Deficiencies (last 7 years)

Deficiencies (over 7 years) 12.7 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

218% worse than California average
California average: 4 deficiencies/year

Deficiencies per year

24 18 12 6 0
2020
2021
2022
2023
2024
2025
2026

Census

Latest occupancy rate 66% occupied

Based on a January 2026 inspection.

This facility has shown a steady increase in demand based on occupancy rates.

Occupancy over time

40 80 120 160 200 Dec 2020 Sep 2021 Jan 2023 Dec 2023 Dec 2024 Jun 2025 Jan 2026

Inspection Report

Census: 113 Capacity: 170 Deficiencies: 0 Date: Jan 27, 2026

Visit Reason
The visit was a case management visit conducted in response to an Unusual Incident Report submitted by the facility regarding a resident's unwitnessed fall and injury.

Findings
The Licensing Program Analyst found no deficiencies during the visit. The resident had an unwitnessed fall resulting in a laceration that required stitches, and appropriate emergency and family notifications were made.

Employees mentioned
NameTitleContext
Joseph VillanuevaExecutive DirectorMet with during the inspection visit.
Alicia DelmundoLicensing Program AnalystConducted the case management visit and authored the report.
Bennett FongLicensing Program ManagerNamed in the report as Licensing Program Manager.

Inspection Report

Complaint Investigation
Census: 145 Capacity: 170 Deficiencies: 2 Date: Dec 2, 2025

Visit Reason
The inspection was an unannounced case management visit in response to Unusual Incident Reports (UIRs) and a Death Report submitted by the facility.

Complaint Details
The visit was triggered by complaints including an incident where Resident R1 was found outside the community lobby, a death report for Resident R2, and a report of missing cash by Resident R3.
Findings
The inspection found that Resident R1 was able to leave the facility unnoticed due to the front exit door lacking an auditory signal, and R1's assessment was not consistent with current care needs. Deficiencies were cited related to care of persons with dementia and reappraisals of residents' conditions.

Deficiencies (2)
Front/exit door did not have auditory signal and Resident R1 was able to leave the facility unnoticed.
Resident R1's assessment was not consistent with current care needs, posing a potential safety risk.
Report Facts
Capacity: 170 Census: 145 Plan of Correction Due Date: Dec 3, 2025 Plan of Correction Due Date: Dec 16, 2025

Employees mentioned
NameTitleContext
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during inspection and discussed deficiencies and plans of correction.
Joseph VillanuevaAdministrator/DirectorNamed as facility administrator/director.
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report.
Bennett FongLicensing Program ManagerOversaw the licensing program related to the inspection.

Inspection Report

Annual Inspection
Census: 101 Capacity: 170 Deficiencies: 2 Date: Oct 30, 2025

Visit Reason
An unannounced annual required inspection was conducted by Licensing Program Analyst Alicia Delmundo to evaluate compliance with licensing requirements at the assisted living facility.

Findings
Two Type A deficiencies were identified: a razor was found unsecured in a memory care unit apartment, and Tylenol was found in a resident's medication cabinet who is not allowed to self-administer or store medications. Both deficiencies pose immediate safety and personal rights risks to residents.

Deficiencies (2)
Razor found in bathroom of an apartment in memory care unit, posing immediate safety and personal rights risk.
Tylenol found in medication cabinet of a resident who cannot administer or store own medications, posing immediate health, safety, and personal rights risks.
Report Facts
Deficiencies cited: 2 Capacity: 170 Census: 101 Plan of Correction Due Date: Oct 31, 2025 Liability Insurance: 3000000

Employees mentioned
NameTitleContext
Joseph VillanuevaExecutive DirectorNamed in relation to deficiency findings and plans of correction
Alicia DelmundoLicensing Program AnalystConducted the inspection and documented findings
Bennett FongLicensing Program ManagerOversight of licensing program, mentioned in report

Inspection Report

Annual Inspection
Census: 101 Capacity: 170 Deficiencies: 2 Date: 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.

Deficiencies (2)
Razor found in the bathroom of an apartment in the memory care unit, posing an immediate safety and/or personal rights risk to residents.
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.
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
NameTitleContext
Joseph VillanuevaExecutive DirectorMet with Licensing Program Analyst during inspection and discussed deficiencies and plans of correction
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Bennett FongLicensing Program ManagerNamed as Licensing Program Manager on the report

Inspection Report

Complaint Investigation
Census: 94 Capacity: 170 Deficiencies: 1 Date: Jun 4, 2025

Visit Reason
The inspection was conducted as an unannounced case management visit to investigate a complaint (Control # 15-AS-20230801150316) regarding the facility's care of a resident requiring a higher level of care.

Complaint Details
The visit was triggered by a complaint investigation (Control # 15-AS-20230801150316). It was substantiated that the facility failed to provide appropriate care for a resident requiring a higher level of care, resulting in repeated falls and staff admitting inability to meet care needs.
Findings
The facility retained a resident (R1) who required a higher level of care than the facility was authorized to provide, resulting in immediate health, safety, and personal rights risks. Staff admitted that R1 would fall daily and did not believe they could provide the required care. The resident is no longer at the facility.

Deficiencies (1)
Facility retained a resident requiring a higher level of care than authorized, posing immediate health, safety, and personal rights risks.
Report Facts
Capacity: 170 Census: 94 Plan of Correction Due Date: Jun 19, 2025

Employees mentioned
NameTitleContext
Nansiela RandhawaExecutive DirectorDiscussed deficiency and plan of correction; named in findings related to resident care
Bennett FongLicensing Program ManagerNamed as Licensing Program Manager on report
Alicia DelmundoLicensing Program AnalystNamed as Licensing Program Analyst on report

Inspection Report

Complaint Investigation
Census: 94 Capacity: 170 Deficiencies: 3 Date: Jun 4, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident sustained a fracture while in care, had multiple falls during transfers, and that staff were not providing appropriate assistance during transfers.

Complaint Details
The complaint investigation was substantiated based on interviews, records review, and incident reports. The resident sustained a fracture and multiple falls due to inadequate assistance during transfers. Staff admitted inability to provide required care. A $1,000 civil penalty was assessed for a repeat violation within 12 months, with ongoing penalties until correction.
Findings
The investigation substantiated all allegations, finding that resident R1, who required two-person assistance during transfers, was frequently transferred by only one staff member, resulting in multiple falls and a displaced femur fracture. Facility staff admitted they could not provide the required level of care, and the wheelchair provided did not fit through R1's bedroom or bathroom doors, causing unsafe transfers and constant falls.

Deficiencies (3)
Failure to meet resident R1's needs of being non-ambulatory by walking R1 to the bathroom causing falls and injury.
Failure to provide safe, healthful, and comfortable accommodations resulting in constant falls.
Failure to meet resident R1's transferring needs by walking R1 to the bathroom causing immediate health and safety risks.
Report Facts
Civil penalty amount: 1000 Daily civil penalty: 100 Deficiency count: 3

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Naensila RandhawaExecutive DirectorMet with Licensing Program Analyst during investigation and discussed deficiencies and corrective actions
Apolinario C. GozonAdministratorFacility administrator named in report header

Inspection Report

Complaint Investigation
Census: 94 Capacity: 170 Deficiencies: 1 Date: 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.

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.
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.

Deficiencies (1)
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.
Report Facts
Capacity: 170 Census: 94 Plan of Correction Due Date: Jun 19, 2025

Employees mentioned
NameTitleContext
Nansiela RandhawaExecutive DirectorDiscussed deficiency and plan of correction with licensing program analyst

Inspection Report

Census: 99 Capacity: 170 Deficiencies: 0 Date: Apr 22, 2025

Visit Reason
The visit occurred for case management and other reasons, including verification of the facility's new administrator/executive director and discussion of Title 22 Regulations related to hiring a new administrator.

Findings
The Licensing Program Analyst learned and verified that the facility's new administrator/executive director is Nanensila 'Nancy' Randhawa, who started on April 7, 2025. Copies of personnel records, designation of facility responsibility, personnel report, and board letter were received. No deficiencies were cited in this report.

Employees mentioned
NameTitleContext
Nanensila RandhawaExecutive DirectorNamed as the facility's new administrator/executive director verified during the visit.

Inspection Report

Complaint Investigation
Census: 99 Capacity: 170 Deficiencies: 0 Date: Apr 22, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility failed to issue an appropriate refund to a resident's responsible person.

Complaint Details
The complaint alleged that the facility withdrew full rent payment for May 2024 despite the resident moving out on 05/04/2024 and that the prorated refund amount was deducted incorrectly. The investigation included review of payment records, interviews with the responsible person and facility staff, and confirmed the refund check was cancelled and no balance was owed. The complaint was closed as unfounded.
Findings
The investigation found that the allegation was unfounded. Documentation and interviews confirmed that the resident moved out on 05/04/2024 and the refund issue was resolved with no balance owed by either party. No deficiencies were cited.

Report Facts
Refund amount paid by responsible person: 780 Refund check amount: 7280 Facility capacity: 170 Census: 99

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Nanensila RandhawaExecutive DirectorMet with investigator and involved in refund issue
Rosana FriasAssociate Executive DirectorMet with investigator and involved in refund issue
Bennett FongSupervisorSupervisor overseeing the investigation

Inspection Report

Census: 99 Capacity: 170 Deficiencies: 0 Date: 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
NameTitleContext
Nanensila RandhawaExecutive DirectorNew administrator/executive director verified during the visit; started on April 7, 2025.

Inspection Report

Complaint Investigation
Census: 99 Capacity: 170 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Capacity: 170 Census: 99 Refund amount: 7280 Prorated rent amount: 780

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Bennett FongLicensing Program ManagerNamed in report as Licensing Program Manager
Nanensila RandhawaExecutive DirectorMet with Licensing Program Analyst during investigation
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation

Inspection Report

Complaint Investigation
Capacity: 170 Deficiencies: 0 Date: Mar 8, 2025

Visit Reason
This was an unannounced complaint investigation visit conducted in response to allegations received on 2021-09-01 regarding medication administration, resident falls, safeguarding of personal belongings, and notification of injuries at Casa Sandoval facility.

Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to administer medication according to physician's instructions, resident falls resulting in injury due to lack of supervision, failure to safeguard resident's personal belongings, and failure to notify the resident's authorized representative of injuries. The Department found insufficient evidence to prove these allegations.
Findings
The investigation reviewed medical records, interviews, and other documentation and found insufficient evidence to substantiate any of the allegations. All allegations including improper medication administration, resident falls due to lack of supervision, failure to safeguard personal belongings, and failure to notify authorized representatives were determined to be unsubstantiated.

Report Facts
Facility capacity: 170 Safety check-ins: 127

Employees mentioned
NameTitleContext
Bennett FongLicensing EvaluatorConducted the complaint investigation and delivered findings
Henrietta BesharesCommunity Relations DirectorMet with Licensing Evaluator during investigation
Apolinario C. GozonAdministratorFacility administrator named in report header
Pam GillSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Capacity: 170 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Facility capacity: 170 Safety check-ins: 127

Employees mentioned
NameTitleContext
Bennett FongEvaluator / Licensing Program AnalystConducted the complaint investigation and delivered findings
Pam GillLicensing Program ManagerOversaw the complaint investigation
Henrietta BesharesCommunity Relations DirectorMet with evaluator during the unannounced visit
Apolinario C. GozonAdministratorFacility administrator named in the report header

Inspection Report

Complaint Investigation
Census: 99 Capacity: 170 Deficiencies: 1 Date: Jan 24, 2025

Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the facility was not responding to a resident's responsible person regarding a refund issue.

Complaint Details
The complaint was substantiated. The resident's family member had been following up on a refund since May 2024 with no response from the facility. The Interim Executive Director was aware but did not communicate with the family member. Deficiency cited under Title 22 California Code of Regulations.
Findings
The investigation found that the facility failed to respond promptly to the resident's responsible person despite repeated attempts since May 2024. The allegation was substantiated based on email communications and interviews with staff and the Interim Executive Director.

Deficiencies (1)
Failure to respond promptly and appropriately to communications from resident's representatives as required by CCR 87468.1(a)(9).
Report Facts
Capacity: 170 Census: 99 Plan of Correction Due Date: Feb 7, 2025

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Gabriella JohnsonWellness DirectorFacility staff member who received the report
Rosana FriasInterim Executive DirectorInterviewed during investigation; aware of refund issues but did not communicate with family member
Bennett FongSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 99 Capacity: 170 Deficiencies: 1 Date: 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.

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.
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.

Deficiencies (1)
Failure to have communications to the licensee from their representatives answered promptly and appropriately, violating CCR 87468.1(a)(9).
Report Facts
Capacity: 170 Census: 99 Deficiency due date: Feb 7, 2025

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Bennett FongLicensing Program ManagerOversaw the complaint investigation
Gabriella JohnsonWellness DirectorFacility staff member who received the report and was interviewed
Rosana FriasInterim Executive DirectorInterviewed during investigation; aware of refund issues but did not communicate with family member

Inspection Report

Complaint Investigation
Census: 104 Capacity: 170 Deficiencies: 2 Date: 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.

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.
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.

Deficiencies (2)
Failure to check resident R1's blood pressure as ordered on specific dates, posing a potential health risk.
Resident R1 had discolored overgrown toenails about 1 to 2 inches long, posing a potential personal rights risk.
Report Facts
Capacity: 170 Census: 104 Plan of Correction Due Date: Jan 30, 2025

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted investigation and signed report
Bennett FongLicensing Program ManagerNamed in report as Licensing Program Manager and Supervisor
Rosana FriasAssociate Executive Director (AED)Met with during inspection and discussed deficiencies and plan of correction

Inspection Report

Complaint Investigation
Census: 104 Capacity: 170 Deficiencies: 2 Date: Jan 16, 2025

Visit Reason
The inspection was conducted as part of a complaint investigation regarding failure to check a resident's blood pressure as ordered and concerns about overgrown toenails.

Complaint Details
Complaint Control # 15-AS-20240319155109. The complaint was substantiated based on record review and interviews indicating noncompliance with medical orders and resident care standards.
Findings
The facility failed to comply with medical orders to check the resident's blood pressure on specified dates and allowed the resident to have overgrown, discolored toenails, posing potential health and personal rights risks.

Deficiencies (2)
Failure to check resident's blood pressure as ordered on particular dates, posing a potential health risk.
Resident had overgrown, discolored toenails which posed a potential personal rights risk.
Report Facts
Census: 104 Total Capacity: 170 Plan of Correction Due Date: Jan 30, 2025

Employees mentioned
NameTitleContext
Rosana FriasAssociate Executive Director (AED)Met with during inspection and discussed deficiencies and plan of correction
Bennett FongSupervisorNamed as supervisor overseeing the inspection
Alicia DelmundoLicensing EvaluatorConducted the inspection and authored the report

Inspection Report

Complaint Investigation
Census: 104 Capacity: 170 Deficiencies: 0 Date: Jan 16, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations received on 2024-03-19 regarding medical attention, assistance with medical needs, communication with responsible persons, and interference with residents' mail at Casa Sandoval facility.

Complaint Details
The complaint involved four allegations: failure to seek timely medical attention for resident R1, improper assistance with R1's medical needs, staff not responding to responsible person's communication requests, and staff interfering with residents' mail. The investigation included interviews with staff, residents, and responsible persons, and review of medical and facility records. All allegations were closed as unsubstantiated.
Findings
After review of records, interviews with staff, residents, and responsible persons, and attempts to contact involved healthcare providers, all four allegations were found to be unsubstantiated due to lack of sufficient evidence to prove violations occurred.

Report Facts
Capacity: 170 Census: 104

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation
Bennett FongSupervisorSupervisor overseeing the investigation
Henry CayiaAdministratorFacility administrator named in report header
S1Staff interviewed regarding medical attention and communication
S2Staff interviewed regarding communication and mail allegations
Former EDFormer Executive DirectorInterviewed regarding communication with responsible person
Wellness DirectorInterviewed regarding medical assistance allegation

Inspection Report

Complaint Investigation
Census: 104 Capacity: 170 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Facility capacity: 170 Census: 104

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Bennett FongLicensing Program ManagerOversaw the complaint investigation
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation
Henry CayiaAdministratorFacility administrator named in report

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: Dec 5, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2024-11-27 regarding staff not ensuring residents' rooms were clean and the facility being free of insects.

Complaint Details
The complaint was substantiated based on interviews with residents, family members, staff, and observations made during the inspection. The complaint control number is 15-AS-20241127165044.
Findings
The investigation substantiated the allegation of roach infestation and unclean apartments. Observations included roach traps with dead roaches, dead roaches in kitchen cabinets, stained carpet flooring, and litter in residents' apartments. The facility was found not to comply with cleanliness and pest control regulations, posing potential health and safety risks.

Deficiencies (1)
Facility did not maintain residents' apartments clean and free of insects, violating Title 22 CCR 87303(a). This is a repeat violation.
Report Facts
Civil penalty amount: 250 Deficiency count: 1 Plan of Correction due date: Dec 19, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and authored the report
Rosana FriasAssociate Executive DirectorFacility representative involved in investigation and plan of correction discussion
Henry CayiaAdministratorFacility administrator named in report header

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: Dec 5, 2024

Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that non-medical staff members were administering injections at the facility.

Complaint Details
The complaint was substantiated based on interviews with residents and staff, and review of resident records. The allegation involved non-medical staff administering injections, which was confirmed by evidence.
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 were not licensed medical professionals.

Deficiencies (1)
Non-medical staff administering insulin injections to residents, violating Title 22 California Code of Regulations section 87628(a).
Report Facts
Capacity: 170 Census: 105 Plan of Correction Due Date: Dec 19, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation and discussed findings
Bennett FongSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: 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.

Complaint Details
The complaint was substantiated based on interviews with residents, family members, staff, and observations of roaches and unclean conditions in residents' apartments.
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.

Deficiencies (1)
Facility failed to maintain clean, safe, sanitary, and insect-free residents' apartments, violating CCR 87303(a).
Report Facts
Civil penalty amount: 250 Plan of Correction due date: Dec 19, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and authored the report
Bennett FongLicensing Program ManagerOversaw the complaint investigation
Rosana FriasAssociate Executive DirectorFacility representative who met with the Licensing Program Analyst and discussed the plan of correction

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: 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.

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.
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.

Deficiencies (1)
Non-medical staff administer insulin injections to residents, violating Title 22 California Code of Regulations section 87628(a).
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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and authored the report
Bennett FongLicensing Program ManagerOversaw the complaint investigation
Rosana FriasAssociate Executive DirectorFacility representative met during investigation and discussion of findings
Cayia HenryAdministratorFacility administrator named in report header

Inspection Report

Annual Inspection
Census: 105 Capacity: 170 Deficiencies: 6 Date: 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.

Deficiencies (6)
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.
Medications and Peritoneal cleanser found in resident rooms accessible to residents with dementia.
Stained/soiled carpet flooring in residents' rooms on 3rd and 5th floors.
Staff member S5 has not completed required total initial hours of medication training.
Staff members S1, S3, and S5 have not completed required numbers of training hours including dementia care and postural supports.
Residents R2 and R4 have postural supports without doctor's orders on file.
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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report.
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during inspection and discussed findings.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.

Inspection Report

Annual Inspection
Census: 105 Capacity: 170 Deficiencies: 6 Date: Sep 26, 2024

Visit Reason
An unannounced annual required inspection was conducted by Licensing Program Analyst Alicia Delmundo to evaluate compliance with regulations at the assisted living facility.

Findings
The inspection identified multiple deficiencies including unsecured 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. Civil penalties were assessed for repeat violations and plans of correction were required.

Deficiencies (6)
Razor, hair developer, perming agent, waving lotion, anti fungal wash and screw driver found in unlocked drawers in unlocked salon; cleaning supplies in unlocked housekeeping room on the 5th floor.
Resident R3 had medications in the bathroom and Peritoneal cleanser was found in another resident's room in Memory Care Unit.
Stained/soiled carpet flooring in resident's rooms on the 3rd and 5th floors.
Staff S5 has not completed the required total initial hours of medication training.
Staff S1 and S3 have not completed the required numbers of training hours including dementia care and postural support training.
Residents R2 and R4 have postural supports (halo; half bed rails) without doctor's orders on file.
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 Plan of Correction due date: Oct 10, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and cited deficiencies.
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during inspection and discussed findings and plans of correction.

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: Sep 26, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that the facility failed to supervise resident (R1) resulting in intoxication, and that staff did not assist resident (R1) with hydration.

Complaint Details
The complaint investigation was substantiated for the allegation that the facility failed to supervise resident (R1) resulting in intoxication. The allegation that staff did not assist resident (R1) with hydration was unsubstantiated.
Findings
The allegation regarding failure to supervise resident (R1) resulting in intoxication was substantiated based on evidence including hospital records, staff interviews, and facility alcohol intake records showing the resident was given more alcohol than permitted. The allegation regarding failure to assist resident (R1) with hydration was unsubstantiated due to lack of sufficient evidence.

Deficiencies (1)
Failure to comply with CCR §1569.269(a)(16) regarding reasonable accommodation of individual needs and preferences, specifically giving the resident alcohol more than the permitted amount.
Report Facts
Alcohol level: 244 Census: 105 Total Capacity: 170 Plan of Correction Due Date: Oct 10, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation and discussed deficiencies and plan of correction
Bennett FongSupervisorSupervisor overseeing the licensing evaluation
Apolinario C. GozonAdministratorFacility administrator named in the report

Inspection Report

Complaint Investigation
Census: 105 Capacity: 170 Deficiencies: 1 Date: 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.

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.
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.

Deficiencies (1)
Failure to comply with reasonable accommodation of individual needs and preferences by giving the resident alcohol more than the permitted amount.
Report Facts
Alcohol level: 244 Census: 105 Total Capacity: 170 Plan of Correction Due Date: Oct 10, 2024

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Bennett FongLicensing Program ManagerOversaw the complaint investigation
Rosana FriasAssociate Executive DirectorFacility representative met during investigation and discussion of findings
Apolinario C. GozonAdministratorFacility administrator named in report header

Inspection Report

Census: 93 Capacity: 170 Deficiencies: 0 Date: 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
NameTitleContext
Cayia HenryExecutive DirectorNamed in the investigation and notification process regarding narcotic medication discrepancies

Inspection Report

Census: 93 Capacity: 170 Deficiencies: 0 Date: Mar 22, 2024

Visit Reason
The visit was an unannounced case management inspection conducted in response to an Unusual Incident Report regarding discrepancies with residents' narcotic medications.

Findings
The investigation found discrepancies in narcotic medication counts, 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
NameTitleContext
Cayia HenryExecutive DirectorNamed in the incident report and investigation

Inspection Report

Complaint Investigation
Census: 83 Capacity: 170 Deficiencies: 2 Date: 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.

Complaint Details
The complaint investigation was substantiated for unsafe storage of hazardous materials and improper food sanitation practices. A $250 civil penalty was assessed for repeat violations. Other allegations regarding roaches, inappropriate alcohol serving, staff drinking alcohol, and obstruction in passageways were unsubstantiated or unfounded.
Findings
Two allegations were substantiated: unsafe storage of hazardous materials posing immediate risk and kitchen staff not observing proper food sanitation practices. A $250 civil penalty was assessed for repeat violations. The allegations of roaches, inappropriate alcohol serving, staff drinking alcohol, and obstruction in passageways were unsubstantiated or unfounded.

Deficiencies (2)
Facility did not ensure hazardous materials were stored inaccessible to residents; housekeeping room and salon unlocked; hazardous materials and debris in garage.
Kitchen staff did not observe food services sanitation practices; two kitchen staff not wearing hairnets.
Report Facts
Civil penalty amount: 250 Capacity: 170 Census: 83 Deficiency count: 2

Employees mentioned
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during inspection and discussed deficiencies and corrective actions
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and inspection
Bennett FongSupervisorSupervisor overseeing the complaint investigation

Inspection Report

Complaint Investigation
Census: 83 Capacity: 170 Deficiencies: 0 Date: Feb 15, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2022-02-16 regarding resident isolation, cold meal delivery, and lack of activities.

Complaint Details
The complaint was unsubstantiated based on the investigation. Although the allegations may have occurred, there was insufficient evidence to prove a violation.
Findings
The investigation found that the allegations were unsubstantiated. The facility followed public health recommendations during a COVID-19 outbreak, including closing dining and activity rooms and delivering meals to residents' rooms. Residents and staff confirmed these practices, and no deficiencies were cited.

Report Facts
Capacity: 170 Census: 83

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during investigation
Bennett FongSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 83 Capacity: 170 Deficiencies: 2 Date: 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.

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.
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.

Deficiencies (2)
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.
Two kitchen staff were observed not wearing hairnets while preparing food, posing potential health and personal rights risks.
Report Facts
Civil penalty amount: 250 Capacity: 170 Census: 83 Deficiency count: 2

Employees mentioned
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during inspection and discussed findings
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and inspection
Bennett FongLicensing Program ManagerOversaw complaint investigation and signed report

Inspection Report

Complaint Investigation
Census: 83 Capacity: 170 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Capacity: 170 Census: 83

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Bennett FongLicensing Program ManagerNamed in report as Licensing Program Manager
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during investigation
Apolinario C. GozonAdministratorFacility Administrator named in report

Inspection Report

Follow-Up
Capacity: 170 Deficiencies: 2 Date: 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.

Deficiencies (2)
Failure to update pre-admission appraisal and care plan after resident had multiple falls in a few months.
Failure to submit incident report for a resident which poses potential health, safety, and personal rights risks.
Report Facts
Capacity: 170 Deficiency count: 2 Plan of Correction Due Date: Jan 5, 2024

Employees mentioned
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during inspection and discussed deficiencies
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection

Inspection Report

Annual Inspection
Census: 69 Capacity: 170 Deficiencies: 0 Date: 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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and reviewed residents' records
Bennett FongLicensing Program ManagerNamed in the report header
Cayia HenryExecutive DirectorMet with the Licensing Program Analyst during the inspection
Apolinario C. GozonAdministratorFacility administrator named in the report

Inspection Report

Follow-Up
Capacity: 170 Deficiencies: 2 Date: 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 that the facility failed to update re-appraisals and care plans after multiple falls of a resident and failed to submit required incident reports for another resident, posing potential health and safety risks.

Deficiencies (2)
Failure to update pre-admission appraisal and care plan after resident had multiple falls.
Failure to submit incident report for resident which poses potential health, safety, and personal rights risks.
Report Facts
Capacity: 170

Employees mentioned
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during inspection and discussed deficiencies and plan of correction.
Alicia DelmundoLicensing EvaluatorConducted the inspection and signed the report.
Bennett FongSupervisorSupervisor overseeing the inspection.

Inspection Report

Annual Inspection
Census: 69 Capacity: 170 Deficiencies: 0 Date: Dec 22, 2023

Visit Reason
The visit was an unannounced continuation of the annual required inspection that began on 2023-10-04, conducted to review compliance with licensing requirements.

Findings
The Licensing Program Analyst reviewed five residents' records, checked medications against doctor's orders and centrally stored medication records, and found no deficiencies. The facility does not handle residents' cash resources.

Employees mentioned
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during inspection
Alicia DelmundoLicensing Program AnalystConducted the inspection and evaluation
Bennett FongSupervisorSupervisor overseeing the inspection

Inspection Report

Follow-Up
Census: 68 Capacity: 170 Deficiencies: 0 Date: 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
NameTitleContext
Cayia HenryExecutive DirectorMet with during the inspection
Alicia DelmundoLicensing Program AnalystConducted the inspection and case management visit
Bennett FongLicensing Program ManagerNamed in the report as Licensing Program Manager

Inspection Report

Follow-Up
Census: 68 Capacity: 170 Deficiencies: 0 Date: Dec 15, 2023

Visit Reason
The visit was an unannounced case management follow-up on a Death Report received by the Department on 12/11/2023 regarding a resident found unresponsive.

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
NameTitleContext
Cayia HenryExecutive DirectorMet with Licensing Program Analyst during the visit
Alicia DelmundoLicensing Program AnalystConducted the unannounced case management follow-up visit
Bennett FongSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Annual Inspection
Census: 64 Capacity: 170 Deficiencies: 3 Date: 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.

Deficiencies (3)
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.
Staff (S2) does not have First Aid certificate on file, posing potential safety and personal rights risk.
Staff (S5) does not have the required 8 hours of medication training for 2022, posing potential health risk.
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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.
Cayia HenryExecutive DirectorFacility representative met during inspection and discussed deficiencies.

Inspection Report

Annual Inspection
Census: 64 Capacity: 170 Deficiencies: 3 Date: Oct 4, 2023

Visit Reason
An unannounced annual required inspection was conducted to evaluate compliance with licensing regulations and facility standards.

Findings
The inspection found several deficiencies including unsecured hazardous materials in unlocked areas, staff lacking required first aid certification and medication training, and outdated infection control plans. A $250 civil penalty was assessed for repeat violations related to storage of dangerous items.

Deficiencies (3)
Blade and scissors stored in unlocked salon drawer without lock, and professional strength glue, paint spray, fabric and vinyl adhesive spray stored in unlocked art room cabinets, posing immediate health and safety risks.
Staff (S2) does not have First Aid certificate on file, posing potential safety and personal rights risk.
Staff (S5) does not have the required 8 hours of medication training for 2022, posing potential health risk.
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 Plan of Correction due date: Oct 18, 2023

Inspection Report

Complaint Investigation
Census: 65 Capacity: 170 Deficiencies: 5 Date: 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.

Complaint Details
The visit was triggered by a priority 1 complaint (Complaint # 15-AS-20230801150316).
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.

Deficiencies (5)
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.
Medical Assessment - Failure to have a medical assessment signed by a physician within the last year for resident R1.
Pre-Admission Appraisal - Resident R1 lacked a pre-admission appraisal to determine suitability for admission.
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.
Oxygen Administration - Missing 'No Smoking - Oxygen in Use' signs in appropriate areas, posing potential risk to persons in care.
Report Facts
Capacity: 170 Census: 65 Deficiency count: 5 Plan of Correction Due Dates: 8 Plan of Correction Due Dates: 14

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and cited deficiencies.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.
Maria DavidBusiness Office SpecialistMet with the Licensing Program Analyst during the inspection and assisted with facility tour.
Phii AtlmanOperations Regional VPContacted by Business Office Specialist during the inspection.

Inspection Report

Complaint Investigation
Census: 65 Capacity: 170 Deficiencies: 5 Date: Aug 3, 2023

Visit Reason
The inspection was conducted unannounced on August 3, 2023, as a result of receiving a priority 1 complaint (Complaint # 15-AS-20230801150316) to conduct a health and safety inspection.

Complaint Details
The visit was triggered by a priority 1 complaint (Complaint # 15-AS-20230801150316).
Findings
The inspection found multiple deficiencies including unsecured cleaning, salon, and art supplies posing safety risks, missing required medical and pre-admission documentation for residents, and lack of proper signage for oxygen use. Deficiencies were cited under Title 22 California Code of Regulations with plans of correction required.

Deficiencies (5)
Unsecured cabinets, drawers, and storage without locks containing disinfectants, cleaning solutions, poisons, and salon supplies posing immediate safety risks.
Missing medical assessment and/or LIC602A Physician's Report for resident R1, posing potential health and safety risks.
Missing pre-admission appraisal for resident R1, posing potential health and safety risks.
Missing updated medical assessment for resident R2, inconsistent documentation regarding dementia and medication administration.
Missing 'No Smoking-Oxygen in Use' signs posted in appropriate areas, posing potential risk to persons in care.
Report Facts
Capacity: 170 Census: 65 Deficiencies cited: 5 Plan of Correction Due Dates: 2

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Bennett FongSupervisorSupervisor overseeing the inspection
Maria DavidBusiness Office SpecialistMet with Licensing Program Analyst during inspection
Apolinario C. GozonAdministratorFacility administrator responsible for addressing deficiencies

Inspection Report

Follow-Up
Census: 55 Capacity: 170 Deficiencies: 2 Date: 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.

Deficiencies (2)
Resident with dementia was able to leave the facility unnoticed, posing immediate safety risk.
Auditory device on the front door was not working, posing immediate safety risks to residents.
Report Facts
Capacity: 170 Census: 55 Plan of Correction Due Date: Jan 20, 2023

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the unannounced case management follow-up visit and cited deficiencies
Bennett FongLicensing Program ManagerSupervisor and Licensing Program Manager overseeing the inspection
Rosana FriasAssociate Executive DirectorFacility representative involved in discussion of deficiencies and plan of correction

Inspection Report

Follow-Up
Census: 55 Capacity: 170 Deficiencies: 2 Date: Jan 19, 2023

Visit Reason
The visit was an unannounced case management follow-up on an Unusual Incident Report involving a resident with dementia who left the facility unassisted.

Findings
The inspection found that the facility failed to maintain a working auditory device at the front door and did not prevent a resident with dementia from leaving the facility unnoticed, posing immediate safety risks. Deficiencies were cited related to care of persons with dementia and safety monitoring devices.

Deficiencies (2)
Failure to comply with safety measures for residents with dementia, allowing a resident to leave the facility unnoticed, posing immediate safety risk.
Auditory device on the front door entrance was not working, posing immediate safety risks to persons in care.
Report Facts
Capacity: 170 Census: 55 Plan of Correction Due Date: Jan 20, 2023

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Rosana FriasAssociate Executive DirectorFacility representative involved in discussion of deficiencies and plan of correction
Bennett FongSupervisorSupervisor overseeing the inspection

Inspection Report

Annual Inspection
Census: 50 Capacity: 170 Deficiencies: 5 Date: Oct 10, 2022

Visit Reason
An unannounced infection control annual inspection was conducted to evaluate compliance with infection control and safety regulations at the assisted living facility.

Findings
The inspection found missing signage related to mask-wearing, hand washing, and physical distancing, as well as construction equipment and chemicals stored in an unlocked room posing a safety risk. The facility was also missing updated infection control plans and other required documents.

Deficiencies (5)
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 in 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 Days of nonperishable food supplies: 7 Days of perishable food supplies: 2 Hot water temperature: 116.2 Fire extinguisher service date: May 4, 2022 Plan of Correction Due Date: Oct 11, 2022 Emergency Disaster Plan pages: 9

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Liridon FiciLicensing Program AnalystConducted the inspection
Rosana FriasAssociate Executive DirectorFacility representative during inspection and discussion of deficiencies
Bennett FongSupervisorSupervisor overseeing the inspection
Apolinario C. GozonAdministratorFacility administrator

Inspection Report

Annual Inspection
Census: 50 Capacity: 170 Deficiencies: 5 Date: 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)
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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and signed the report.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.
Rosana FriasAssociate Executive DirectorFacility representative who met with LPAs and took corrective action by locking the unsafe room.
Apolinario C. GozonAdministratorFacility administrator named in the report.

Inspection Report

Complaint Investigation
Census: 50 Capacity: 99 Deficiencies: 0 Date: Apr 27, 2022

Visit Reason
The visit was an unannounced complaint investigation conducted due to a complaint received on 2021-01-21 alleging that the facility was unsafe due to construction.

Complaint Details
The complaint was unsubstantiated. Although the allegation may have been valid, there was not a preponderance of evidence to prove the alleged violation occurred.
Findings
The investigation included interviews with staff, residents, and witnesses, as well as observations of the facility. The allegation that the facility was unsafe due to construction was found to be unsubstantiated, with no imminent health or safety concerns observed and residents reporting feeling safe during renovations.

Report Facts
Elevators observed: 3 Elevator wait time (seconds): 30

Employees mentioned
NameTitleContext
Laura HallLicensing Program AnalystConducted the complaint investigation and delivered complaint findings.
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during the investigation.
Harpreet HumpalSupervisorSupervisor overseeing the licensing evaluation.

Inspection Report

Complaint Investigation
Census: 50 Capacity: 99 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Elevators observed: 3 Elevator wait time (seconds): 30

Employees mentioned
NameTitleContext
Laura HallLicensing Program AnalystConducted the complaint investigation and delivered findings
Harpreet HumpalLicensing Program ManagerNamed as Licensing Program Manager on the report
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during investigation

Inspection Report

Annual Inspection
Census: 53 Capacity: 99 Deficiencies: 4 Date: 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 inspection found expired food items, lack of handwashing signage, missing visitor and cough etiquette posters, and requested updated documentation. A deficiency was cited related to expired prunes posing immediate health risks.

Deficiencies (4)
Three cans of expired prunes were found, one can was rusted, posing immediate health risks to persons in care.
No handwashing signage in bathrooms and trash cans without 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 Plan of Correction Due Date: Oct 21, 2021 Liability Insurance Coverage: 3000000

Employees mentioned
NameTitleContext
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst and discussed deficiencies and plan of correction
Alicia DelmundoLicensing EvaluatorConducted the inspection and signed the report
Bennett FongSupervisorSupervisor overseeing the inspection

Inspection Report

Census: 53 Capacity: 99 Deficiencies: 0 Date: 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 regarding four residents.

Findings
The Licensing Program Analyst conducted interviews and reviewed relevant documents related to the incidents involving four residents. No deficiencies were cited during the visit, and two residents had not returned to the facility at the time of the report.

Report Facts
Residents involved in incident reports: 4

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing EvaluatorConducted the case management visit and evaluation
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during the visit
Valentine MathanganiWellness Director/LVNSpoke with Licensing Program Analyst regarding the incidents

Inspection Report

Annual Inspection
Census: 53 Capacity: 99 Deficiencies: 4 Date: 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.

Deficiencies (4)
Three cans of expired prunes were found, one of which was rusted, posing immediate health risks.
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
NameTitleContext
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst and discussed deficiencies and plan of correction
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection

Inspection Report

Census: 53 Capacity: 99 Deficiencies: 0 Date: 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
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the case management visit and interviews
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during the visit
Valentine MathanganiWellness Director/LVNSpoke with Licensing Program Analyst regarding residents
Bennett FongLicensing Program ManagerNamed in report header and signature section

Inspection Report

Complaint Investigation
Census: 53 Capacity: 99 Deficiencies: 5 Date: Sep 6, 2021

Visit Reason
The inspection was conducted unannounced as a result of a complaint received by the Department (Control # 15-AS-20210901144412). The Licensing Program Analyst arrived to conduct a health and safety inspection.

Complaint Details
Inspection was triggered by a complaint (Control # 15-AS-20210901144412).
Findings
The inspection found multiple deficiencies including the presence of insect killers in the patio area, uneven pavement by the dining room exit door, pieces of construction metal in the patio, frayed carpet flooring by the entrance door in a resident's room, and bathroom doors removed from a resident's room. These conditions posed immediate health and safety risks.

Deficiencies (5)
Frayed carpet flooring in resident's room
Bathroom doors removed from resident's room
Insect killers present in patio area
Uneven pavement by dining room exit door
Pieces of construction metal in patio
Report Facts
Plan of Correction Due Date: Sep 7, 2021

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and cited deficiencies
Rosana FriasAssociate Executive DirectorFacility representative who discussed deficiencies and plan of correction
Vivian ValerosAssisted Living CoordinatorMet with Licensing Program Analyst at start of inspection
Ricky DulayActivity DirectorParticipated in inspection of resident rooms

Inspection Report

Complaint Investigation
Census: 53 Capacity: 99 Deficiencies: 1 Date: Sep 6, 2021

Visit Reason
The inspection was conducted unannounced as a result of a complaint received by the Department (Control # 15-AS-20210901144412).

Complaint Details
The visit was triggered by a complaint (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.

Deficiencies (1)
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.
Report Facts
Capacity: 99 Census: 53 Plan of Correction Due Date: Sep 7, 2021

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the inspection and authored the report.
Rosana FriasAssociate Executive DirectorFacility representative met during inspection and discussed deficiencies.
Vivian ValerosAssisted Living CoordinatorMet with Licensing Program Analyst at start of inspection.
Ricky DulayActivity DirectorParticipated in inspection of resident rooms.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.

Inspection Report

Complaint Investigation
Census: 53 Capacity: 99 Deficiencies: 0 Date: Sep 3, 2021

Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 2021-05-03 alleging that the facility was not ensuring resident (R1) receives sufficient meal.

Complaint Details
The complaint alleging insufficient meal provision to resident R1 was investigated and found to be unfounded, meaning the allegation was false or without reasonable basis.
Findings
The investigation found that prior to hospice care, R1 was independent in eating and was assisted after hospice placement. Staff, family members, and hospice nurse statements indicated no problem with meal provision. The allegation was closed as unfounded.

Report Facts
Complaint Control Number: 15-AS-20210503093311

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings.
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during the investigation and exit interview.
Bennett FongSupervisorSupervisor overseeing the investigation.

Inspection Report

Complaint Investigation
Census: 53 Capacity: 99 Deficiencies: 0 Date: 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.

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.
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.

Report Facts
Facility capacity: 99 Census: 53

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the complaint investigation and delivered findings
Bennett FongLicensing Program ManagerNamed in report as Licensing Program Manager
Rosana FriasAssociate Executive DirectorFacility representative met during inspection and exit interview
Apolinario C. GozonAdministratorFacility Administrator named in report

Inspection Report

Census: 52 Capacity: 99 Deficiencies: 0 Date: Aug 12, 2021

Visit Reason
The visit was conducted for case management and other reasons, including discussion of a conditional use permit for capacity increase, construction upgrades, delayed egress installation, and fire safety inspection request.

Findings
No alterations to the physical plant were found; ongoing work observed were upgrades. The Licensing Program Analyst reviewed plans for capacity increase and fire safety inspection requests.

Report Facts
Capacity increase application: 170

Employees mentioned
NameTitleContext
Apolinario C. GozonExecutive DirectorMet with Licensing Program Analyst to discuss facility matters

Inspection Report

Follow-Up
Census: 52 Capacity: 99 Deficiencies: 1 Date: Aug 12, 2021

Visit Reason
The visit was an unannounced case management follow-up to a previous case management conducted on December 15, 2020, related to an incident involving a resident wandering off the facility.

Findings
The licensee failed to comply with supervision requirements for a resident who 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.

Deficiencies (1)
Failure to determine the amount of supervision necessary by assessing the mental status of the prospective resident who tends to wander, resulting in a resident leaving the facility unnoticed.
Report Facts
Deficiency Type A: 1

Employees mentioned
NameTitleContext
Apolinario C. GozonExecutive DirectorDiscussed deficiency and plan of correction; named in relation to the incident and corrective actions

Inspection Report

Census: 52 Capacity: 99 Deficiencies: 0 Date: 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
NameTitleContext
Apolinario C. GozonExecutive DirectorMet with Licensing Program Analyst to discuss facility matters
Alicia DelmundoLicensing Program AnalystConducted facility visit and discussions
Bennett FongLicensing Program ManagerNamed in report header

Inspection Report

Follow-Up
Census: 52 Capacity: 99 Deficiencies: 1 Date: 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.

Deficiencies (1)
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.
Report Facts
Deficiency Type Count: 1 Capacity: 99 Census: 52

Employees mentioned
NameTitleContext
Alicia DelmundoLicensing Program AnalystConducted the case management follow-up inspection and discussed deficiency and plan of correction with facility administrator.
Bennett FongLicensing Program ManagerSupervisor overseeing the inspection.
Apolinario C. GozonExecutive DirectorFacility administrator involved in discussion of deficiency and plan of correction.

Inspection Report

Complaint Investigation
Census: 54 Capacity: 99 Deficiencies: 0 Date: Apr 5, 2021

Visit Reason
The visit was conducted as a case management tele-visit following a self-reported incident call from the administrator regarding alleged elder abuse involving a resident and staff member.

Complaint Details
The complaint involved alleged elder abuse where a staff member was reported to have hit a resident on the left shoulder. The allegation was investigated via tele-visit and no marks or bruises were observed. The staff member was placed on administrative leave pending investigation.
Findings
No deficiencies were observed during the tele-visit. The resident was observed to be comfortable with no visible marks or bruises. The staff member allegedly involved was placed on administrative leave pending an internal investigation.

Report Facts
Capacity: 99 Census: 54

Employees mentioned
NameTitleContext
Rosana FriasAdministratorReported the alleged elder abuse incident and participated in the tele-visit

Inspection Report

Census: 54 Capacity: 99 Deficiencies: 0 Date: 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.

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.
Findings
No deficiencies were observed during the tele-visit. The alleged staff member was placed on administrative leave pending an internal investigation.

Employees mentioned
NameTitleContext
Rosana FriasAdministratorReported the alleged elder abuse incident and was involved in the tele-visit.

Inspection Report

Census: 55 Capacity: 99 Deficiencies: 0 Date: 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
NameTitleContext
Rosana FriasAssociate Executive DirectorMet with Licensing Program Analyst during case management visit
Alicia DelmundoLicensing Program AnalystConducted the case management visit and interview
Isaac TaggartLicensing Program ManagerNamed in report header

Viewing

Loading inspection reports...