Deficiencies (last 5 years)
Deficiencies (over 5 years)
11.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
180% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
36
27
18
9
0
Census
Latest occupancy rate
0% occupied
Based on a October 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy over time
Inspection Report
Monitoring
Capacity: 60
Deficiencies: 11
Date: Oct 27, 2025
Visit Reason
The visit was an unannounced office non-compliance conference meeting conducted to discuss multiple violations and to increase frequency of monitoring inspection visits to ensure compliance with Title 22 regulations.
Findings
During the meeting, several violations related to basic services, medical care, reappraisals, resident records, personnel requirements, and other regulatory areas were discussed. The licensee agreed to contact the Technical Support Program and was informed that additional civil penalties may be assessed pending review.
Deficiencies (11)
Violation of 87464 Basic Services
Violation of 87465 Incidental Medical and Dental Care
Violation of 87463 Reappraisals
Violation of 1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds
Violation of 87303 Maintenance and Operation
Violation of 87506 Resident Records
Violation of 87355 Criminal Record
Violation of 1569.69 Employees assisting residents with self-administration of medication; training requirements
Violation of 87101 Care and Supervision
Violation of 87309 Storage Space
Violation of 87411 Personnel Requirements
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shayan Gheisar | Administrator | Met with during inspection and discussed violations |
| Carl Knepler | CEO | Present at non-compliance conference meeting |
| Beau Ayers | Senior Vice President of Operations | Present at non-compliance conference meeting |
| Terry Rose | Regional Director of Operations | Present at non-compliance conference meeting |
| Marlene Nelon | Director of Regulatory Compliance | Present at non-compliance conference meeting |
| April Cowan | Licensing Program Manager | Present at non-compliance conference meeting and named as Licensing Program Manager |
| Brenda Chan | Licensing Program Manager | Present at non-compliance conference meeting |
| Komal Curley | Licensing Program Analyst | Present at non-compliance conference meeting |
Inspection Report
Capacity: 60
Deficiencies: 11
Date: Oct 27, 2025
Visit Reason
The visit was an unannounced office inspection conducted to address non-compliance issues and discuss violations with facility leadership.
Findings
During the non-compliance conference meeting, multiple violations related to basic services, medical care, resident records, personnel requirements, and other regulatory areas were discussed. The licensing agency plans to increase monitoring visits to ensure compliance and informed the licensee of potential additional civil penalties.
Deficiencies (11)
Violation of Basic Services (87464)
Violation of Incidental Medical and Dental Care (87465)
Violation of Reappraisals (87463)
Violation of Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (1569.652)
Violation of Maintenance and Operation (87303)
Violation of Resident Records (87506)
Violation of Criminal Record (87355)
Violation of Employees assisting residents with self-administration of medication; training requirements (1569.69)
Violation of Care and Supervision (87101)
Violation of Storage Space (87309)
Violation of Personnel Requirements (87411)
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shayan Gheisar | Administrator | Met with during the inspection and named in the non-compliance meeting |
| Carl Knepler | CEO | Present in the non-compliance conference meeting |
| Beau Ayers | Senior Vice President of Operations | Present in the non-compliance conference meeting |
| Terry Rose | Regional Director of Operations | Present in the non-compliance conference meeting |
| Marlene Nelon | Director of Regulatory Compliance | Present in the non-compliance conference meeting |
| April Cowan | Licensing Program Manager | Present in the non-compliance conference meeting |
| Brenda Chan | Licensing Program Manager | Present in the non-compliance conference meeting |
| Komal Curley | Licensing Program Analyst | Present in the non-compliance conference meeting |
Inspection Report
Annual Inspection
Census: 56
Capacity: 60
Deficiencies: 0
Date: Jul 17, 2025
Visit Reason
An unannounced annual inspection visit was conducted to evaluate compliance with licensing requirements at the facility.
Findings
The facility was found to be clean, odor-free, and free from hazards. Resident rooms and bathrooms were properly furnished and equipped. Kitchen and medication storage met safety standards. Emergency drills and safety equipment were up to date. Resident and staff records were complete and current. No citations were issued during the visit.
Report Facts
Hot water temperature range: 111
Hot water temperature range: 118
Perishable food observation days: 2
Non-perishable food observation days: 7
Fire extinguisher check date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shayan Gheisar | Administrator | Met with Licensing Program Analyst during inspection and discussed visit purpose |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced annual inspection visit |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 60
Deficiencies: 3
Date: Jul 17, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff did not provide adequate supervision resulting in a resident sustaining multiple fractures, did not seek timely medical attention, and failed to communicate with the resident's responsible party.
Complaint Details
The complaint investigation was substantiated. The allegations included inadequate supervision leading to multiple fractures, delayed medical attention, and failure to communicate with the resident's responsible party. The resident was a known fall risk requiring two-person transfer and close supervision. The resident fell on 12/2/2024, sustained injuries, and was not sent to the hospital until 12/4/2024. The resident passed away on 12/19/2024 with pelvic fractures noted as a cause of death.
Findings
The investigation substantiated the allegations that staff failed to provide adequate supervision to a fall-risk resident who sustained multiple pelvic fractures, did not seek timely medical attention after the resident's fall, and failed to communicate changes in the resident's condition to the responsible party. The resident later passed away with pelvic fractures noted as a primary cause of death.
Deficiencies (3)
Facility staff did not provide adequate supervision resulting in resident sustaining multiple fractures.
Staff did not seek medical attention to resident in a timely manner.
Facility failed to communicate with resident's responsible party regarding significant change in condition.
Report Facts
Civil penalty amount: 1000
Civil penalty amount: 500
Deficiency count: 3
Resident fall date: Dec 2, 2024
Resident death date: Dec 19, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
| Shayan Gheisar | Administrator | Facility administrator met during investigation and was informed of findings and penalties. |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Annual Inspection
Census: 56
Capacity: 60
Deficiencies: 0
Date: Jul 17, 2025
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and ensure the safety and well-being of residents at the facility.
Findings
The facility was found to be clean, odor-free, and free from hazards. Resident rooms and bathrooms were properly furnished and equipped. Medications and hazardous materials were securely stored. Emergency drills and safety equipment were up to date. Resident and staff records were complete and current. No citations were issued during the visit.
Report Facts
Hot water temperature range: 111-118
Perishable food observation days: 2
Non-perishable food observation days: 7
Fire extinguisher check date: 2024
Emergency drill frequency: 3
Resident records reviewed: 5
Staff records reviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shayan Gheisar | Administrator | Met with Licensing Program Analyst during inspection and discussed visit purpose |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection visit |
| April Cowan | Licensing Program Manager | Named in report header |
Inspection Report
Capacity: 60
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The inspection was an unannounced office visit conducted to evaluate the facility's compliance with licensing requirements.
Findings
The report does not provide specific narrative details or findings about deficiencies or compliance status.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shayan Gheisar | Administrator/Director | Named as facility administrator/director. |
| Carl Knepler | Person met with during the inspection. | |
| April Cowan | Licensing Program Manager | Named as licensing program manager. |
| Komal Charitra | Licensing Program Analyst | Named as licensing program analyst. |
Inspection Report
Capacity: 60
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was an unannounced office inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The report does not provide any narrative or specific findings, deficiencies, or plans of correction; it mainly outlines procedural information about deficiencies, plans of correction, civil penalties, and appeal rights.
Inspection Report
Complaint Investigation
Census: 51
Capacity: 60
Deficiencies: 1
Date: Feb 24, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate multiple allegations including untimely refund of advance fees, staff neglect resulting in resident's death, medication dispensing issues, bathroom repair, provision of bed linens, and postural supports for a resident.
Complaint Details
The complaint investigation was triggered by allegations including untimely refund of advance fees, staff neglect resulting in resident's death, failure to dispense medication as prescribed, failure to maintain resident's bathroom in good repair, failure to provide adequate bed linens, and failure to provide postural supports. The refund allegation was substantiated; other allegations were unsubstantiated.
Findings
The investigation substantiated the allegation that the licensee did not issue a timely refund of advance fees, with a refund check issued past the required 15-day period. Other allegations including staff neglect resulting in resident's death, medication dispensing, bathroom repair, bed linens, and postural supports were found unsubstantiated due to lack of preponderance of evidence.
Deficiencies (1)
Licensee did not issue a timely refund of advance fees as required by HSC 1569.652(c).
Report Facts
Refund amount: 2094
Days late for refund: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Shayan Gheisar | Administrator | Facility administrator met during investigation and provided information |
| April Cowan | Licensing Program Manager | Reviewed the report and signed |
Inspection Report
Complaint Investigation
Census: 51
Capacity: 60
Deficiencies: 1
Date: Feb 24, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2024-12-10 regarding issues such as untimely refund of advance fees, staff neglect resulting in resident's death, medication dispensing failures, bathroom repair, bed linens adequacy, and postural supports provision.
Complaint Details
The complaint investigation was triggered by multiple allegations including untimely refund of advance fees, staff neglect resulting in resident's death, failure to dispense medication as prescribed, failure to maintain resident's bathroom in good repair, inadequate provision of bed linens, and lack of postural supports. The refund allegation was substantiated while the others were unsubstantiated.
Findings
The investigation substantiated the allegation that the licensee did not issue a timely refund of advance fees, with a refund check issued past the required 15-day period. Other allegations including staff neglect causing resident death, medication dispensing failures, bathroom repair, bed linens adequacy, and postural supports were found unsubstantiated based on document reviews, interviews, and observations.
Deficiencies (1)
Licensee did not issue a timely refund of advance fees as required by HSC 1569.652(c).
Report Facts
Refund amount: 2094
Capacity: 60
Census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Shayan Gheisar | Administrator | Facility administrator met during investigation and involved in interviews |
| April Cowan | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 1
Date: Feb 11, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2025-01-29 regarding temperature control, visitor restrictions, and sleeping accommodations at the facility.
Complaint Details
The complaint investigation was substantiated for the allegation that the licensee failed to maintain a comfortable temperature for residents. The allegations that residents were not allowed visitors in their rooms and that residents were provided inadequate sleeping accommodations were unsubstantiated.
Findings
The allegation that the facility did not maintain a comfortable temperature was substantiated due to lack of functioning heating units and residents wearing heavy jackets and blankets. The allegations regarding visitor restrictions and inadequate sleeping accommodations were unsubstantiated based on staff interviews and observations during the visit.
Deficiencies (1)
87303 Maintenance and Operation: (b) A comfortable temperature for residents shall be maintained at all times. This requirement is not met as evidenced by the facility not having a functioning heating unit on both floors and using portable heaters in common areas, with residents observed wearing heavy jackets and wrapped in blankets.
Report Facts
Capacity: 60
Census: 54
Deficiencies cited: 1
Plan of Correction Due Date: Feb 12, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Mary Anne Rodriguez | Resident Services Director | Met with Licensing Program Analyst during the investigation and report review |
| Shayan Gheisar | Administrator | Interviewed during the investigation regarding allegations |
| April Cowan | Licensing Program Manager | Reviewed the report |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 1
Date: Feb 11, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to complaints received on 2025-01-29 regarding temperature maintenance, visitor access, and sleeping accommodations at the facility.
Complaint Details
The complaint investigation was substantiated for the allegation that the licensee failed to maintain a comfortable temperature for residents. The allegations that residents were not allowed visitors in their rooms and that residents were sleeping on the floor were unsubstantiated.
Findings
The allegation that the facility did not maintain a comfortable temperature for residents was substantiated due to lack of functioning heating units and residents wearing heavy jackets and blankets. The allegations that residents were not allowed visitors in their rooms and that residents were sleeping on the floor were unsubstantiated based on staff interviews and observations.
Deficiencies (1)
87303 Maintenance and Operation: (b) A comfortable temperature for residents shall be maintained at all times. This requirement is not met as evidenced by lack of functioning heating units and use of portable heaters, with residents observed wearing heavy jackets and wrapped in blankets.
Report Facts
Capacity: 60
Census: 54
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met with Licensing Program Analyst during investigation and report review |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
| April Cowan | Supervisor | Supervisor overseeing the investigation |
| Shayan Gheisar | Administrator | Interviewed during investigation regarding allegations |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Jan 9, 2025
Visit Reason
An unannounced case management visit was conducted in relation to complaint #14-AS-20240717162214 to investigate alleged deficiencies.
Complaint Details
The visit was complaint-related, investigating complaint #14-AS-20240717162214. The complaint was substantiated by the finding of incomplete resident records.
Findings
The investigation found that Resident 1's file was incomplete, lacking completed reappraisals, service plans, and pre-admission appraisal. Deficiencies were cited under California Code of Regulations, Title 22.
Deficiencies (1)
Resident Records: The licensee failed to maintain a separate, complete, and current record for Resident 1, including missing reappraisals, service plans, and pre-admission appraisal.
Report Facts
Capacity: 60
Census: 55
Deficiencies cited: 1
Plan of Correction Due Date: Jan 10, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met during inspection and discussed visit purpose |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Shayan Gheisar | Administrator/Director | Current administrator mentioned in report |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Jan 9, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations received on 07/17/2024 regarding inadequate hydration, neglect, and other care concerns for a resident at Pacifica Senior Living Mission Villa.
Complaint Details
The complaint investigation was substantiated for inadequate hydration leading to hospitalization. Other allegations including neglect causing death, leaving resident soiled, failure to address condition changes, failure to seek timely medical attention, and failure to assist with repositioning were unsubstantiated.
Findings
The investigation substantiated the allegation that staff did not ensure a resident was adequately hydrated, resulting in hospitalization for dehydration and UTI. Other allegations including neglect resulting in death, leaving resident soiled, failure to address condition changes, failure to seek timely medical attention, and failure to assist with repositioning were found unsubstantiated due to lack of preponderance of evidence.
Deficiencies (1)
Failure to ensure residents are adequately hydrated, resulting in resident hospitalization for dehydration and UTI.
Report Facts
Capacity: 60
Census: 55
Civil penalty amount: 250
Repeat violation date: Nov 6, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Mary Anne Rodriguez | Resident Services Director | Interviewed during investigation and involved in findings discussion |
| Karen Nickolai | Administrator | Facility administrator at time of report |
| April Cowan | Licensing Program Manager | Oversaw licensing program and signed report |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Jan 9, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations including inadequate hydration of a resident, neglect resulting in resident's death, leaving resident soiled, failure to address change in resident's condition, failure to seek timely medical attention, and failure to assist with repositioning.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not ensure a resident was adequately hydrated, resulting in hospitalization for dehydration and UTI. Other allegations including neglect resulting in death, leaving resident soiled, failure to address change in condition, failure to seek timely medical attention, and failure to assist with repositioning were unsubstantiated.
Findings
The investigation substantiated the allegation that staff did not ensure a resident was adequately hydrated, citing medical records showing dehydration and UTI requiring hospital treatment. Other allegations including neglect resulting in death, leaving resident soiled, failure to address condition changes, failure to seek timely medical attention, and failure to assist with repositioning were unsubstantiated due to lack of sufficient evidence.
Deficiencies (1)
Failure to provide adequate care and supervision to ensure residents are hydrated as required by CCR 87464(f)(1).
Report Facts
Capacity: 60
Census: 55
Civil penalty: 250
Repeat violation date: Nov 6, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Mary Anne Rodriguez | Resident Services Director | Interviewed during investigation and involved in findings discussion |
| Karen Nickolai | Administrator | Facility administrator at time of report |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Jan 9, 2025
Visit Reason
An unannounced case management visit was conducted in relation to complaint #14-AS-20240717162214 to investigate the complaint regarding incomplete resident files.
Complaint Details
The visit was complaint-related for complaint #14-AS-20240717162214. The complaint was substantiated by the finding of incomplete resident records.
Findings
The inspection found that Resident 1's file was incomplete, lacking completed reappraisals, service plans, and pre-admission appraisal. Deficiencies were cited under California Code of Regulations, Title 22, Section 87506(a).
Deficiencies (1)
Resident Records: The licensee failed to maintain a separate, complete, and current record for each resident, as evidenced by missing reappraisals, service plans, and pre-admission appraisal in Resident 1's file.
Report Facts
Capacity: 60
Census: 55
Plan of Correction Due Date: Jan 10, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met with during the inspection and discussed the findings |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Shayan Gheisar | Administrator/Director | Current administrator mentioned in relation to complaint timing |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 1
Date: Nov 6, 2024
Visit Reason
An unannounced case management visit was conducted in relation to complaint #14-AS-20240424121204 to investigate compliance with fingerprint clearance and facility association requirements for staff.
Complaint Details
Complaint #14-AS-20240424121204 triggered the investigation. The deficiency related to fingerprint clearance was substantiated and resulted in a civil penalty.
Findings
The investigation found that Staff #1 was not fingerprint cleared or associated with the facility as required. Documentation was not available from facility representatives. A civil penalty of $500 was assessed.
Deficiencies (1)
Failure to obtain fingerprint clearance and facility association documentation for Staff #1 as required by Health and Safety Code Section 1569.17(b).
Report Facts
Civil penalty amount: 500
Census: 52
Total capacity: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met with Licensing Program Analyst during inspection and involved in providing documentation |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection and authored the report |
| Karen Nickolai | Administrator/Director | Facility Administrator named in the report header |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 2
Date: Nov 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations of lack of supervision resulting in an unwitnessed fall with a fractured hip and failure to seek timely medical care for a resident, as well as an allegation that staff left a resident in dirty clothes.
Complaint Details
The complaint was substantiated. The allegations included lack of supervision leading to an unwitnessed fall with a fractured hip and failure to seek timely medical care. The investigation found that staff delayed calling 911 despite the resident's pain and that short staffing contributed to inadequate supervision. The allegation that staff left a resident in dirty clothes was unsubstantiated.
Findings
The investigation substantiated that due to lack of supervision and short staffing, a resident had an unwitnessed fall resulting in a fractured hip and staff did not seek timely medical care, causing delayed hospital transfer. Another allegation that staff left a resident in dirty clothes was unsubstantiated due to insufficient evidence.
Deficiencies (2)
Failure to provide proper care and supervision to residents, including lack of an individualized fall prevention plan and inadequate staffing.
Failure to seek timely medical attention for a resident who fell and had a change in condition.
Report Facts
Capacity: 60
Census: 52
Civil penalty: 1000
Civil penalty: 500
Plan of Correction Due Date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met with during investigation and involved in findings discussion |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation |
| April Cowan | Licensing Program Manager | Oversaw the investigation and signed report |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 2
Date: Nov 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-04-24 regarding lack of supervision leading to an unwitnessed fall resulting in a fractured hip and failure to seek timely medical care for a resident, as well as an allegation that staff left a resident in dirty clothes.
Complaint Details
The complaint was substantiated. The allegations included lack of supervision causing an unwitnessed fall with a fractured hip and failure to seek timely medical care. The investigation found staff did not call 911 despite the resident's pain and delayed hospital transfer. The allegation that staff left a resident in dirty clothes was unsubstantiated.
Findings
The investigation substantiated that due to lack of supervision and short staffing, a resident had an unwitnessed fall resulting in a fractured hip and staff failed to seek timely medical care, causing injury. Another allegation that staff left a resident in dirty clothes was found to be unsubstantiated.
Deficiencies (2)
Failure to provide proper care and supervision to residents, including lack of individualized fall prevention plan and inadequate staffing.
Failure to develop and implement a plan for incidental medical and dental care, including failure to seek timely medical attention for a resident.
Report Facts
Civil penalty amount: 1000
Capacity: 60
Census: 52
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Mary Anne Rodriguez | Resident Services Director | Met with the Licensing Program Analyst during the investigation and was involved in the findings discussion. |
| Karen Nickolai | Administrator | Facility administrator mentioned in the report. |
| April Cowan | Supervisor | Supervisor overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 1
Date: Nov 6, 2024
Visit Reason
An unannounced case management visit was conducted in relation to complaint #14-AS-20240424121204 to investigate staff fingerprint clearance and facility association compliance.
Complaint Details
Complaint #14-AS-20240424121204 triggered the visit. The complaint was substantiated based on findings of noncompliance with fingerprint clearance requirements.
Findings
The investigation found that Staff #1 was working without fingerprint clearance and was not associated with the facility as required. The facility was unable to provide documentation confirming clearance or association for this staff member.
Deficiencies (1)
Failure to obtain California fingerprint clearance or criminal record exemption for Staff #1 prior to working at the facility.
Report Facts
Civil penalty amount: 500
Penalty daily rate: 100
Penalty duration days: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Anne Rodriguez | Resident Services Director | Met with Licensing Program Analyst during the visit and involved in providing documentation. |
| Komal Charitra | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report. |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Sep 23, 2024
Visit Reason
An unannounced case management visit was conducted related to complaint #14-AS-20240514090937 to investigate medication administration practices by the memory care director.
Complaint Details
Investigation was conducted in relation to complaint #14-AS-20240514090937. The deficiency was substantiated as the memory care director did not pass the required medication handling exam.
Findings
The investigation found that the memory care director was administering medication to residents without having passed the required medication handling/med-tech certification exam, posing an immediate health and safety risk to residents. A citation was issued for this deficiency.
Deficiencies (1)
Memory care director was passing medications to residents but did not pass the examination regarding med-tech training, violating training requirements for employees assisting residents with self-administration of medication.
Report Facts
Capacity: 60
Census: 55
Plan of Correction Due Date: Sep 24, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and investigation |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during the visit |
| Karen Nickolai | Administrator/Director | Facility Administrator/Director |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 1
Date: Sep 23, 2024
Visit Reason
An unannounced case management visit was conducted on 09/23/2024 in relation to complaint #14-AS-20240514090937 to investigate medication administration practices at the facility.
Complaint Details
The visit was conducted as a complaint investigation related to complaint #14-AS-20240514090937. The complaint was substantiated by the finding that the memory care director administered medication without proper certification.
Findings
The investigation found that the director of memory care was administering medication to residents without having passed the required medication handling/med-tech certification exam, posing an immediate health and safety risk. A citation was issued for this deficiency.
Deficiencies (1)
The memory care director was passing medications to residents but did not pass the examination regarding med-tech training as required by HSC 1569.69(a)(5).
Report Facts
Capacity: 60
Census: 55
Plan of Correction Due Date: Sep 24, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jovy Castro | Business Office Manager | Met with the Licensing Program Analyst during the inspection |
| Karen Nickolai | Administrator/Director | Facility administrator named in the report header |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 2
Date: Sep 16, 2024
Visit Reason
Unannounced complaint investigation visit to provide additional citations related to previously substantiated complaint allegations regarding staff neglect causing resident weight loss and dehydration.
Complaint Details
Complaint substantiated. Allegations included staff neglect causing resident weight loss and dehydration. Additional citations issued on 09/16/2024 following prior substantiation on 08/20/2024.
Findings
The facility failed to adequately monitor the resident's food and water intake, resulting in weight loss from 120lbs to 111lbs and dehydration requiring emergency room treatment. There was also a change in the resident's mental condition noted at the hospital. These findings pose an immediate health and safety risk.
Deficiencies (2)
Failure to monitor food intake or special diets, resulting in resident weight loss from 120lbs to 111lbs.
Failure to regularly observe the resident's physical and mental condition, resulting in dehydration and mental status changes.
Report Facts
Resident weight loss: 9
Facility capacity: 60
Resident census: 55
Plan of Correction due date: Sep 17, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
| Jovy Castro | Business office manager | Met with the investigator during the visit. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 60
Deficiencies: 2
Date: Sep 16, 2024
Visit Reason
The visit was an unannounced subsequent complaint investigation conducted to provide additional citations related to previously substantiated complaint allegations regarding staff neglect causing resident weight loss and dehydration.
Complaint Details
The complaint was substantiated. Allegations included staff neglect causing resident weight loss and dehydration. Additional citations were issued on 09/16/2024 following a prior substantiation on 08/20/2024.
Findings
The investigation found that the facility failed to properly monitor the resident's food and water intake, resulting in the resident losing weight from 120 lbs to 111 lbs and becoming dehydrated, requiring emergency room treatment. There was also a noted change in the resident's mental condition. These deficiencies pose an immediate health and safety risk.
Deficiencies (2)
Failure to monitor food intake or special diets, resulting in resident weight loss from 120 lbs to 111 lbs.
Failure to regularly observe the resident's physical and mental condition, resulting in dehydration requiring intravenous fluids and mental status changes.
Report Facts
Resident weight loss: 9
Capacity: 60
Census: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Jovy Castro | Business Office Manager | Met with the evaluator during the investigation and reviewed the report. |
| Karen Nickolai | Administrator | Facility administrator named in the report. |
| April Cowan | Supervisor | Supervisor overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 1
Date: Aug 30, 2024
Visit Reason
An unannounced case management - incident visit was conducted following a report that a resident was found with a bottle of cleaning solution in her room, posing an immediate health and safety risk.
Complaint Details
The visit was complaint-related due to a report on 08/29/2024 that a resident was found with a bottle of cleaning solution in her room. The complaint was substantiated as the facility failed to keep cleaning solutions inaccessible to residents, posing an immediate health and safety risk.
Findings
The facility failed to keep cleaning solutions inaccessible to residents, as a cleaning solution was left in a resident's room and the resident had some of the solution on her face. The resident was evaluated and placed on increased supervision for 72 hours as a safety precaution.
Deficiencies (1)
Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement has not been met as evidenced by a cleaning solution left in a resident's room accessible to the resident.
Report Facts
Census: 57
Total Capacity: 60
Plan of Correction Due Date: Aug 31, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management - incident visit and authored the report |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during the inspection and was involved in the investigation |
| April Cowan | Licensing Program Manager | Supervisor named in the report overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 1
Date: Aug 30, 2024
Visit Reason
An unannounced case management - incident visit was conducted following a report that a resident was found with a bottle of cleaning solution in her room, posing a potential health and safety risk.
Complaint Details
The visit was complaint-related due to a report that a resident was found with a bottle of cleaning solution in her room. The complaint was substantiated as the facility failed to keep cleaning solutions inaccessible to residents, posing an immediate health and safety risk.
Findings
The facility failed to keep cleaning solutions inaccessible to residents, as a resident was found holding a bottle containing cleaning solution with residue observed on the resident's face. Emergency responders evaluated the resident and recommended no hospital transfer. The resident is on increased supervision for 72 hours as a safety precaution.
Deficiencies (1)
Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement has not been met as evidenced by a cleaning solution left in a resident's room accessible to the resident.
Report Facts
Census: 57
Total Capacity: 60
Plan of Correction Due Date: Aug 31, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jovy Castro | Business Office Manager | Met with the Licensing Program Analyst during the inspection and was involved in the report review |
| Karen Nickolai | Administrator/Director | Facility Administrator/Director named in the report header |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 60
Deficiencies: 1
Date: Aug 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted to deliver findings regarding allegations of staff neglect resulting in resident weight loss and dehydration.
Complaint Details
The complaint investigation was substantiated for allegations of staff neglect causing resident weight loss and dehydration. Other allegations about staff not seeking timely medical care or not noticing changes in the resident's condition were unsubstantiated.
Findings
The investigation substantiated that a resident lost weight from 120 lbs to 111 lbs over approximately five weeks and was diagnosed with a dehydration-related condition requiring intravenous fluids. Other allegations regarding timely medical care and noticing changes in the resident's condition were unsubstantiated.
Deficiencies (1)
Basic services requirement not met: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Resident lost weight and suffered dehydration requiring hospitalization.
Report Facts
Resident weight loss: 9
Capacity: 60
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings. |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during the investigation. |
| Karen Nickolai | Administrator | Facility administrator named in the report. |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 60
Deficiencies: 1
Date: Aug 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted to deliver findings regarding allegations of staff neglect resulting in resident weight loss and dehydration.
Complaint Details
The complaint was substantiated regarding staff neglect causing resident weight loss and dehydration. Other allegations about staff not seeking timely medical care or noticing changes in the resident's condition were unsubstantiated.
Findings
The investigation substantiated that a resident lost weight from 120 lbs to 111 lbs over approximately five weeks and was dehydrated, requiring intravenous fluids at a hospital. Other allegations regarding timely medical care and noticing changes in the resident's condition were unsubstantiated.
Deficiencies (1)
Basic services requirement not met, including care and supervision, resulting in resident weight loss and dehydration.
Report Facts
Resident weight loss: 9
Capacity: 60
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Karen Nickolai | Administrator | Facility administrator named in the report |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Annual Inspection
Census: 55
Capacity: 60
Deficiencies: 0
Date: Jun 17, 2024
Visit Reason
An unannounced 1 year annual inspection visit was conducted by Licensing Program Analyst Jaime Vado to evaluate compliance with licensing regulations.
Findings
The facility was toured inside and outside, with checks on water temperature, fire extinguishers, smoke detectors, food supplies, medication storage, and emergency egress routes. No citations were issued and the facility was found to be in compliance with regulations.
Report Facts
Water temperature: 110
Fire extinguisher inspection date: Nov 17, 2023
Fire drill date: Apr 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
| Jovy Castro | Business Office Manager | Met with the Licensing Program Analyst during the inspection |
Inspection Report
Annual Inspection
Census: 55
Capacity: 60
Deficiencies: 0
Date: Jun 17, 2024
Visit Reason
An unannounced 1 year annual inspection visit was conducted by Licensing Program Analyst Jaime Vado to evaluate compliance with regulations at Pacifica Senior Living Mission Villa.
Findings
The facility was toured inside and outside, with checks on water temperature, fire extinguishers, smoke detectors, food supplies, medication storage, and emergency egress routes. No citations were issued and the facility was found to be in compliance with regulatory requirements.
Report Facts
Water temperature: 110
Fire extinguisher inspection date: Nov 17, 2023
Food supply duration: 7
Food supply duration: 2
Last fire drill date: Apr 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 60
Deficiencies: 0
Date: May 20, 2024
Visit Reason
An unannounced case management visit was conducted in conjunction with a complaint visit to make observations throughout the facility.
Complaint Details
Visit was conducted in conjunction with a complaint investigation; no citations were issued.
Findings
Staffing observations were made and a copy of the weekly staff schedule was requested. Staffing levels were discussed with the Marketing Director. No citations were issued.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Connor Perfumo | Marketing Director | Discussed staffing levels and was present during the visit. |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 60
Deficiencies: 0
Date: May 20, 2024
Visit Reason
An unannounced case management visit was conducted to make observations throughout the facility in conjunction with a complaint visit on this day.
Complaint Details
Visit was conducted in conjunction with a complaint. No citations issued.
Findings
Staffing observations were made and a copy of the weekly staff schedule was requested. Staffing levels were discussed with the Marketing Director. No citations were issued.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connor Perfumo | Marketing Director | Discussed staffing levels and was met with during the inspection. |
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management visit. |
| April Cowan | Supervisor | Supervisor overseeing the inspection. |
Inspection Report
Census: 57
Capacity: 60
Deficiencies: 2
Date: May 10, 2024
Visit Reason
An unannounced case management visit was conducted to observe facility operations and staffing, including review of staff schedules and resident roster.
Findings
The inspection found staffing and training violations, including a shortage of med-techs with only one med-tech handling medications for both floors, and a memory care director administering medications without proper certification or training. These violations pose a health and safety risk to residents.
Deficiencies (2)
Facility personnel are insufficient in numbers and competence to meet resident needs, with only one med-tech handling AM and PM medications and four caregivers assisting 57 residents.
Employees assisting residents with self-administration of medication have not met required training, evidenced by the memory care director not fully trained yet administering medications.
Report Facts
Census: 57
Total Capacity: 60
Hospice Residents: 8
Staffing: 1
Staffing: 4
Staffing: 5
Plan of Correction Due Date: May 11, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during inspection |
| Karen Nickolai | Administrator/Director | Facility administrator noted as not assigned on-site during inspection |
| April Cowan | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 57
Capacity: 60
Deficiencies: 2
Date: May 10, 2024
Visit Reason
An unannounced case management - other visit was conducted to observe facility operations and staffing at Pacifica Senior Living Mission Villa.
Findings
The inspection found staffing and training violations, including a shortage of med-techs with only one med-tech handling medications for both floors and a memory care director administering medications without proper certification, posing health and safety risks to residents.
Deficiencies (2)
Personnel Requirements - Facility personnel are insufficient in numbers and competence to meet resident needs, with only one med-tech for AM and PM shifts and inadequate caregiver staffing.
Employees assisting residents with self-administration of medication are not fully trained; the memory care director administered medications without completing required training.
Report Facts
Capacity: 60
Census: 57
Hospice residents: 8
Med-techs: 1
Caregivers: 4
Caregivers: 5
Plan of Correction Due Date: May 11, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jovy Castro | Business Office Manager | Met with Licensing Program Analyst during inspection |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
| Karen Nickolai | Administrator/Director | Named as facility administrator, but no administrator assigned providing oversight at time of visit |
| April Cowan | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 0
Date: Dec 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations received regarding inadequate housekeeping service, safeguarding of personal belongings, assistance with grooming and showering, and provision of toiletry items to residents.
Complaint Details
The complaint investigation was unsubstantiated as there was insufficient evidence to prove the alleged violations occurred.
Findings
The investigation included interviews, document reviews, and observations. The resident appeared well kept and their room was in order. Toiletry items were provided based on evaluations and behaviors. The allegations could neither be proven nor disproven and were therefore unsubstantiated.
Report Facts
Capacity: 60
Census: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Karen Nickolai | Administrator | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 0
Date: Dec 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations received regarding inadequate housekeeping service, safeguarding of personal belongings, assistance with grooming and showering, and provision of toiletry items to residents.
Complaint Details
The complaint investigation was unsubstantiated as there was not a preponderance of evidence to prove the alleged violations occurred.
Findings
The Licensing Program Analyst conducted interviews, reviewed documents, and observed the resident and their room. The resident appeared well kept and groomed, and the room was in order. Toiletry items were provided based on resident evaluations and behaviors. The allegations could not be proven or disproven and were therefore unsubstantiated.
Report Facts
Capacity: 60
Census: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | Administrator | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
Date: May 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2022-10-06 regarding multiple allegations about staff and resident care at the facility.
Complaint Details
The complaint included allegations such as staff not preventing a skin rash outbreak, locking residents in rooms for extended periods, neglecting residents' bathroom and hygiene needs, failing to schedule medical check-ups, and not providing a safe and healthy environment. All allegations were found unsubstantiated due to lack of evidence.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations. Conflicting information and inability to contact the reporting party resulted in all allegations being unsubstantiated.
Report Facts
Capacity: 60
Census: 57
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nickolai | Administrator | Met with Licensing Program Analyst during investigation and reviewed report |
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
Date: May 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2022-10-06 regarding multiple allegations about resident care and facility conditions.
Complaint Details
The complaint included allegations such as staff not preventing a skin rash outbreak, locking residents in rooms for extended periods, neglecting bathroom and hygiene needs, failing to schedule medical check-ups, and not providing a safe and healthy environment. All allegations were found unsubstantiated.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations. Conflicting information and inability to contact the reporting party resulted in all allegations being unsubstantiated.
Report Facts
Capacity: 60
Census: 57
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nickolai | Administrator | Met with Licensing Program Analyst during investigation and reviewed report |
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 60
Deficiencies: 0
Date: Apr 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations including failure to conduct a preadmission appraisal, illegal eviction, failure to provide a refund, medication mismanagement, failure to inform authorized representative of condition changes, false facility advertisement, failure to intervene timely in resident altercation, and resident isolation.
Complaint Details
The complaint was investigated and found to be unfounded or unsubstantiated. Specifically, the facility did conduct a preadmission appraisal, did not evict the resident illegally, and provided the required refund. Medication management was reviewed with no evidence of mismanagement found. Notifications to the authorized representative were documented. Allegations of false advertisement and failure to intervene timely were not proven. The claim of resident isolation was inconclusive due to conflicting accounts.
Findings
The investigation found the initial complaint regarding preadmission appraisal, eviction, and refund to be unfounded. Additional allegations related to medication management, communication, advertisement, intervention, and isolation were unsubstantiated due to lack of sufficient evidence. The facility was found to have acted appropriately in all investigated matters.
Report Facts
Capacity: 60
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Karen Nickolai | Administrator | Facility administrator met during investigation and involved in findings review |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 0
Date: Apr 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that the facility failed to ensure infection control practices were followed or maintained, resulting in multiple residents getting scabies.
Complaint Details
The complaint was unsubstantiated. Although the allegations may have occurred, there was insufficient evidence to prove the violations did or did not occur.
Findings
The investigation found that the facility is adhering to its infection control policies and scabies was not widespread, indicating control practices are being followed. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | Administrator | Met with the Licensing Program Analyst during the investigation |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 0
Date: Apr 12, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that the facility failed to ensure infection control practices were followed or maintained, resulting in multiple residents getting scabies.
Complaint Details
The complaint alleged failure to maintain infection control practices resulting in multiple residents contracting scabies. The allegation was unsubstantiated after investigation.
Findings
The investigation found that the facility is adhering to its infection control policies and scabies was not widespread throughout the facility, indicating control practices are being followed. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | Administrator | Met with the investigator during the visit |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 60
Deficiencies: 0
Date: Apr 12, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to multiple allegations including failure to conduct a preadmission appraisal, illegal eviction, failure to provide refund, medication mismanagement, failure to inform authorized representative of condition changes, false facility advertisement, failure to intervene timely in resident altercation, and resident isolation.
Complaint Details
The complaint investigation was triggered by allegations received on 08/18/2021. The complaint was found unfounded regarding preadmission appraisal, eviction, and refund issues. Additional allegations related to medication management, communication, advertisement, intervention, and isolation were unsubstantiated due to insufficient evidence.
Findings
The investigation found the initial complaint allegations unfounded and dismissed. Subsequent allegations were unsubstantiated due to lack of preponderance of evidence. The facility was found to have provided refunds, conducted appraisals, and intervened appropriately in incidents, though some family-facility disagreements on medication variances were noted.
Report Facts
Capacity: 60
Census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | Administrator | Facility administrator met during investigation and report review |
| Cara Smith | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
Date: Sep 27, 2022
Visit Reason
Unannounced complaint investigation visit conducted in response to a complaint alleging that the facility abandoned a resident.
Complaint Details
Complaint alleging the facility abandoned a resident was investigated and found to be unfounded.
Findings
The investigation found the allegation to be unfounded, meaning the complaint was false, could not have happened, or was without reasonable basis. No citations were issued.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Karen Nickolai | Administrator | Facility administrator who communicated with Licensing Program Analyst regarding the complaint |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
Date: Sep 27, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility abandoned a resident.
Complaint Details
The complaint alleging that the facility abandoned a resident was investigated and found to be unfounded, meaning the allegation was false, could not have happened, and/or was without reasonable basis.
Findings
The investigation found the allegation to be unfounded after reviewing documentation and communications, including family member interactions with the resident. No citations were issued and the complaint was dismissed.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen Nickolai | Administrator | Facility administrator involved in communications regarding the complaint |
Inspection Report
Annual Inspection
Census: 58
Capacity: 60
Deficiencies: 2
Date: Nov 15, 2021
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements, including infection control and safety measures.
Findings
The facility was found to have adequate infection control practices, proper storage of medications and sharps, and sufficient PPE and cleaning supplies. However, the administrator was unable to provide documentation for staff and resident screening logs, and was advised to begin daily temperature screening and logging.
Deficiencies (2)
Administrator was not able to provide documentation on the staff and resident screening log.
Administrator was advised to cover all trash cans with lids.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nikolai | Administrator | Met with Licensing Program Analyst during inspection and involved in findings regarding screening logs |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
| Julio Montes | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 58
Capacity: 60
Deficiencies: 1
Date: Nov 15, 2021
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and infection control practices.
Findings
The facility was found to have adequate infection control measures, proper storage of medications and sharps, and sufficient PPE and cleaning supplies. However, the administrator was unable to provide documentation for staff and resident screening logs and was advised to begin daily temperature screening and logging.
Deficiencies (1)
Administrator was not able to provide documentation on the staff and resident screening log.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nikolai | Administrator | Met with Licensing Program Analyst and involved in findings related to screening logs |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Census: 56
Capacity: 60
Deficiencies: 0
Date: Oct 1, 2021
Visit Reason
Unannounced case management inspection visit to discuss and obtain documents pertaining to resident R1, including circumstances regarding the eviction of R1.
Findings
LPAs met with the administrator, discussed the eviction circumstances of R1, and received some requested documents in person. Additional documents will be forwarded once received from the facility's corporate office.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nickolai | Administrator | Met with LPAs during the inspection and discussed eviction circumstances of R1. |
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced case management inspection visit. |
| Brenda Chan | Licensing Program Manager | Named in the report header. |
Inspection Report
Census: 56
Capacity: 60
Deficiencies: 0
Date: Oct 1, 2021
Visit Reason
An unannounced case management inspection visit was conducted to discuss and obtain documents pertaining to the eviction of resident R1.
Findings
The Licensing Program Analysts met with the facility administrator to discuss the circumstances regarding the eviction of R1 and requested specific documents, some of which were received during the visit with additional items to be forwarded later.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Nickolai | Administrator | Met with Licensing Program Analysts during the inspection visit and discussed eviction circumstances of R1. |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
Date: May 4, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2021-03-03 regarding resident care concerns at Pacifica Senior Living Mission Villa.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included severe dehydration of a resident and lack of communication with the authorized representative. The Department found no evidence supporting these allegations after reviewing medical and hospice records.
Findings
The investigation found no evidence to substantiate the allegations that a resident sustained severe dehydration or that staff failed to communicate with the authorized representative regarding the resident's change in health conditions. Both allegations were determined to be unsubstantiated after review of medical records and hospice documents.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mohamed Filouane | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Karen Nickolai | Administrator | Facility administrator involved in the investigation and exit interview |
| Julio Montes | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
Date: May 4, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2021-03-03 regarding a resident sustaining severe dehydration and staff failing to communicate with the authorized representative about the resident's change in health conditions.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included severe dehydration of a resident and lack of communication with the authorized representative. The Department found no evidence to support these allegations after reviewing medical and hospice records.
Findings
The investigation found no evidence to support the allegations. The resident did not sustain severe dehydration while in care, and staff communication with the authorized representative was adequate. Both allegations were unsubstantiated after review of medical records and hospice documents.
Report Facts
Capacity: 60
Census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mohamed Filouane | Licensing Program Analyst | Conducted the complaint investigation and follow-up visit |
| Karen Nickolai | Administrator | Facility administrator involved in the investigation and exit interview |
| Julio Montes | Supervisor | Supervisor overseeing the licensing evaluation |
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