capacity: 99
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Interviewed during the visit and provided information about the resident's admission and incident |
Inspection Report
Census: 71
Capacity: 99
Deficiencies: 0
Jun 8, 2022
Visit Reason
An unannounced case management visit was conducted as a result of a Death Report dated 06/02/22 regarding an unknown cause of death.
Findings
The administrator reported that the resident had a history of acute posthemorrhagic anemia and was stable until passing. Staff interviewed did not notice any change in the resident's health condition while in care. Documentation including preplacement appraisal, care plans, and therapy notes were reviewed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Administrator who provided information about the resident's condition during the visit. |
| Catherine Lin | Licensing Program Analyst | Conducted the unannounced case management visit. |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 99
Deficiencies: 0
Apr 19, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations including resident sustaining pressure injuries, facility not following physician's medical orders, not observing changes in resident's health, and staff not treating resident with dignity.
Findings
All allegations were found to be unsubstantiated after interviews with staff and review of medical records. No deficiencies were noted.
Complaint Details
The complaint involved allegations of pressure injuries, failure to follow medical orders, failure to observe health changes, and disrespectful treatment of a resident. The investigation included interviews with the Executive Director, nurse, receptionist, and caregivers, and review of medical records. The allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 99
Census: 62
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analysts during investigation |
| Catherine Lin | Licensing Program Analyst | Conducted complaint investigation |
| Luisa Fontanilla | Licensing Program Analyst | Interviewed staff and reviewed records during investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 99
Deficiencies: 0
Apr 8, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not ensure that resident (R1) was adequately fed.
Findings
The investigation included interviews with staff and residents, review of records, and menu verification. The allegation that R1 was not served the requested hot dog and was given chicken instead was unsubstantiated due to insufficient evidence.
Complaint Details
The complaint alleged that resident R1 ordered a hot dog but never received it and was served chicken, which R1 dislikes, without any alternative food. The investigation found that residents are given meal options if they do not like the menu, and food substitutions are available. The allegation was closed as unsubstantiated.
Report Facts
Capacity: 99
Census: 75
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report signature and management |
| Jasmine Seabourne | Administrator | Facility administrator named in report |
| Lydia Olson | Activities Coordinator | Met with Licensing Program Analyst during investigation and received report |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 99
Deficiencies: 0
Apr 4, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that residents were not being provided food.
Findings
The investigation included interviews with residents, staff, and witnesses, as well as review of resident files. It was found that residents were receiving three meals a day and were getting enough food. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that residents were not being provided food. The allegation was unsubstantiated after investigation.
Report Facts
Residents interviewed: 7
Staff interviewed: 1
Witnesses interviewed: 2
Resident files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 99
Deficiencies: 2
Apr 4, 2022
Visit Reason
Unannounced complaint investigation conducted in response to allegations that staff failed to address a resident's diabetic needs and failed to ensure the resident was properly fed, as well as an allegation that a resident sustained a fall while in care.
Findings
The investigation substantiated the allegations regarding failure to address diabetic needs and proper feeding, citing noncompliance with physician's orders and facility diet plans posing potential health risks. The allegation of a resident fall was unsubstantiated due to lack of evidence in incident reports and staff interviews.
Complaint Details
The complaint investigation was substantiated for failure to address diabetic needs and proper feeding, but unsubstantiated for the allegation that a resident sustained a fall while in care.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to address R1's diabetic needs, posing a potential health and safety risk. | Type B |
| Failed to follow physician's order for carb controlled diet, posing a potential health and safety risk. | Type B |
Report Facts
Deficiencies cited: 2
Capacity: 99
Census: 73
Plan of Correction Due Date: Apr 15, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Oversaw complaint investigation |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation |
| Jasmine Seabourne | Administrator | Named in relation to plan of correction for deficiencies |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 99
Deficiencies: 1
Dec 9, 2021
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation of neglect/lack of supervision, specifically that staff failed to seek timely medical attention for a resident's wound.
Findings
The investigation substantiated the allegation that the licensee failed to seek timely medical attention for resident R1's open wound, posing an immediate health and safety risk. Interviews, medical records, and other documentation supported this finding. A plan of correction was agreed upon by the Executive Director.
Complaint Details
The complaint was substantiated based on a preponderance of evidence that staff neglected to provide timely medical care for a resident's wound. The allegation was investigated through interviews, review of medical and care records, and other evidence. The licensee was found noncompliant with regulations.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to arrange or assist in arranging timely medical care for resident's open wound, violating CCR 87465(a)(1). | Type A |
Report Facts
Capacity: 99
Census: 69
Deficiencies cited: 1
Plan of Correction Due Date: Dec 10, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation and named in findings |
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 99
Deficiencies: 1
Dec 9, 2021
Visit Reason
The visit was an unannounced case management inspection conducted during the course of investigation for a complaint (#15-AS-20210812150406).
Findings
A deficiency was observed where staff were unaware of Resident 1's open wound on the leg despite providing ADL care with 2-person assist, violating California Code of Regulations, Title 22.
Complaint Details
The visit was triggered by complaint #15-AS-20210812150406. The deficiency related to failure to observe Resident 1's open wound was substantiated during the investigation.
Deficiencies (1)
| Description |
|---|
| Staff was unaware of Resident 1's open wound on the leg despite providing ADL care with 2-person assist. |
Report Facts
Capacity: 99
Census: 69
Plan of Correction Due Date: Dec 17, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during the inspection |
| Grace Luk | Licensing Program Analyst | Conducted the inspection and authored the report |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 99
Deficiencies: 0
Dec 7, 2021
Visit Reason
The inspection was an unannounced complaint investigation conducted due to an allegation that the facility does not provide a safe and healthful environment for the resident.
Findings
The investigation found that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, resulting in the allegation being unsubstantiated.
Complaint Details
The complaint alleged that the facility does not provide a safe and healthful environment for the resident. During the investigation, it was discovered that a resident (R2) was going into another resident's (R1) apartment at night. The facility was notified on 8/21/2020 and moved R2 to a different room on 8/26/2020. The allegation was unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 99
Census: 68
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizette Francisco | Licensing Program Analyst | Conducted the complaint investigation |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during the investigation |
| Harpreet Humpal | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Routine
Census: 71
Capacity: 99
Deficiencies: 0
Dec 2, 2021
Visit Reason
The visit was an unannounced Infection Control Inspection conducted as a required 1-year routine inspection.
Findings
The facility was found to have adequate infection control measures including proper PPE use, screening procedures, and sufficient food and PPE supplies. No deficiencies were cited during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during the inspection and involved in the inspection process. |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 99
Deficiencies: 0
Nov 3, 2021
Visit Reason
The inspection was conducted as a result of priority 2 complaints (15-AS-20211029160831 and 15-AS-20211026093939) to perform an unannounced Health & Safety inspection.
Findings
The Licensing Program Analyst toured the facility and found no deficiencies. Observations included appropriate hot water temperature, sufficient food supplies, proper refrigerator and freezer temperatures, locked medication storage, functioning smoke and carbon monoxide detectors, complete first-aid kit, and a fully serviced fire extinguisher. Passageways were free of obstruction and no accessible bodies of water were observed.
Complaint Details
The visit was triggered by priority 2 complaints (15-AS-20211029160831 and 15-AS-20211026093939). No deficiencies were cited during this complaint investigation.
Report Facts
Hot water temperature: 106.6
Food supply duration: 7
Food supply duration: 2
Refrigerator temperature: 40
Freezer temperature: -10
Facility capacity: 99
Facility census: 68
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during inspection |
| Grace Luk | Licensing Program Analyst | Conducted the inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Capacity: 99
Deficiencies: 1
Oct 14, 2021
Visit Reason
The visit was conducted as an investigation of a complaint (15-AS-20211008153646) regarding missing re-appraisals for a resident with dementia.
Findings
The facility was found deficient for failing to provide annual medical assessments and reappraisals for a resident with dementia for the years 2020 and 2021, which posed potential health and safety risks.
Complaint Details
Investigation of complaint 15-AS-20211008153646 found that Resident 1 admitted on September 24, 2019 with dementia lacked required reappraisals for 2020 and 2021. The deficiency was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Resident with dementia does not have reappraisals for 2020 and 2021 as required by Title 22 California Code of Regulations 87705. | Type B |
Report Facts
Total licensed capacity: 99
Plan of Correction Due Date: Oct 28, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristinia Morgan | Wellness Director | Interviewed regarding resident appraisal records |
| Bennett Fong | Licensing Program Manager | Named as supervisor and licensing program manager |
| Alicia Delmundo | Licensing Program Analyst | Licensing evaluator and analyst who signed the report |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 99
Deficiencies: 1
Aug 13, 2021
Visit Reason
An unannounced Health & Safety inspection was conducted as a result of a priority 1 complaint.
Findings
The inspection found that the freezer temperature was measured at 10-15 degrees F, which does not meet the required 0 degrees F (-17.7 degrees C) standard, posing a potential health and safety risk. Other facility conditions such as hot water temperature, food supplies, medication storage, and safety equipment were satisfactory.
Complaint Details
The visit was triggered by a priority 1 complaint. The deficiency related to freezer temperature was cited.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C). This requirement is not met as evidence by freezer temperature at 10-15 degrees F posing a potential health and safety risk. | Type B |
Report Facts
Freezer temperature: 10
Freezer temperature: 15
Hot water temperature: 109.4
Refrigerator temperature: 40
Census: 56
Total capacity: 99
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bessy John | Caregiver Lead | Met with Licensing Program Analysts during inspection |
| Grace Luk | Licensing Program Analyst | Conducted inspection and signed report |
| Harpreet Humpal | Licensing Program Manager | Supervisor of inspection and named in report |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 99
Deficiencies: 1
May 12, 2021
Visit Reason
The inspection was conducted as a case management visit in response to an incident report received on 2021-05-10 regarding a resident who went AWOL.
Findings
The facility was found non-compliant due to a resident leaving the facility unsupervised, posing a potential health and safety risk. The facility staff notified law enforcement and the resident was returned safely. Procedures were changed to prevent future incidents.
Complaint Details
The visit was complaint-related due to an incident report about a resident who went AWOL. The report was substantiated by the observed deficiency.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to comply with care requirements for persons with dementia due to resident AWOL, posing a potential health and safety risk. | Type B |
Report Facts
Capacity: 99
Census: 49
Plan of Correction Due Date: May 21, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Rizvi | Administrator | Met with Licensing Program Analysts during inspection and participated in exit interview |
| Grace Luk | Licensing Program Analyst | Conducted the inspection and signed the report |
| Harpreet Humpal | Licensing Program Manager | Supervisor of the inspection |
Inspection Report
Complaint Investigation
Census: 46
Capacity: 99
Deficiencies: 1
Apr 22, 2021
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 2019-11-22 alleging that resident's personal care needs were not being met by the facility.
Findings
Investigation found that wound care for a resident was only done once daily for about two weeks instead of the required twice daily, substantiating the complaint. The licensee did not comply with wound care instructions, posing a potential health and safety risk.
Complaint Details
Complaint was substantiated based on preponderance of evidence. The allegation was that resident's personal care needs were not met, specifically wound care was insufficient.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Personal Rights of Residents in All Facilities not met due to failure to follow wound care instructions. | Type B |
Report Facts
Capacity: 99
Census: 46
Deficiency Type Count: 1
Plan of Correction Due Date: Apr 30, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Dolly Rizvi | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 99
Deficiencies: 0
Jan 21, 2021
Visit Reason
Unannounced complaint investigation visit conducted in response to a complaint received on 08/07/2020 alleging illegal eviction at Marymount Villa Retirement Center.
Findings
The investigation found that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation was unsubstantiated.
Complaint Details
Complaint was unsubstantiated after investigation. The allegation was illegal eviction. The resident (R1) was sent to hospital for a medical issue, tested positive for COVID-19, and passed away at hospital before returning to the facility.
Report Facts
Facility capacity: 99
Census: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacob Williams | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Dolly Rizvi | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Jasmine Seabourne | Administrator | Named as facility administrator |
| Julio Montes | Licensing Program Manager | Oversaw complaint investigation |
Loading inspection reports...
