Inspection Reports for Mirabel Lodge
6950 Mirabel Rd, Forestville, CA 95436, United States, CA, 95436
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating that many concerns raised were not confirmed. However, earlier reports documented multiple deficiencies related to fire safety, medication management, resident rights, and maintenance issues, including a $1,000 civil penalty issued in March 2025 for fire clearance and staff clearance violations. The facility also received fines of $500 in April and May 2024 for fire safety violations and $250 in August 2025 for repeated personal rights and care order violations, with some findings posing immediate risks to residents. The most recent report from September 23, 2025, had no deficiencies and found all complaints unsubstantiated, showing improvement over time. While some issues were serious, recent inspections suggest the facility has addressed many prior concerns.
Deficiencies per Year
12
9
6
3
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 28
Capacity: 34
Deficiencies: 0
Sep 23, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not assist a resident with obtaining medical care in a timely manner and did not report the incident to appropriate parties.
Findings
The investigation found that the facility followed proper protocol regarding seeking timely medical care for the resident and reported the incident to one of the two responsible parties listed. Both allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint involved two allegations: 1) staff did not assist a resident with obtaining medical care timely, and 2) staff did not report the incident to appropriate parties. Both allegations were found unsubstantiated after review of records, interviews, and police investigation.
Report Facts
Facility capacity: 34
Census: 28
Complaint control number: 21-AS-20250826101958
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bethany Moellers | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 28
Capacity: 34
Deficiencies: 0
Sep 23, 2025
Visit Reason
The visit was an unannounced Case Management Visit to follow up on a self-death report dated 2025-07-21 involving a resident who choked and died while under the care of the facility.
Findings
The Licensing Program Analyst reviewed relevant medical and care records, confirmed that the facility followed adequate protocols including timely medical assistance, and found no deficiencies during the visit.
Report Facts
Facility capacity: 34
Resident census: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during the visit |
| Marisol Cuadra | Licensing Program Analyst | Conducted the Case Management Visit |
| Alexander Varshavsky | Administrator/Director | Facility Administrator named in report header |
Inspection Report
Complaint Investigation
Census: 29
Capacity: 34
Deficiencies: 0
Sep 2, 2025
Visit Reason
An unannounced complaint investigation was conducted following allegations that facility staff unlawfully confined a resident to their room, did not adhere to the resident care plan, and failed to provide oral hygiene.
Findings
The investigation found insufficient evidence to substantiate the allegations. The resident was isolated per facility protocol due to COVID-19 exposure, care plan supervision requirements were not clearly supported by documentation, and oral hygiene care had some gaps but was inconsistently documented due to staff oversight. All allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included unlawful confinement of a resident to their room, failure to adhere to the resident's care plan, and failure to provide oral hygiene. Evidence did not prove violations occurred.
Report Facts
Capacity: 34
Census: 29
Complaint control number: 21-AS-20250728132515
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bethany Moellers | Licensing Program Manager | Named as Licensing Program Manager on report |
| Alexander Varshavsky | Administrator | Facility administrator unavailable onsite but available by phone during investigation |
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 30
Capacity: 34
Deficiencies: 2
Aug 1, 2025
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations of violations of personal rights and failure of facility staff to follow physician care orders.
Findings
The investigation substantiated that staff made inappropriate comments and failed to communicate intentions during resident transfers, violating personal rights. Staff also did not follow physician orders to use gait belts during transfers, posing immediate risk to residents. A civil penalty of $250 was assessed for repeated violations within 12 months.
Complaint Details
The complaint investigation was substantiated. Allegations included personal rights violations and failure to follow physician care orders. The preponderance of evidence standard was met for both allegations. A civil penalty of $250 was assessed for repeated violations within 12 months.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility staff assisted residents using inappropriate comments and did not notify residents of their intentions during transfers, violating residents' dignity and personal rights. | Type A |
| Staff did not follow physician's written order to use gait belts for resident transfers, posing immediate risk to health and safety. | Type A |
Report Facts
Civil Penalty Amount: 250
Estimated Days of Completion: 90
Residents needing two-person assistance: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bethany Moellers | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Alex Varshavsky | Licensee | Facility licensee involved in the investigation |
Inspection Report
Census: 33
Capacity: 34
Deficiencies: 0
Jun 5, 2025
Visit Reason
The visit was an unannounced Case Management - Incident inspection to follow up on two self-incident reports dated 5/12/2025 and 6/2/2025 involving resident injuries.
Findings
The Licensing Program Analyst reviewed physician reports and care plans for the residents involved in the incidents, confirmed the call alert system was working properly, and observed adequate paper products in resident bathrooms. No deficiencies were cited during the visit.
Report Facts
Incident dates: Two self-incident reports dated 5/12/2025 and 6/2/2025
Incident date: Resident 1 incident on 5/8/2024
Incident date: Resident 2 incident on 5/27/2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Astudillo | Med-Tech | Met with during the inspection and exit interview |
| Alexander Varshavsky | Administrator/Director | Licensee who authorized staff to sign the report by phone |
| Marisol Cuadra | Licensing Program Analyst | Conducted the inspection visit |
| Bethany Moellers | Licensing Program Manager | Named on the report |
Inspection Report
Census: 33
Capacity: 34
Deficiencies: 0
Apr 2, 2025
Visit Reason
The visit was an unannounced Case Management - Other inspection to update the facility's Fire Clearance received on 3/27/25.
Findings
The facility received an approved fire clearance dated March 27, 2025, allowing 34 non-ambulatory residents and 7 bedridden rooms. The updated fire clearance addressed previous concerns including the secured perimeter. No deficiencies were cited during the visit.
Report Facts
Capacity: 34
Census: 33
Fire clearance date: Mar 27, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the case management visit |
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during the visit |
| Alexander Varshavsky | Administrator/Director | Facility Administrator/Director |
Inspection Report
Annual Inspection
Census: 33
Capacity: 34
Deficiencies: 7
Mar 13, 2025
Visit Reason
The inspection was an unannounced required 1-year annual inspection to assess compliance with licensing regulations and facility operations.
Findings
The inspection identified multiple deficiencies including fire clearance violations due to bedridden residents occupying non-cleared rooms, expired fire extinguishers, call alert system failures, medication administration errors, staff working without proper clearance, and sanitation and maintenance issues such as cracked toilets, feces in bathrooms, lack of hygiene supplies, and unpacked dry goods without expiration dates. Civil penalties totaling $1000 were issued for fire clearance and staff clearance violations.
Severity Breakdown
Type A: 4
Type B: 3
Deficiencies (7)
| Description | Severity |
|---|---|
| Fire clearance violation due to bedridden residents occupying non-cleared rooms and expired fire extinguishers. | Type A |
| Call alert system was off causing delayed staff response to emergency alerts. | Type A |
| Two out of 27 staff worked without being properly associated with the facility. | Type A |
| Two out of five residents were not given medications as prescribed by their physician. | Type A |
| Bathroom toilet in room 7 cracked, sticky floors, trash can without lid, and feces on floor in shared bathroom. | Type B |
| No toilet paper or paper towels found in residents' shared bathrooms. | Type B |
| Unpacked dry goods with no expiration dates noted. | Type B |
Report Facts
Civil penalty: 500
Civil penalty: 500
Residents reviewed: 9
Staff reviewed: 5
Staff clearance issue: 2
Residents with medication errors: 2
Total staff: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Varshavsky | Administrator | Named in relation to administrator certificate and facility operations. |
| Lisa DiBartolo | Administrative Assistant | Met with LPAs during inspection and involved in corrective actions. |
| Ethel Contreras | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Kimberley Mota | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 28
Capacity: 34
Deficiencies: 1
Aug 29, 2024
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to allegations received on 07/24/2024 regarding medication administration and notification of resident condition changes at Mirabel Lodge.
Findings
The investigation substantiated that staff did not dispense medication to a resident as prescribed, including missed doses of Seroquel and improper medication crushing practices, posing an immediate risk to resident health. Another allegation that staff failed to inform the resident's authorized representative of a change in condition was found unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not dispense medication to a resident as prescribed, confirmed by medication administration records and hospice documentation. The allegation that staff failed to inform the resident's authorized representative of a change in condition was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff did not dispense medication to resident as prescribed, including missed doses of Seroquel and improper medication crushing. | Type A |
Report Facts
Capacity: 34
Census: 28
Immediate Civil Penalty: 250
Plan of Correction Due Date: Aug 30, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bethany Moellers | Licensing Program Manager | Oversaw the complaint investigation |
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during investigation and involved in medication administration issues |
| Alexander Varshavsky | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 28
Capacity: 34
Deficiencies: 0
Jul 16, 2024
Visit Reason
The visit was an unannounced Case Management visit to follow up on an incident report dated 7/13/24 involving resident aggression and subsequent hospital assessment.
Findings
The facility reviewed the incident involving resident aggression and developed a plan of action including behavior assessment, staff training, and engagement with responsible parties. No deficiencies were cited during the visit.
Complaint Details
The visit was triggered by a complaint/incident report of resident (R1) aggression towards another resident (R2) on 7/13/24, resulting in hospital assessment for altered mental status and hypernatremia. The complaint remains under review with no physician response yet.
Report Facts
Incident date: Jul 13, 2024
Incident time: 1615
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during visit |
| Marisol Cuadra | Licensing Program Analyst | Conducted the Case Management visit |
| Bethany Moellers | Licensing Program Manager | Named in report header |
Inspection Report
Census: 29
Capacity: 34
Deficiencies: 0
Jul 9, 2024
Visit Reason
The visit was a Case Management Visit conducted unannounced to amend a report originally dated 05/23/2024 due to an error in reviewing the secured perimeter after a change of ownership.
Findings
The facility is operating under fire clearance approved on 11/16/2022 without a secured perimeter waiver. The Fire Department approval is pending. No citations were issued during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the Case Management Visit |
Inspection Report
Complaint Investigation
Census: 28
Capacity: 34
Deficiencies: 1
May 23, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the facility does not maintain a proper fire clearance, specifically regarding locked and impassable gates preventing safe exit.
Findings
The investigation found that the facility had issues with the front and side gates being locked and impassable, posing an immediate health and safety risk. The gate maglock was faulty and was replaced promptly. The allegation was substantiated, and an immediate civil penalty of $500 was assessed. However, an amendment noted that the secured perimeter waiver was not approved, and the facility is operating under a previous fire clearance.
Complaint Details
The complaint was substantiated based on evidence that the facility gates were locked and impassable, preventing safe exit. The licensee repaired the gate promptly. An immediate civil penalty of $500 was assessed.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Type A 87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Facility did not ensure all exits were free from obstructions, posing an immediate health, safety, or personal rights risk. | Type A |
Report Facts
Capacity: 34
Census: 28
Immediate Civil Penalty: 500
Deficiency Count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bethany Moellers | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Lisa DiBartolo | Administrative Assistant | Met with Licensing Program Analyst during investigation |
| Alexander Varshavsky | Administrator | Facility administrator mentioned in report |
Inspection Report
Complaint Investigation
Census: 28
Capacity: 34
Deficiencies: 0
May 23, 2024
Visit Reason
An unannounced complaint investigation was conducted following an allegation received on 2024-04-09 regarding a resident's personal rights being violated by another resident.
Findings
The investigation found the allegation of personal rights violation unsubstantiated due to lack of evidence, despite incidents of resident-on-resident aggression. The facility followed its program plan by addressing issues with residents' responsible parties and consulting physicians as needed.
Complaint Details
The complaint alleged that resident R2 entered resident R1's room at night and physically assaulted them. The Sheriff's report and facility records showed no injuries consistent with the allegation, resulting in an unsubstantiated finding.
Report Facts
Complaint control number: 21-AS-20240409090025
Facility capacity: 34
Census: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bethany Moellers | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 28
Capacity: 34
Deficiencies: 12
Apr 18, 2024
Visit Reason
The inspection was an unannounced required 1-year annual inspection conducted to assess compliance with licensing regulations.
Findings
The facility was found to have multiple deficiencies including fire clearance violations, maintenance and safety issues, medication administration errors, lack of activities, expired food items, incomplete care plans, insufficient staff training, and non-functional emergency alarm systems. An immediate civil penalty of $500 was issued for the fire clearance violation.
Severity Breakdown
Type A: 6
Type B: 6
Deficiencies (12)
| Description | Severity |
|---|---|
| Wheelchair stored in front of sliding glass door obstructing exit, violating fire clearance. | Type A |
| Two rusty shower chairs, holes in bedroom screen, broken faucets, urine smell, dusty ceiling fans, uneven cement ramp, sticky floors, trash cans without lids, non-working lights, broken electrical plate. | Type A |
| Hot water temperature in one resident bedroom measured at 131.6°F, exceeding safe limits. | Type A |
| Auditory emergency signal system not working or lacking in 4 of 12 client bedrooms inspected. | Type A |
| Medications for 4 out of 5 residents not given according to physician's orders. | Type A |
| Storage cabinets with potentially toxic chemicals unlocked and accessible to residents with dementia. | Type A |
| Activities not occurring during scheduled times; no resident participation observed. | Type B |
| Expired canned goods, unpacked dry goods without expiration dates, and uncovered prepared foods in walk-in refrigerator. | Type B |
| Care plans for 4 out of 5 residents need updating. | Type B |
| 3 out of 5 staff do not have annual required training hours completed. | Type B |
| Auditory alarms on several resident bedroom sliding glass door exits were not activated. | Type B |
| No menus posted for residents to view; no dated menus on file. | Type B |
Report Facts
Immediate civil penalty: 500
Residents with medication errors: 4
Client bedrooms inspected for emergency signals: 12
Staff without required training: 3
Residents with outdated care plans: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Varshavsky | Administrator | Named as facility administrator; certificate expires 07/15/2024. |
| Lisa DiBartolo | Assistant Administrator | Met with Licensing Program Analysts during inspection. |
| Julie Florio | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Bethany Moellers | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Census: 23
Capacity: 34
Deficiencies: 0
Jan 26, 2024
Visit Reason
The inspection was an unannounced case management visit to follow up on death reports submitted to Community Care Licensing regarding two residents who passed away unexpectedly.
Findings
The investigation found that the facility followed all regulation and training requirements. However, the two residents were not receiving hospice services when they passed away. No deficiencies were found during the inspection.
Report Facts
Capacity: 34
Census: 23
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Varshavsky | Licensee | Met with during the inspection and involved in the case management visit |
Inspection Report
Complaint Investigation
Census: 32
Capacity: 34
Deficiencies: 1
Jan 9, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff did not ensure a resident received their medication as prescribed while in care.
Findings
The investigation substantiated that the facility failed to ensure resident R1 received their prescribed medication Sertraline for approximately six months due to errors in medication ordering and management. The designated medication technician was no longer employed, and the facility had not contacted a pharmacy for medication management review as required.
Complaint Details
The complaint was substantiated. The allegation was that staff did not ensure a resident received their medication as prescribed, leading to behavioral issues. The investigation confirmed the medication was not administered from June 2023 until November 2023 due to ordering errors and inadequate medication management.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure medication was given according to physician's directions as required by CCR 87465(c)(2). | Type A |
Report Facts
Capacity: 34
Census: 32
Deficiency count: 1
Plan of Correction Due Date: Jan 10, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marisol Cuadra | Licensing Program Analyst | Conducted the complaint investigation |
| Bethany Moellers | Licensing Program Manager | Oversaw the complaint investigation |
| Ana Martinez | Med-Technician | Met with investigator during complaint investigation |
| Alexander Varshavsky | Administrator | Facility licensee and administrator available by phone during investigation |
Inspection Report
Census: 28
Capacity: 34
Deficiencies: 0
Aug 29, 2023
Visit Reason
The inspection was an unannounced case management visit to follow up on two self-reported incident reports submitted to Community Care Licensing on 08/04/2023 and 08/18/2023.
Findings
The facility followed all regulations and training requirements related to the incidents. No deficiencies were cited during the inspection.
Report Facts
Incident report dates: Incident reports submitted on 08/04/2023 and 08/18/2023
Resident incident dates: Incidents occurred on 07/09/2023 and 08/11/2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Diandra Chadwick | Lead staff | Met with Licensing Program Analyst during inspection |
| Alexander Varshavsky | Administrator | Facility administrator named in report header |
| Julia Latifi | Owner met during inspection | |
| Marisol Cuadra | Licensing Program Analyst | Conducted the inspection |
| Bethany Moellers | Licensing Program Manager | Named in exit interview section |
Inspection Report
Original Licensing
Census: 29
Capacity: 34
Deficiencies: 4
Jun 23, 2023
Visit Reason
The inspection was an unannounced post-licensing and Non-Compliance inspection conducted to evaluate the facility's compliance with licensing requirements following a change of ownership.
Findings
The facility was found to have several deficiencies including maintenance issues such as missing face cover plates and drawers, hot water temperatures outside the regulated range, and admission agreements not updated after change of ownership. Staff training and resident care plans were generally compliant, but there were noted failures in timely medical attention and adequate direct care staffing.
Deficiencies (4)
| Description |
|---|
| Missing face cover plate in room #7, bathroom in room #6 has an out of order sign, and two drawers missing in shared bathroom for rooms #4 and #5. |
| Hot water temperatures in four out of six resident bathrooms measured outside the regulated range (123.8, 118.6, 121.6, 122.4, 108.1, and 127.9 degrees). |
| Admission agreements were not updated after change of ownership in 29 out of 29 resident files, including lack of addendum for surveillance camera use. |
| Failure to ensure timely medical attention and adequate direct care staffing to meet residents' needs. |
Report Facts
Capacity: 34
Census: 29
Hot water temperature readings: 6
Admission agreements not updated: 29
Direct care staff count: 6
Direct care staff count: 5
Direct care staff count: 2
Staff training hours: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Varshavsky | Administrator | Licensee and administrator whose certificate expires on 7/15/2023; authorized lead staff to sign report. |
| Diandra Chadwick | Lead Staff | Met with Licensing Program Analyst during inspection and participated in observations. |
| Marisol Cuadra | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Bethany Moellers | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Capacity: 34
Deficiencies: 0
Apr 7, 2023
Visit Reason
The purpose of this office meeting was to discuss the non-compliance plan from the old facility Mirabel Lodge #496800941, which is being rolled over to the new facility number 496804122 due to change of ownership.
Findings
The facility has several ongoing non-compliance issues including failure to seek timely medical attention, inadequate staffing, failure to ensure resident rights and safety resulting in a resident's death, lack of observation of resident condition changes after falls, inability to provide resident care notes, and failure to notify the licensing agency about incidents after falls. No new deficiencies were cited at this time.
Report Facts
Facility capacity: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Moellers | Licensing Program Manager | Present at the office meeting and named in the report |
| Marisol Cuadra | Licensing Program Analyst | Present at the office meeting and named in the report |
| Alex Varshavsky | Licensee | Facility administrator and participant in the office meeting |
Inspection Report
Original Licensing
Census: 31
Capacity: 34
Deficiencies: 0
Mar 28, 2023
Visit Reason
The visit was a pre-licensing continuation facility inspection to evaluate compliance for issuing a new license.
Findings
The facility met all requirements with no deficiencies cited. Exits were unobstructed and auditory alarms were operational. Pre-licensing deficiencies have been resolved and the inspection is complete.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Varshavsky | Applicant/Administrator | Met with Licensing Program Analyst during the pre-licensing inspection. |
| Marisol Cuadra | Licensing Program Analyst | Conducted the pre-licensing continuation facility inspection. |
| Bethany Moellers | Licensing Program Manager | Named in the report header. |
Inspection Report
Original Licensing
Census: 29
Capacity: 34
Deficiencies: 2
Mar 13, 2023
Visit Reason
Pre-licensing unannounced inspection conducted due to an application for Change of Ownership at the facility.
Findings
The facility was observed to have some deficiencies including non-operational auditory alarm systems in all resident rooms and obstructed exits in rooms 2, 4, and 6, which were immediately cleared. Other observations included compliance with fire safety, food storage, and emergency preparedness regulations.
Deficiencies (2)
| Description |
|---|
| All resident rooms' auditory alarm systems were not operational or working properly. |
| Exits from resident rooms (room #2, 4, and 6) were obstructed. |
Report Facts
Residents currently in care: 29
Licensed capacity: 34
Fire clearance allowance: 28
Fire clearance allowance: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alex Varshavsky | Applicant | Met during inspection and discussed facility operations and deficiencies |
| Marisol Cuadra | Licensing Program Analyst | Conducted the pre-licensing inspection and documented findings |
Inspection Report
Original Licensing
Census: 31
Capacity: 34
Deficiencies: 0
Feb 16, 2023
Visit Reason
The visit was conducted as a pre-licensing inspection and Component II (COMP II) evaluation by telephone to verify the applicant and administrator's understanding of Title 22 and facility operation requirements.
Findings
COMP II was successfully completed via telephone call with the applicant and administrator, confirming understanding of facility operation, staff qualifications, training, grievances, complaints, food service, medication management, and application document review. No deficiencies or violations were noted in the report.
Report Facts
Capacity: 34
Census: 31
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Varshavsky | Administrator/Owner | Participant in COMP II telephone call and applicant/administrator verified |
| Shannon Betker | Analyst | CAB analyst conducting COMP II telephone call |
| Jude De La Concepcion | Licensing Program Manager | Named as Licensing Program Manager on the report |
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