Inspection Reports for Merrill Gardens at Willow Glen
1420 Curci Dr, San Jose, CA 95126,, CA, 95126,
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating that many concerns raised were not supported by evidence. However, the facility had a recurring issue with pest control, specifically cockroach infestations in a resident’s room, which was substantiated multiple times and cited as an immediate health and safety risk. Medication management and documentation also showed some deficiencies in late 2024 and early 2025, including improper medication storage and failure to follow physician orders, though these were addressed with plans of correction. The most recent report from October 8, 2025, had no deficiencies and found no neglect or foul play related to a resident’s death. This suggests some improvement over time, especially following earlier pest control and medication-related findings.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
2.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
35% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
59% occupied
Based on a September 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Capacity: 150
Deficiencies: 0
Oct 8, 2025
Visit Reason
The visit was an unannounced case management - incident visit to deliver the final report on a case management initiated on 2025-09-19 regarding a death report received on 2025-08-12 for a former resident.
Findings
The investigation found no deficiencies or evidence of neglect or foul play by the facility. The resident was independent in care needs, had multiple health conditions, and the cause of death was unknown at the time of the report. The facility responded promptly and called 911 upon discovering the resident unresponsive.
Report Facts
Facility capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ida Gemignani-Stearns | General Manager | Met with during the inspection and reviewed the report |
| Christine Kabariti | Licensing Program Analyst | Conducted the case management - incident visit |
| Jackie Jin | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Census: 88
Capacity: 150
Deficiencies: 0
Sep 19, 2025
Visit Reason
The visit was an unannounced case management - incident inspection to follow up on a death report received on 08/12/2025 regarding a former resident.
Findings
During the visit, documents including the resident's face sheet, service plan, progress notes, and staff schedule were reviewed, and interviews were conducted with a witness and two staff members. The case management remains open pending further investigation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Kabariti | Licensing Program Analyst | Conducted the case management - incident visit. |
| Ida Gemignani-Stearns | General Manager | Met with Licensing Program Analyst during the visit and reviewed the report. |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 0
Aug 4, 2025
Visit Reason
The visit was an unannounced case management inspection to amend two previously closed complaint investigations issued on July 14, 2025, specifically to change the findings regarding pest allegations to substantiated due to an erroneous finding on the previous report.
Findings
No deficiencies were cited during this visit. The amended findings changed the pest allegations to substantiated based on corrected information from the prior complaint investigations.
Complaint Details
The visit amended two complaint investigations (26-AS-20240430134658 & 26-AS-202402131434450) that were closed on July 14, 2025, changing the pest allegation findings to substantiated due to an erroneous finding on the previous report.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ida Gemignani-stearns | Administrator | Met with during the inspection and discussed the purpose of the visit; reviewed the report. |
| Manuel Monter | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Simi Rai | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 1
Aug 4, 2025
Visit Reason
An unannounced complaint investigation was conducted due to allegations that the facility had cockroaches in a resident's room.
Findings
The investigation found that despite the facility having a contract with Orkin for pest control, cockroaches were present in resident R1's bedroom, posing an immediate health, safety, and personal rights risk. The complaint was substantiated based on interviews and document reviews.
Complaint Details
The complaint alleging cockroaches in a resident room was substantiated. The issue was ongoing with multiple reports dating back to 12/05/2023, and subsequent complaints on 02/13/2024 and 04/30/2024 were considered a continuation of the same pest-related allegation.
Deficiencies (1)
| Description |
|---|
| Facility did not ensure resident R1's bedroom was free of cockroaches despite having a pest control contract. |
Report Facts
Facility capacity: 150
Resident census: 82
Orkin service visits: 4
Investigation dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Ida Gemignani-stearns | Administrator | Met with Licensing Program Analyst during inspection |
| Will Carter | Former Administrator | Interviewed regarding pest control contract and treatments |
| Ollie Moor Jr. | Maintenance Director | Interviewed about ongoing pest issues and housekeeping |
Inspection Report
Census: 82
Capacity: 150
Deficiencies: 0
Jul 29, 2025
Visit Reason
Licensing Program Analyst Simi Rai conducted a case management visit in response to information received during a complaint investigation.
Findings
During the visit, medications for resident R1 were found in a locked office outside the medication room, and the destruction log for R1's medications was not located. The Resident Care Director, responsible for medication destruction and documentation, was not available during the visit. Further investigation was deemed necessary.
Complaint Details
The visit was conducted in response to information received during a complaint investigation. Further investigation was determined to be needed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ida Gemignani-Stearns | Administrator | Met with Licensing Program Analyst during the visit and reviewed the report. |
| Simi Rai | Licensing Program Analyst | Conducted the case management visit and authored the report. |
Inspection Report
Plan of Correction
Capacity: 150
Deficiencies: 1
Jul 24, 2025
Visit Reason
The visit was an unannounced Plan of Correction (POC) visit conducted to verify correction of a previously cited Type A deficiency during a complaint investigation.
Findings
No deficiencies were cited during the POC visit. The facility provided a plan of corrections and a Letter of Deficiencies Cleared letter was issued.
Complaint Details
The original deficiency was cited during a complaint investigation visit for complaint number 26-AS-20231205101721. The deficiency was substantiated and corrected with a POC due date of July 15, 2025.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87303 Maintenance and Operation (a) | Type A |
Report Facts
Capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ida Gemignani-Stearns | Administrator | Met with Licensing Program Analyst during the POC visit and reviewed the report |
| Manuel Monter | Licensing Program Analyst | Conducted the unannounced POC visit |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 1
Jul 14, 2025
Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff did not ensure a resident's unit was free of pests, specifically cockroaches.
Findings
The investigation found that despite the facility having a contract with Orkin for pest control services, the resident's bedroom was not free of cockroaches, posing an immediate health, safety, and personal rights risk. The allegation was substantiated based on interviews and document reviews.
Complaint Details
The complaint alleging staff did not ensure resident's unit was free of pests was substantiated. The complaint was received on 12/05/2023, with subsequent related complaints on 02/13/2024 and 04/30/2024, all considered a continuation of the same pest-related allegation.
Deficiencies (1)
| Description |
|---|
| Facility did not ensure resident R1's bedroom was free of cockroaches despite having a pest control contract. |
Report Facts
Capacity: 150
Census: 82
Number of Orkin visits: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Ida Gemignani-stearns | Administrator | Met with Licensing Program Analyst during investigation |
| Will Carter | Former Administrator | Interviewed regarding pest control contract and treatments |
| Ollie Moor Jr. | Maintenance Director | Interviewed regarding ongoing pest issues and housekeeping |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 1
Jul 14, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple complaints received on 2023-12-05 regarding staff smoking marijuana, charging residents for services not rendered, residents left in soiled bedding/clothing, failure to reposition residents, medication administration issues, and pest infestations.
Findings
The investigation found the allegations of staff smoking marijuana, charging residents for services not rendered, residents left in soiled bedding/clothing, failure to reposition residents, and medication administration issues to be unsubstantiated or unfounded. However, the allegation that staff failed to ensure the facility was free from pests, specifically cockroaches in resident R1's bedroom and other areas, was substantiated, posing an immediate health and safety risk.
Complaint Details
The complaint investigation was initiated based on multiple allegations received on 2023-12-05, including staff smoking marijuana, charging residents for services not rendered, residents left in soiled bedding/clothing, failure to reposition residents, medication administration issues, and pest infestations. The investigation included interviews with staff, residents, and administrators, facility tours, and record reviews. Most allegations were found to be unsubstantiated or unfounded except for the pest infestation allegation, which was substantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87303 Maintenance and Operation (a): The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of residents, employees and visitors. The licensee did not ensure the facility was free of cockroaches, posing an immediate health, safety and personal rights risk to residents. | Type A |
Report Facts
Capacity: 150
Census: 82
Outstanding fees owed by resident R1: 16920.79
Plan of Correction Due Date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Ida Gemignani-stearns | Administrator | Facility administrator met during inspection and involved in findings discussion |
| Kim Golden | Administrator | Named as facility administrator in report header |
| Romeo Manzano | Licensing Program Manager | Oversaw complaint investigation |
| Christine Dolores | Licensing Program Analyst | Conducted initial complaint investigation visit and interviews |
| Will Carter | Former Administrator | Interviewed regarding pest control and housekeeping |
| Ollie Moor Jr. | Maintenance Director | Interviewed regarding pest control issues |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 0
Jul 14, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2024-02-13 regarding resident assistance with ADLs, staffing adequacy, foul odors, and medication error reporting, as well as allegations of staff providing care under the influence and making fun of residents.
Findings
The investigation found all allegations related to resident assistance, staffing, foul odors, and medication error reporting to be unsubstantiated, meaning there was insufficient evidence to prove the allegations. However, the report was amended to substantiate a prior finding that the facility had cockroaches in a resident room, correcting an earlier erroneous unfounded finding. Allegations of staff working under the influence and making fun of residents were found to be unfounded.
Complaint Details
The complaint investigation was unannounced and conducted by Licensing Program Analyst Manuel Monter. Allegations included residents not being assisted with ADLs, inadequate staffing, foul urine odor, failure to report medication errors, staff providing care under the influence, and staff making fun of residents. Interviews with residents, staff, and administration, as well as record reviews and medication audits, were conducted. The majority of allegations were found unsubstantiated or unfounded except for the amended substantiated finding of cockroaches in a resident room.
Report Facts
Incident reports for medication errors: 2
Residents interviewed: 11
Staff interviewed: 8
Resident bedrooms toured: 21
Resident medication records audited: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Ida Gemignani-stearns | Administrator | Met with Licensing Program Analyst during inspection |
| Will Carter | Former Administrator | Interviewed as staff during investigation regarding staffing and medication error reporting |
Inspection Report
Complaint Investigation
Capacity: 150
Deficiencies: 0
Jul 11, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 2024-10-24 alleging multiple issues including facility disrepair, cold food, lack of transportation assistance, staff rudeness, and inadequate accommodations.
Findings
The investigation included interviews with residents, staff, and administrators, as well as review of documentation. All allegations were found to be unsubstantiated with no citations issued. Residents and staff consistently reported no issues with food quality, transportation, staff behavior, or facility maintenance.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included poor facility repair, cold food, lack of transportation assistance, staff rudeness, and inadequate accommodations. Interviews and documentation review did not support these claims.
Report Facts
Capacity: 150
Residents interviewed: 12
Staff interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ida Gemignani-Stearns | General Manager | Met during inspection and exit interview |
| Kim Golden | Administrator | Interviewed during initial complaint investigation |
| Marcela Yanez | Licensing Program Analyst | Conducted the complaint investigation visit |
| Romeo Manzano | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 150
Deficiencies: 0
Jul 2, 2025
Visit Reason
The inspection visit was an unannounced case management-incident visit triggered by an Incident Report received on 6/30/2025 regarding a financial theft reported by a resident on 6/26/2025.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst interviewed facility management and a resident, requested additional documentation, and conducted an exit interview with the Senior Resident Care Director.
Complaint Details
The complaint involved a financial theft reported by Resident R1 on 6/26/2025. The complaint was investigated during the visit, but no deficiencies were cited.
Report Facts
Capacity: 150
Census: 82
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Lucio | Senior Resident Care Director | Met with Licensing Program Analyst during the inspection and exit interview |
| Ida Gemignani-Stearns | General Manager | Interviewed by Licensing Program Analyst during the inspection |
| Marcella Tarin | Licensing Program Analyst | Conducted the unannounced case management-incident visit |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 150
Deficiencies: 0
Jun 27, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2023-09-19, including failure to report a resident's fall, failure to ensure resident safety resulting in injury, charging for unauthorized services, and medication administration without a physician's order.
Findings
The investigation found all allegations to be unfounded after interviews and records review. The resident's fall was reported appropriately given no responsible party was listed, medication was administered with a valid physician's order, and the facility's charging for private companion services was authorized by the resident despite no family member consent. Overall, the allegations were determined to be false or without reasonable basis.
Complaint Details
The complaint investigation addressed allegations that facility staff did not report a resident's fall to responsible parties, failed to ensure resident safety resulting in injury, charged the resident for unauthorized services, and administered medication without a physician's order. The investigation included interviews with staff and the resident, review of progress notes, physician reports, admission agreements, and medication orders. The findings concluded all allegations were unfounded.
Report Facts
Facility capacity: 150
Resident census: 79
Complaint control number: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Michael Lucio | Resident Care Director | Met with Licensing Program Analyst during the investigation |
| Simi Rai | Licensing Program Analyst | Interviewed staff and resident during the investigation |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 150
Deficiencies: 0
Jun 20, 2025
Visit Reason
The visit was conducted as an unannounced complaint investigation following an allegation received on 2024-02-06 that facility staff were threatening a resident with eviction.
Findings
The investigation found the allegations to be unfounded after interviews with staff, residents, and review of records, confirming no threats of eviction were made by facility staff.
Complaint Details
The complaint alleged that facility staff were threatening a resident with eviction. After investigation, including interviews with multiple staff members, residents, and review of communications, the allegations were determined to be unfounded.
Report Facts
Capacity: 150
Census: 76
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Michael Lucio | Resident Care Director | Met with Licensing Program Analyst during investigation |
| Romeo Manzano | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 150
Deficiencies: 0
Jun 6, 2025
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations received on 2023-06-20 that facility staff slapped a resident and treated the resident in a rough manner.
Findings
After interviews with residents, staff, and witnesses, and review of records including law enforcement and medical notes, the allegations were found to be unsubstantiated due to lack of preponderance of evidence to prove the claims.
Complaint Details
The complaint alleged that staff slapped resident R1 and treated him/her in a rough manner. Multiple residents and staff denied witnessing such behavior. Witness W1 observed bruises on R1 but believed they may have come from an assistive device. Law enforcement and medical records noted bruising and skin tear but no conclusive evidence of abuse by staff S2 and S3. The investigation concluded the allegations were unsubstantiated.
Report Facts
Capacity: 150
Census: 80
Number of residents interviewed: 13
Number of staff interviewed: 10
Number of allegations: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Ida Gemignani-stearns | Administrator | Met with Licensing Program Analyst during investigation and report review |
| Kim Golden | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 150
Deficiencies: 0
Jun 6, 2025
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to complaints alleging that facility staff were not assisting residents with showering, wheelchair transfers, and medication administration as prescribed.
Findings
The investigation found the allegations regarding lack of assistance with showering and wheelchair transfers to be unfounded, with residents and staff confirming adequate assistance was provided. The medication administration allegations were unsubstantiated, with some staff reporting occasional delays but no evidence of consistent issues.
Complaint Details
The complaint investigation was triggered by allegations received on 11/30/2023 that facility staff were not assisting residents with showering and wheelchair transfers, and not dispensing medications as prescribed. The showering and transfer allegations were found to be unfounded, and the medication administration allegations were unsubstantiated.
Report Facts
Capacity: 150
Census: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Monter | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Ida Gemignani-Stearns | Administrator | Interviewed regarding resident assistance and medication administration |
| Will Carter | General Manager | Interviewed regarding incidents and complaints |
Inspection Report
Complaint Investigation
Capacity: 150
Deficiencies: 2
May 7, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints alleging the facility did not follow physician’s orders when administering medication, increased residents services without proper notice, and charging for services not being provided.
Findings
The investigation substantiated two allegations: the facility did not follow physician’s orders regarding medication administration and increased residents services without proper notice. The allegation that the facility charged for services not being provided was found to be unsubstantiated. Deficiencies were cited related to medication administration and failure to provide proper notification of rate increases.
Complaint Details
The complaint investigation was substantiated for allegations that the facility did not follow physician’s orders when administering medication and increased residents services without proper notice. The allegation that the facility charged for services not being provided was unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| 87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self administered medications as needed. This requirement was not met. | Type A |
| 1569.655 Increase in fee rates for elderly residents (a) Licensee failed to provide no less than 90 days’ prior written notice of rate increases. | Type B |
Report Facts
Capacity: 150
Deficiency Type A Plan of Correction Due Date: May 8, 2025
Deficiency Type B Plan of Correction Due Date: May 14, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dominic Tobola | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Andrea Medlin | Licensing Program Manager | Oversaw the complaint investigation |
| Ida Gemignani-Stearns | Executive Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 150
Deficiencies: 0
Mar 13, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation that staff were overcharging a resident for services not received.
Findings
The investigation found no indication that staff were not meeting resident care needs. Review of payment records showed the resident owed outstanding fees and late fees accrued. The complaint was determined to be unfounded with no deficiencies cited.
Complaint Details
The complaint alleged staff were overcharging a resident for services not received, specifically unexplained rental fees. The complaint was investigated and found to be unfounded.
Report Facts
Capacity: 150
Census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dominic Tobola | Licensing Program Analyst | Conducted the complaint investigation |
| Will Carter | General Manager | Met with Licensing Program Analyst during investigation |
| Kim Golden | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 150
Deficiencies: 0
Mar 13, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-10-31 regarding allegations about resident care and facility practices.
Findings
The investigation found the complaint allegations unsubstantiated after touring the facility, interviewing staff, reviewing records, and making observations. No deficiencies were cited and the allegations were determined to lack sufficient evidence.
Complaint Details
The complaint alleged the facility did not provide alternatives to water, failed to provide proper supervision in the memory care dining room, and did not change a resident's diaper. The investigation found these allegations unsubstantiated due to lack of corroborating evidence and observations supporting proper care.
Report Facts
Capacity: 150
Census: 87
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dominic Tobola | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Will Carter | General Manager | Met with Licensing Program Analyst during the investigation |
| Kim Golden | Administrator | Facility administrator named in the report |
Inspection Report
Annual Inspection
Census: 88
Capacity: 150
Deficiencies: 1
Dec 4, 2024
Visit Reason
The inspection was an unannounced Annual Continuation visit, continuing the required 1 Year Annual Inspection started on 2024-11-27.
Findings
A deficiency was cited due to incorrect prescription numbers on centrally stored medication and destruction records for 5 out of 8 reviewed residents, posing a potential health risk. Resident and staff records were otherwise found to be complete.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not ensure that 5 out of 8 reviewed Centrally Stored Medication Logs had correct prescription numbers, which poses a potential health risk for residents in care. | Type B |
Report Facts
Residents with incorrect prescription numbers: 5
Residents reviewed: 8
Staff records reviewed: 8
Plan of Correction due date: Dec 11, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the inspection and cited the deficiency |
| Karen Nickolai | Administrator | Met with the Licensing Program Analyst during the inspection |
| Sarah Yip | Licensing Program Manager | Supervisor of the inspection |
Inspection Report
Follow-Up
Census: 88
Capacity: 150
Deficiencies: 0
Dec 4, 2024
Visit Reason
The visit was an unannounced case management follow-up regarding an incident report submitted by the facility about a resident accessing and consuming another resident's medications.
Findings
The investigation found that the medication tray was left within reach on a kitchen counter and the kitchen swing door was not locked, allowing resident access. A technical violation was issued, but no deficiencies were cited under California Code of Regulations Title 22.
Report Facts
Observation period: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nikolai | Administrator | Met during the visit and discussed medication handling and door locking procedures. |
| Santino Fortes | Licensing Program Analyst | Conducted the unannounced case management visit. |
| S1 | Medication Technician | Interviewed regarding the medication incident. |
Inspection Report
Annual Inspection
Capacity: 150
Deficiencies: 0
Nov 27, 2024
Visit Reason
The inspection was an unannounced Required 1 Year visit to evaluate the facility's compliance with regulations.
Findings
The Licensing Program Analyst toured the facility, including kitchen, outside areas, bathrooms, and resident living units, and found no deficiencies at this time. The annual inspection will be continued at a later date due to time constraints.
Report Facts
Water temperature: 105
Water temperature: 109
Water temperature: 111
Food supply duration: 2
Food supply duration: 7
Resident living units toured: 8
Resident hallway bathrooms toured: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Karen Nikolai | Administrator | Met with the Licensing Program Analyst during the inspection |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 150
Deficiencies: 0
Nov 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint alleging that a resident's call cord was in disrepair.
Findings
The investigation found no evidence of damaged call cords after testing multiple resident bedrooms and interviewing staff. The allegation was determined to be unsubstantiated and no deficiencies were cited during the visit.
Complaint Details
The complaint alleged that a resident's call cord was in disrepair. The allegation was found to be unsubstantiated due to lack of corroborating evidence.
Report Facts
Capacity: 150
Census: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dominic Tobola | Licensing Program Analyst | Conducted the complaint investigation |
| Karen Nickolai | General Manager | Met with investigators during the visit |
| Andrea Medlin | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 150
Deficiencies: 0
Nov 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint alleging that the facility did not have proper emergency protocols for wheelchair-bound residents.
Findings
The investigation found that the facility had emergency evacuation chairs at each stairwell on the second and fourth floors and did not lack proper emergency protocols for wheelchair-bound residents. The complaint was determined to be unsubstantiated.
Complaint Details
Complaint alleged the facility did not have proper emergency protocols for wheelchair-bound residents. The allegation was found unsubstantiated after investigation.
Report Facts
Complaint Control Number: 26
Capacity: 150
Census: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dominic Tobola | Licensing Program Analyst | Conducted the complaint investigation |
| Karen Nickolai | General Manager | Met with investigators during the visit |
| Andrea Medlin | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 150
Deficiencies: 0
Nov 7, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 05/04/2022 regarding staff children sleeping in the common area and facility plumbing in disrepair.
Findings
The investigation found no evidence that staff children slept or ran around the facility, and residents and staff confirmed children were not disruptive. The plumbing issue in the memory care unit was found to have been repaired and was not affecting daily operations. Therefore, the allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated as there was insufficient evidence to prove the alleged violations regarding staff children sleeping in common areas and plumbing disrepair.
Report Facts
Capacity: 150
Census: 88
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | General Manager | Met with Licensing Program Analyst during the investigation |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 150
Deficiencies: 5
Nov 7, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations including improper medication storage and disposal, disrepair of the med-tech room door, failure to report incidents, outdated resident medical files, and alleged resident abuse.
Findings
The investigation substantiated deficiencies related to improper medication storage and disposal, disrepair of the med-tech room door, and failure to report incidents. The allegation regarding outdated resident medical files was unsubstantiated, and the alleged resident abuse was unsubstantiated due to lack of evidence. Several Type B deficiencies were cited with plans of correction due in mid-November 2024.
Complaint Details
The complaint investigation was triggered by allegations received on 04/12/2022 regarding medication storage and disposal, med-tech room door disrepair, failure to report incidents, outdated resident medical files, and resident abuse. The abuse allegation was unsubstantiated due to lack of evidence and inability to interview involved parties. The outdated medical files allegation was also unsubstantiated after record review.
Severity Breakdown
Type B: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Medications were being pre-poured into plastic organizers or small cups labeled for morning and bedroom numbers, transferring medications from their original containers. | Type B |
| Centrally stored prescription medications were not properly logged; 8 packs of Acetaminophen and a resident's eye drops were not recorded on the Centrally Stored Medication Record (CSMR). | Type B |
| Expired medications were not properly disposed of; medication destruction had not occurred since 2/15/22, and a full box of medications needing destruction was observed. | Type B |
| The med-tech room door was in disrepair, with a loose top hinge, a sign indicating disrepair, and a missing nail; the door did not lock and was often propped open. | Type B |
| Facility failed to report incidents to the licensing agency as required, including failure to file an incident report for an alleged abuse incident. | Type B |
Report Facts
Capacity: 150
Census: 88
Deficiency count: 5
Plan of Correction Due Date: 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Karen Nickolai | General Manager | Interviewed during investigation and involved in findings discussion |
| Kim Golden | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 150
Deficiencies: 0
Sep 17, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2022-01-13 regarding residents' care needs not being met, staff not providing residents with food of good quality, and residents being charged for services not received.
Findings
The investigation found that resident R1 refused facility services including shower, meal service, and care to reduce monthly payments and hired a private caregiver instead. Other residents reported no complaints about care or food quality. The allegation that the facility charged for services not received during a hospital stay was unfounded based on facility policy and agreements. Overall, the allegations were determined to be unfounded.
Complaint Details
The complaint was received on 2022-01-13 with allegations that residents' care needs were not met, staff did not provide food of good quality, and residents were charged for services not received. The investigation concluded the allegations were unfounded.
Report Facts
Complaint control number: 26
Hospital stay days: 4
Resident interviews: 7
Resident interviews: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Chihhsien Chang | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation |
| Karen Nickolai | General Manager | Facility representative met during the investigation |
| Corinne Gies | Previous General Manager | Interviewed during the investigation regarding resident care and services |
| Steve Chang | Licensing Program Analyst | Delivered investigation findings report on 2024-07-09 |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 150
Deficiencies: 0
Sep 17, 2024
Visit Reason
The visit was conducted to deliver an amended investigation report for the complaint control number 26-AS-20220113142014.
Findings
No citation was issued during this unannounced visit. The Licensing Program Analyst met with the General Manager, explained the purpose of the visit, and provided a copy of the amended investigation report.
Complaint Details
The visit was related to a complaint investigation for control number 26-AS-20220113142014. An amended investigation report was delivered, and no citation was issued.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nickolai | General Manager | Met with Licensing Program Analyst during the visit and received the amended investigation report. |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced visit to deliver the amended investigation report. |
| Chihhsien Chang | Licensing Program Analyst | Named as Licensing Program Analyst on the report. |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 95
Capacity: 150
Deficiencies: 0
Jul 16, 2024
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2023-05-12 regarding allegations of staff neglect resulting in a resident's death and staff sleeping while residents are present.
Findings
The investigation found that the allegation of staff neglect resulting in a resident's death was unsubstantiated based on interviews and records, including the timeline of care provided. The allegation of staff sleeping while residents are present was also unsubstantiated due to lack of evidence and staff interviews indicating no such behavior.
Complaint Details
The complaint involved allegations that staff neglect resulted in a resident's death and that staff were sleeping while residents were present. The investigation concluded both allegations were unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 150
Census: 95
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Donato | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | General Manager | Met with Licensing Program Analyst during investigation |
| Kim Golden | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 150
Deficiencies: 0
Jul 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2022-01-13 regarding unsanitary resident bedrooms and staff not responding to call buttons.
Findings
The investigation found that one resident (R1) refused facility housekeeping and call button services to reduce monthly payments and hired private caregivers instead. No other residents reported unsanitary conditions or issues with call button response. The allegations were determined to be unsubstantiated with no deficiencies cited.
Complaint Details
The complaint involved allegations that a facility resident bedroom was not sanitary and that staff were not responding to call buttons. The investigation included interviews with residents, prior and current general managers, and observations. The findings concluded the allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 150
Census: 94
Residents interviewed: 7
Residents interviewed: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Chihhsien Chang | Licensing Program Analyst | Conducted the complaint investigation and delivered the report |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation report |
| Karen Nickolai | General Manager | Facility representative met during investigation and exit interview |
| Corinne Gies | Prior General Manager | Interviewed during initial investigation visit |
| Steve Chang | Licensing Program Analyst | Delivered investigation findings report on 2024-07-09 |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 150
Deficiencies: 1
Jun 9, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff do not respond to residents' calls for assistance in a timely manner.
Findings
The investigation found that between May 22 and June 2, 2023, the facility had 71 instances where call response times exceeded 45 minutes, with the longest wait time being 2 hours and 41 minutes. Interviews with residents confirmed delays, and the facility acknowledged staffing issues due to simultaneous sick calls. The allegation was substantiated and a deficiency was cited related to insufficient staffing to meet resident needs.
Complaint Details
The complaint was substantiated based on records review and interviews. The facility had multiple instances of delayed call response times, confirmed by resident interviews and facility call logs. The facility acknowledged staffing shortages due to sick calls and is in the process of hiring additional staff.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility personnel were not sufficient in numbers and competent to provide the services necessary to meet resident needs, resulting in delayed response to calls for assistance. | Type B |
Report Facts
Call response delays over 45 minutes: 71
Facility capacity: 150
Census: 84
Plan of Correction due date: Jun 16, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Will Carter | General Manager | Met with Licensing Program Analyst during investigation and named in findings |
| Ryker Heberle | Licensing Program Analyst | Conducted the complaint investigation |
| Sarah Yip | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
Inspection Report
Census: 90
Capacity: 150
Deficiencies: 0
May 12, 2023
Visit Reason
The visit was an unannounced case management investigation related to claims that the facility disallowed visitation during a COVID-19 outbreak in February 2023.
Findings
The investigation found no evidence that the facility restricted visitation during the most recent COVID-19 outbreak in 2023. Records and resident interviews indicated visitation was not restricted, although mask-wearing and social distancing were encouraged.
Complaint Details
The visit was complaint-related, investigating claims that visitation was disallowed during a COVID-19 outbreak. The claims were not substantiated based on records and interviews.
Report Facts
Visitors during outbreak period: 225
Residents interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ryker Heberle | Licensing Program Analyst | Conducted the unannounced case management visit and investigation. |
| Corinne Geis | Facility Administrator | Met with Licensing Program Analyst during the investigation. |
| Will Carter | Operations Specialist | Conducted the remainder of the investigation after the administrator left. |
Inspection Report
Annual Inspection
Census: 88
Capacity: 150
Deficiencies: 0
Nov 10, 2022
Visit Reason
An unannounced Required 1 Year visit was conducted as part of the annual inspection process.
Findings
The facility was toured inside and outside, with observations including visitor screening, PPE supply, food supply, and bathroom hygiene supplies. No deficiencies were cited according to California Code of Regulations Title 22.
Report Facts
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the inspection and observations |
| Corinne Gies | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Original Licensing
Census: 84
Capacity: 150
Deficiencies: 0
Oct 20, 2021
Visit Reason
The inspection was a pre-licensing visit conducted to evaluate the facility for licensure approval.
Findings
The facility was inspected inside and out, with no deficiencies cited. The physical plant was approved for licensure pending final approval by the Centralized Application Bureau. Safety measures, emergency preparedness, medication security, and documentation were all found to be in compliance.
Report Facts
Food supply duration: 7
Food supply duration: 7
Water temperature: 110
Fire extinguisher check date: Dec 21, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Nguyen | Licensing Program Analyst | Conducted the pre-licensing inspection |
| Corinne Gies | Administrator | Facility administrator met during inspection |
| Jackie Jin | Licensing Program Manager | Named in report header |
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