Inspection Report Summary
Most inspections found deficiencies, with issues primarily related to resident safety, medication management, and environment/sanitation. The most recent report from October 30, 2025, cited two deficiencies involving unsafe storage of a razor in a memory care unit and improper medication storage for a resident unable to self-administer medications. Past reports included substantiated complaints about unsafe resident supervision, improper medication administration by unlicensed staff, pest infestations, and failure to comply with license requirements by retaining residents needing higher care levels. Several complaint investigations were unsubstantiated, and the facility received civil penalties totaling $500 for repeat violations related to hazardous storage and food sanitation. While deficiencies have persisted over time, the October 2025 inspection shows ongoing concerns with safety and medication practices, with no clear pattern of overall improvement.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 101
Capacity: 170
Deficiencies: 2
Oct 30, 2025
Visit Reason
An unannounced annual required inspection was conducted to evaluate compliance with licensing requirements at the assisted living facility.
Findings
The inspection included a tour of the facility and review of various areas including resident apartments, common areas, and safety equipment. Two Type A deficiencies were cited related to unsafe storage of a razor in a memory care unit apartment and improper storage of Tylenol medication for a resident who cannot self-administer medications.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Razor found in the bathroom of an apartment in the memory care unit, posing an immediate safety and/or personal rights risk to residents. | Type A |
| Tylenol found in the medication cabinet of a resident who cannot administer and store own medications, posing an immediate health, safety, and/or personal rights risk. | Type A |
Report Facts
Capacity: 170
Census: 101
Plan of Correction Due Date: Oct 31, 2025
Number of residents' apartments inspected: 10
Food supply duration: 7
Food supply duration: 2
Hot water temperature: 117.1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joseph Villanueva | Executive Director | Met with Licensing Program Analyst during inspection and discussed deficiencies and plans of correction |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 170
Deficiencies: 1
Jun 4, 2025
Visit Reason
The inspection was conducted as part of a complaint investigation (Control # 15-AS-20230801150316) regarding the care provided to a resident who required a higher level of care than the facility was authorized to provide.
Findings
The facility was found to have retained a resident who required a higher level of care than authorized, posing an immediate risk to the resident's health, safety, and personal rights. Staff admitted the resident fell daily and did not believe they could provide the necessary care.
Complaint Details
The complaint investigation revealed that the resident (R1) required assistance to get up after falling every day, and staff acknowledged they could not provide the required level of care but retained the resident anyway.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to comply with license requirements by retaining a resident who required a higher level of care than the facility is authorized to provide, posing immediate health, safety, and personal rights risks. | Type A |
Report Facts
Capacity: 170
Census: 94
Plan of Correction Due Date: Jun 19, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nansiela Randhawa | Executive Director | Discussed deficiency and plan of correction with licensing program analyst |
Inspection Report
Census: 99
Capacity: 170
Deficiencies: 0
Apr 22, 2025
Visit Reason
The visit was conducted for case management purposes under 'Other' type of visit, during which the Licensing Program Analyst learned about the facility's new administrator/executive director and reviewed related personnel documentation.
Findings
The Licensing Program Analyst verified the new administrator/executive director's credentials and discussed Title 22 Regulations related to hiring a new administrator. Copies of personnel records and related documents were received, and an exit interview was conducted.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nanensila Randhawa | Executive Director | New administrator/executive director verified during the visit; started on April 7, 2025. |
Inspection Report
Complaint Investigation
Census: 99
Capacity: 170
Deficiencies: 0
Apr 22, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility failed to issue an appropriate refund to a resident's responsible person.
Findings
The investigation found that the allegation was unfounded. Documentation and interviews confirmed that the resident moved out on 05/04/2024, the prorated rent was paid, and the refund check issued was cancelled due to a banking error by the responsible person. No deficiencies were cited.
Complaint Details
The complaint alleged that the facility failed to issue an appropriate refund for a prorated rent amount after a resident moved out. The allegation was closed as unfounded based on evidence and interviews.
Report Facts
Capacity: 170
Census: 99
Refund amount: 7280
Prorated rent amount: 780
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Nanensila Randhawa | Executive Director | Met with Licensing Program Analyst during investigation |
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Capacity: 170
Deficiencies: 0
Mar 8, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-09-01 regarding medication administration, resident falls, safeguarding personal belongings, and notification of injuries.
Findings
All allegations were investigated through interviews, records review, and conflicting information. The investigation concluded that there was insufficient evidence to substantiate any of the allegations, resulting in all allegations being unsubstantiated.
Complaint Details
The complaint included allegations that facility staff did not administer medication according to physician's instructions, resident sustained falls resulting in injuries due to lack of supervision, staff did not safeguard resident's personal belongings, and staff did not notify the resident's authorized representative of injuries. All allegations were found unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 170
Safety check-ins: 127
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bennett Fong | Evaluator / Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Pam Gill | Licensing Program Manager | Oversaw the complaint investigation |
| Henrietta Beshares | Community Relations Director | Met with evaluator during the unannounced visit |
| Apolinario C. Gozon | Administrator | Facility administrator named in the report header |
Inspection Report
Complaint Investigation
Census: 99
Capacity: 170
Deficiencies: 1
Jan 24, 2025
Visit Reason
Unannounced complaint investigation conducted due to a complaint alleging the facility was not responding to a resident's responsible person regarding refund issues.
Findings
The investigation found that the facility did not respond promptly to the resident's responsible person as required. The Interim Executive Director was aware of the refund issues but did not communicate with the family member. The allegation was substantiated and a deficiency was cited.
Complaint Details
Complaint was substantiated. The allegation was that the facility was not responding to the resident's responsible person regarding refund issues. Evidence showed ongoing lack of communication from May 2024 through January 2025.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to have communications to the licensee from their representatives answered promptly and appropriately, violating CCR 87468.1(a)(9). | Type B |
Report Facts
Capacity: 170
Census: 99
Deficiency due date: Feb 7, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Gabriella Johnson | Wellness Director | Facility staff member who received the report and was interviewed |
| Rosana Frias | Interim Executive Director | Interviewed during investigation; aware of refund issues but did not communicate with family member |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 170
Deficiencies: 2
Jan 16, 2025
Visit Reason
The inspection was conducted as part of a complaint investigation (Control # 15-AS-20240319155109) regarding failure to check a resident's blood pressure as ordered and concerns about overgrown toenails.
Findings
The facility failed to comply with medical orders to check resident R1's blood pressure on specified dates, and resident R1 was found to have discolored overgrown toenails posing a personal rights risk. Deficiencies were cited under Title 22 California Code of Regulations.
Complaint Details
Complaint investigation related to failure to check blood pressure as ordered and resident having overgrown toenails. Licensing Program Analyst was unable to obtain explanation for missed blood pressure checks. Podiatrist confirmed resident was seen in April 2024.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to check resident R1's blood pressure as ordered on specific dates, posing a potential health risk. | Type B |
| Resident R1 had discolored overgrown toenails about 1 to 2 inches long, posing a potential personal rights risk. | Type B |
Report Facts
Capacity: 170
Census: 104
Plan of Correction Due Date: Jan 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted investigation and signed report |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager and Supervisor |
| Rosana Frias | Associate Executive Director (AED) | Met with during inspection and discussed deficiencies and plan of correction |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 170
Deficiencies: 0
Jan 16, 2025
Visit Reason
Unannounced complaint investigation visit conducted to investigate allegations received on 2024-03-19 regarding failure to seek timely medical attention, improper assistance with medical needs, lack of staff communication with responsible person, and staff interference with residents' mail.
Findings
After review of records, interviews with staff, residents, and responsible parties, and investigation of all allegations, the complaint was found to be unsubstantiated with no deficiencies cited.
Complaint Details
The complaint included allegations that the facility failed to seek timely medical attention for resident R1, improperly assisted R1 with medical needs, staff did not respond to the responsible person's communication requests, and staff interfered with residents' mail. All allegations were investigated and found unsubstantiated due to lack of sufficient evidence.
Report Facts
Facility capacity: 170
Census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during investigation |
| Henry Cayia | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 170
Deficiencies: 1
Dec 5, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff were not ensuring residents' rooms were clean and the facility was not kept free of insects.
Findings
The investigation found substantiated evidence of roach infestations in residents' apartments, including dead roaches and roach traps with dead roaches. The facility was found not to be maintaining cleanliness and pest control, posing potential health and safety risks. A repeat violation was cited.
Complaint Details
The complaint was substantiated based on interviews with residents, family members, staff, and observations of roaches and unclean conditions in residents' apartments.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to maintain clean, safe, sanitary, and insect-free residents' apartments, violating CCR 87303(a). | Type B |
Report Facts
Civil penalty amount: 250
Plan of Correction due date: Dec 19, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Rosana Frias | Associate Executive Director | Facility representative who met with the Licensing Program Analyst and discussed the plan of correction |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 170
Deficiencies: 1
Dec 5, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that non-medical staff members were administering injections.
Findings
The investigation substantiated the allegation that non-medical staff administered insulin injections to residents. Interviews and records review confirmed that some residents received insulin injections from med-techs who are not licensed medical professionals.
Complaint Details
The complaint was substantiated based on interviews with residents and staff, and review of resident records. The allegation was that non-medical staff members were administering injections, which was confirmed during the investigation.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Non-medical staff administer insulin injections to residents, violating Title 22 California Code of Regulations section 87628(a). | Type B |
Report Facts
Census: 105
Total Capacity: 170
Deficiency Type: 1
Plan of Correction Due Date: Dec 19, 2024
Number of residents interviewed: 5
Number of staff interviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Rosana Frias | Associate Executive Director | Facility representative met during investigation and discussion of findings |
| Cayia Henry | Administrator | Facility administrator named in report header |
Inspection Report
Annual Inspection
Census: 105
Capacity: 170
Deficiencies: 6
Sep 26, 2024
Visit Reason
An unannounced annual required inspection was conducted to evaluate compliance with licensing regulations and facility operations.
Findings
The inspection identified multiple deficiencies including unsafe storage of hazardous materials accessible to residents, medications stored improperly in resident rooms, stained and soiled carpet flooring, incomplete staff training hours, and lack of physician orders for postural supports for some residents. Plans of correction were requested with due dates.
Severity Breakdown
Type A: 2
Type B: 4
Deficiencies (6)
| Description | Severity |
|---|---|
| Razor, hair developer, perming agent, waving lotion, anti fungal wash and screwdriver found in unlocked drawers in unlocked salon; cleaning supplies in unlocked housekeeping room on 5th floor. | Type A |
| Medications and Peritoneal cleanser found in resident rooms accessible to residents with dementia. | Type A |
| Stained/soiled carpet flooring in residents' rooms on 3rd and 5th floors. | Type B |
| Staff member S5 has not completed required total initial hours of medication training. | Type B |
| Staff members S1, S3, and S5 have not completed required numbers of training hours including dementia care and postural supports. | Type B |
| Residents R2 and R4 have postural supports without doctor's orders on file. | Type B |
Report Facts
Civil penalty amount: 250
Number of residents' rooms inspected: 10
Number of staff files reviewed: 5
Number of resident files reviewed: 6
Number of residents interviewed: 4
Hot water temperature: 114.6
Facility capacity: 170
Current census: 105
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during inspection and discussed findings. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 170
Deficiencies: 1
Sep 26, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to allegations that the facility failed to supervise resident (R1) resulting in intoxication and failed to assist resident (R1) with hydration.
Findings
The allegation that the facility failed to supervise resident (R1) resulting in intoxication was substantiated based on evidence including hospital records and facility alcohol intake logs showing R1 was given more alcohol than permitted. The allegation that staff did not assist resident (R1) with hydration was unsubstantiated due to lack of sufficient evidence.
Complaint Details
The complaint was substantiated regarding failure to supervise resident (R1) resulting in intoxication. The allegation regarding failure to assist resident (R1) with hydration was unsubstantiated. The investigation included interviews, review of resident and staff records, and hospital discharge summaries.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to comply with reasonable accommodation of individual needs and preferences by giving the resident alcohol more than the permitted amount. | Type B |
Report Facts
Alcohol level: 244
Census: 105
Total Capacity: 170
Plan of Correction Due Date: Oct 10, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Rosana Frias | Associate Executive Director | Facility representative met during investigation and discussion of findings |
| Apolinario C. Gozon | Administrator | Facility administrator named in report header |
Inspection Report
Census: 93
Capacity: 170
Deficiencies: 0
Mar 22, 2024
Visit Reason
The visit was an unannounced case management visit conducted in response to an Unusual Incident Report regarding discrepancies with residents' narcotic medications.
Findings
The investigation found discrepancies in narcotic medication containers, which led to an in-service training for med-techs and notification of local law enforcement. No deficiencies were cited during the visit.
Report Facts
Capacity: 170
Census: 93
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cayia Henry | Executive Director | Named in the investigation and notification process regarding narcotic medication discrepancies |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 170
Deficiencies: 2
Feb 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate multiple allegations including unsafe storage of hazardous materials, improper food service sanitation practices, presence of roaches, inappropriate serving of alcohol to residents, staff drinking alcohol at the facility, and obstruction in passageways.
Findings
The investigation substantiated two allegations: unsafe storage of hazardous materials posing immediate risk and kitchen staff not observing proper food sanitation practices, resulting in a $250 civil penalty for repeat violations. The allegations regarding roaches, inappropriate alcohol serving, staff drinking alcohol, and obstruction in passageways were unsubstantiated or unfounded.
Complaint Details
The complaint investigation was substantiated for unsafe storage of hazardous materials and food service sanitation violations. A $250 civil penalty was assessed for repeat violation of Regulation section 87309(a). Other allegations including presence of roaches, inappropriate alcohol serving, staff drinking alcohol, and obstruction in passageways were unsubstantiated or unfounded.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Hazardous materials and cleaning supplies were stored in unlocked areas accessible to residents, including the housekeeping room and salon, and hazardous debris was found in the garage. | Type A |
| Two kitchen staff were observed not wearing hairnets while preparing food, posing potential health and personal rights risks. | Type B |
Report Facts
Civil penalty amount: 250
Capacity: 170
Census: 83
Deficiency count: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cayia Henry | Executive Director | Met with Licensing Program Analyst during inspection and discussed findings |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Bennett Fong | Licensing Program Manager | Oversaw complaint investigation and signed report |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 170
Deficiencies: 0
Feb 15, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that the facility was isolating residents, delivering residents meals cold, and not providing activities for residents.
Findings
The investigation found that the dining and activity rooms were closed per Local Public Health recommendations during a COVID-19 outbreak, and meals were delivered to residents' rooms with caregivers warming food when residents were ready to eat. Residents expressed understanding or acceptance of these measures. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint was unsubstantiated. Although the allegations may have happened or be valid, there was not sufficient evidence to prove the alleged violations occurred.
Report Facts
Capacity: 170
Census: 83
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Cayia Henry | Executive Director | Met with Licensing Program Analyst during investigation |
| Apolinario C. Gozon | Administrator | Facility Administrator named in report |
Inspection Report
Follow-Up
Capacity: 170
Deficiencies: 2
Dec 22, 2023
Visit Reason
The visit was an unannounced case management follow-up on Death Reports and Unusual Incident Reports (UIRs) received by the Department.
Findings
The inspection found deficiencies related to failure to update resident re-appraisals and failure to submit incident reports for a resident, posing potential health and safety risks. Two resident deaths and two unusual incidents involving falls and injuries were reported and reviewed.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to update pre-admission appraisal and care plan after resident had multiple falls in a few months. | Type B |
| Failure to submit incident report for a resident which poses potential health, safety, and personal rights risks. | Type B |
Report Facts
Capacity: 170
Deficiency count: 2
Plan of Correction Due Date: Jan 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cayia Henry | Executive Director | Met with Licensing Program Analyst during inspection and discussed deficiencies |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 69
Capacity: 170
Deficiencies: 0
Dec 22, 2023
Visit Reason
The visit was an unannounced continuation of the annual required inspection that was started on 2023-10-04.
Findings
The Licensing Program Analyst reviewed 5 residents' records, checked medications against doctor's orders and centrally stored medication records, and found no deficiencies cited.
Report Facts
Residents' records reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and reviewed residents' records |
| Bennett Fong | Licensing Program Manager | Named in the report header |
| Cayia Henry | Executive Director | Met with the Licensing Program Analyst during the inspection |
| Apolinario C. Gozon | Administrator | Facility administrator named in the report |
Inspection Report
Follow-Up
Census: 68
Capacity: 170
Deficiencies: 0
Dec 15, 2023
Visit Reason
Unannounced case management visit conducted as a follow-up on the Death Report received by the Department on 2023-12-11.
Findings
No deficiencies were cited during this visit. The Licensing Program Analyst reviewed relevant documents and conducted interviews related to the incident.
Report Facts
Capacity: 170
Census: 68
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cayia Henry | Executive Director | Met with during the inspection |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and case management visit |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 64
Capacity: 170
Deficiencies: 3
Oct 4, 2023
Visit Reason
An unannounced annual required inspection was conducted by Licensing Program Analyst Alicia Delmundo to evaluate compliance with regulatory requirements at the assisted living facility.
Findings
The inspection found several deficiencies including unlocked hazardous items in resident-accessible areas, staff lacking required first aid certification and medication training, and outdated infection control plans. A $250 civil penalty was assessed for a repeat violation related to storage of dangerous items.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Blade and scissors in the drawer without lock in unlocked salon and professional strength glue, paint spray, fabric and vinyl adhesive spray in cabinets without lock in unlocked art room, posing immediate health and safety risks. | Type A |
| Staff (S2) does not have First Aid certificate on file, posing potential safety and personal rights risk. | Type B |
| Staff (S5) does not have the required 8 hours of medication training for 2022, posing potential health risk. | Type B |
Report Facts
Civil penalty amount: 250
Number of residents' rooms inspected: 8
Number of staff files reviewed: 5
Number of staff interviewed: 4
Number of residents interviewed: 4
Hot water temperature: 116.8
Freezer temperature: -7
Refrigerator temperature: 35
Plan of Correction due date: Oct 18, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
| Cayia Henry | Executive Director | Facility representative met during inspection and discussed deficiencies. |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 170
Deficiencies: 5
Aug 3, 2023
Visit Reason
The inspection was conducted as a result of the Department receiving a priority 1 complaint (Complaint # 15-AS-20230801150316). The Licensing Program Analyst arrived unannounced to conduct a health and safety inspection.
Findings
The inspection found multiple safety and documentation deficiencies including unsecured cleaning, salon, and art supplies posing immediate safety risks, missing medical assessments and pre-admission appraisals for residents, inconsistent medical documentation regarding residents' medication administration abilities, and missing required 'Oxygen in Use' signage on resident doors.
Complaint Details
The visit was triggered by a priority 1 complaint (Complaint # 15-AS-20230801150316).
Severity Breakdown
Type A: 1
Type B: 4
Deficiencies (5)
| Description | Severity |
|---|---|
| Storage Space - Cabinets, drawers, and storage without locks containing disinfectants, cleaning solutions, poisons, and scissors were accessible, posing immediate safety risks to persons in care. | Type A |
| Medical Assessment - Failure to have a medical assessment signed by a physician within the last year for resident R1. | Type B |
| Pre-Admission Appraisal - Resident R1 lacked a pre-admission appraisal to determine suitability for admission. | Type B |
| Medical Assessment - Resident R2's medical assessment was inconsistent; it indicated R2 has dementia but can administer medications, conflicting with doctor's notes stating R2 cannot determine medication needs. | Type B |
| Oxygen Administration - Missing 'No Smoking - Oxygen in Use' signs in appropriate areas, posing potential risk to persons in care. | Type B |
Report Facts
Capacity: 170
Census: 65
Deficiency count: 5
Plan of Correction Due Dates: 8
Plan of Correction Due Dates: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and cited deficiencies. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
| Maria David | Business Office Specialist | Met with the Licensing Program Analyst during the inspection and assisted with facility tour. |
| Phii Atlman | Operations Regional VP | Contacted by Business Office Specialist during the inspection. |
Inspection Report
Follow-Up
Census: 55
Capacity: 170
Deficiencies: 2
Jan 19, 2023
Visit Reason
Unannounced case management follow-up visit was conducted in response to an Unusual Incident Report regarding a resident with dementia who left the facility unassisted.
Findings
The inspection found that a resident with dementia was able to leave the facility unnoticed, posing an immediate safety risk. Additionally, the front door's auditory device was not working, which also posed safety risks to residents.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Resident with dementia was able to leave the facility unnoticed, posing immediate safety risk. | Type A |
| Auditory device on the front door was not working, posing immediate safety risks to residents. | Type A |
Report Facts
Capacity: 170
Census: 55
Plan of Correction Due Date: Jan 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the unannounced case management follow-up visit and cited deficiencies |
| Bennett Fong | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the inspection |
| Rosana Frias | Associate Executive Director | Facility representative involved in discussion of deficiencies and plan of correction |
Inspection Report
Annual Inspection
Census: 50
Capacity: 170
Deficiencies: 5
Oct 10, 2022
Visit Reason
Unannounced infection control annual inspection conducted to evaluate compliance with infection control and safety regulations.
Findings
The facility was found to have several deficiencies including missing COVID-19 related signage, unlocked storage of construction tools and chemicals posing safety risks to residents with dementia, and failure to submit updated infection control plans. The Associate Executive Director immediately locked the unsafe room and plans to conduct staff training.
Deficiencies (5)
| Description |
|---|
| No 'Wear Mask' poster on the front entrance. |
| No hand washing posters in the common bathrooms/toilets. |
| No COVID-19 physical distancing signages in common areas. |
| Construction equipment/tools and chemicals stored in an unlocked room on the ground floor, posing immediate safety risk to residents with dementia. |
| Failure to submit updated Infection Control Plan and Monkeypox Infection Control Plan by due date. |
Report Facts
Capacity: 170
Census: 50
Plan of Correction Due Date: Oct 11, 2022
Emergency Disaster Plan pages: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
| Rosana Frias | Associate Executive Director | Facility representative who met with LPAs and took corrective action by locking the unsafe room. |
| Apolinario C. Gozon | Administrator | Facility administrator named in the report. |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 99
Deficiencies: 0
Apr 27, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted due to an allegation that the facility is unsafe due to construction.
Findings
The investigation found that residents felt safe during the renovation, elevators were functioning normally, and scaffolding was checked daily for safety. There were no imminent health or safety concerns, and the allegation was unsubstantiated.
Complaint Details
The complaint was unsubstantiated based on interviews and observations. Although the allegation may have been valid, there was not a preponderance of evidence to prove the violation occurred.
Report Facts
Elevators observed: 3
Elevator wait time (seconds): 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 53
Capacity: 99
Deficiencies: 4
Oct 20, 2021
Visit Reason
An unannounced infection control annual inspection was conducted to evaluate compliance with health and safety regulations, including COVID-19 mitigation measures.
Findings
The facility had an approved COVID-19 mitigation plan and generally maintained infection control practices, but deficiencies were noted including expired food items, lack of handwashing signage, missing visitor and cough etiquette posters, and trash cans without lids in resident rooms.
Severity Breakdown
Type A: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Three cans of expired prunes were found, one of which was rusted, posing immediate health risks. | Type A |
| No handwashing signage in bathrooms and trash cans with no lids in resident rooms including shared rooms. | — |
| No updated visitor's poster on the entrance door. | — |
| No cough and sneeze etiquette posters. | — |
Report Facts
Deficiencies cited: 4
Capacity: 99
Census: 53
Plan of Correction Due Date: Nov 3, 2021
Liability Insurance Coverage: 3000000
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst and discussed deficiencies and plan of correction |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 53
Capacity: 99
Deficiencies: 0
Oct 20, 2021
Visit Reason
The visit was an unannounced case management inspection conducted in response to Unusual/Injury Incident Reports (UIRs) submitted by the facility concerning four residents (R1, R2, R3, and R4).
Findings
The Licensing Program Analyst reviewed incident reports and related documents for the four residents. Two residents (R1 and R4) had not returned to the facility at the time of the report. No deficiencies were cited during the visit, and a follow-up visit will be conducted if warranted.
Report Facts
Capacity: 99
Census: 53
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the case management visit and interviews |
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during the visit |
| Valentine Mathangani | Wellness Director/LVN | Spoke with Licensing Program Analyst regarding residents |
| Bennett Fong | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 53
Capacity: 99
Deficiencies: 1
Sep 6, 2021
Visit Reason
The inspection was conducted unannounced as a result of a complaint received by the Department (Control # 15-AS-20210901144412).
Findings
The inspection found several health and safety deficiencies including the presence of insect killers and pieces of metal in the patio, uneven pavement, frayed carpet flooring in a resident's room, and bathroom doors in one resident's room needing repair.
Complaint Details
The visit was triggered by a complaint (Control # 15-AS-20210901144412).
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Frayed carpet flooring in resident's room; bathroom doors in one resident's bedroom; insect killers, uneven pavement and pieces of metal in the patio. | Type A |
Report Facts
Capacity: 99
Census: 53
Plan of Correction Due Date: Sep 7, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Rosana Frias | Associate Executive Director | Facility representative met during inspection and discussed deficiencies. |
| Vivian Valeros | Assisted Living Coordinator | Met with Licensing Program Analyst at start of inspection. |
| Ricky Dulay | Activity Director | Participated in inspection of resident rooms. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 53
Capacity: 99
Deficiencies: 0
Sep 3, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility was not ensuring resident (R1) receives sufficient meal.
Findings
Based on all information obtained, including interviews with staff, family members, and hospice nurse, the allegation was found to be unfounded. The resident's refusal to eat was attributed to medical condition and hospice care status, and no facility fault was found.
Complaint Details
The complaint alleged that the facility was not ensuring resident (R1) received sufficient meals. The complaint was investigated and closed as unfounded, meaning the allegation was false or without reasonable basis.
Report Facts
Facility capacity: 99
Census: 53
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Rosana Frias | Associate Executive Director | Facility representative met during inspection and exit interview |
| Apolinario C. Gozon | Administrator | Facility Administrator named in report |
Inspection Report
Census: 52
Capacity: 99
Deficiencies: 0
Aug 12, 2021
Visit Reason
The visit occurred for case management and other reasons, including discussion of a conditional use permit for capacity increase, construction upgrades, delayed egress installation, application process for capacity increase, and fire safety inspection request.
Findings
No alterations to the physical plant were observed; ongoing work consisted of upgrades. The Licensing Program Analyst reviewed facility conditions and plans for capacity increase and fire safety inspection submission.
Report Facts
Capacity increase application: 170
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Apolinario C. Gozon | Executive Director | Met with Licensing Program Analyst to discuss facility matters |
| Alicia Delmundo | Licensing Program Analyst | Conducted facility visit and discussions |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Follow-Up
Census: 52
Capacity: 99
Deficiencies: 1
Aug 12, 2021
Visit Reason
Unannounced case management follow-up visit conducted to review compliance with previous case management findings related to resident supervision and safety.
Findings
The facility was found non-compliant with supervision requirements as resident R1 was able to leave the facility unnoticed, posing immediate health and safety risks. A deficiency was cited for failure to submit proof of correction by the due date.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to determine the amount of supervision necessary by assessing the mental status of the prospective resident who tends to wander, resulting in resident R1 leaving the facility unnoticed. | Type A |
Report Facts
Deficiency Type Count: 1
Capacity: 99
Census: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the case management follow-up inspection and discussed deficiency and plan of correction with facility administrator. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
| Apolinario C. Gozon | Executive Director | Facility administrator involved in discussion of deficiency and plan of correction. |
Inspection Report
Census: 54
Capacity: 99
Deficiencies: 0
Apr 5, 2021
Visit Reason
The visit was a case management tele-visit conducted due to a self-reported incident call from the administrator regarding an alleged elder abuse incident reported by a resident.
Findings
No deficiencies were observed during the tele-visit. The alleged staff member was placed on administrative leave pending an internal investigation.
Complaint Details
The visit was triggered by a complaint of alleged elder abuse where a resident reported being hit by staff on 3/21/2021. The complaint was investigated during the tele-visit, and no marks or bruises were observed on the resident.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosana Frias | Administrator | Reported the alleged elder abuse incident and was involved in the tele-visit. |
Inspection Report
Census: 55
Capacity: 99
Deficiencies: 0
Dec 15, 2020
Visit Reason
The visit was a case management incident conducted regarding incident reports for two residents received on the day of the visit, December 15, 2020.
Findings
Resident R1 was found missing from his room on December 12, 2020, and returned with police escort after staff search. Resident R2 was found injured on December 10, 2020, requiring emergency hospitalization. The licensing analyst requested submission of various resident and staff documents following the interview.
Report Facts
Capacity: 99
Census: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosana Frias | Associate Executive Director | Met with Licensing Program Analyst during case management visit |
| Alicia Delmundo | Licensing Program Analyst | Conducted the case management visit and interview |
| Isaac Taggart | Licensing Program Manager | Named in report header |
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