Inspection Report Summary
Most inspections found deficiencies related to medication management, resident care, and safety systems, with several complaint investigations substantiating issues such as medication mismanagement, inadequate supervision leading to resident injury, and failure to notify responsible parties during a scabies outbreak. The facility received a $500 civil penalty in May 2024 for inadequate care and supervision after a resident fall. Some deficiencies involved environmental safety, including a broken wander management alarm system and overdue fire suppression maintenance. The most recent report from August 20, 2025, cited a minor deficiency regarding outdated PRN medication letters and failure to follow doctor’s orders on medication notifications, indicating some ongoing attention needed in medication administration. While serious enforcement actions occurred earlier, recent findings suggest some improvement, though isolated issues persist.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 77
Capacity: 81
Deficiencies: 1
Aug 20, 2025
Visit Reason
The inspection was an unannounced annual inspection conducted to evaluate the facility's compliance with licensing requirements and ensure the health and safety of residents.
Findings
The facility was generally well maintained with proper safety equipment and adequate lighting. However, deficiencies were found related to outdated PRN medication letters and failure to follow doctor's orders regarding notification before and after medication administration, resulting in a citation and advisory for reporting requirements.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility is not following the doctor's orders as requested in the current and outdated PRN letters for residents R1 through R7 regarding notification before and after medication administration. | Type A |
Report Facts
Client files reviewed: 15
Staff files reviewed: 5
Memory care files with outdated PRN letters: 5
Residents affected by PRN letter deficiency: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Tracy Burke | Administrator/Director | Met with Licensing Program Analyst during inspection and involved in review of PRN letters |
| Lisa Rios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 81
Deficiencies: 2
Apr 18, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that the facility is in disrepair and does not ensure residents are provided a comfortable environment while in care.
Findings
The investigation substantiated that the facility had a broken wander management alarm system from 9/24/2024 through 10/23/2024, causing frequent triggering and an uncomfortable environment for residents, including those with hearing impairments. The system was repaired on 10/23/2024, but the auditory alarms subjected residents to loud noise, violating personal rights to a comfortable environment.
Complaint Details
The complaint investigation was substantiated based on the preponderance of evidence. Allegations included facility disrepair and failure to ensure a comfortable environment for residents. The broken alarm system and its frequent triggering were confirmed, causing discomfort to residents with or without hearing impairments.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to maintain a clean, safe, sanitary, and in good repair environment as evidenced by a broken alarm system that frequently triggered and required staff to call Phillips lifeline systems to reset. | Type B |
| Facility failed to provide residents with safe, healthful, and comfortable accommodations due to the loud auditory alarms causing an uncomfortable environment. | Type B |
Report Facts
Capacity: 81
Census: 80
Estimated Days of Completion: 0
Plan of Correction Due Date: Apr 25, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lisa Rios | Licensing Program Manager | Oversaw the complaint investigation |
| Tracy Burke | Administrator | Facility Administrator met during investigation and involved in findings |
Inspection Report
Follow-Up
Census: 78
Capacity: 81
Deficiencies: 0
Apr 4, 2025
Visit Reason
The visit was an unannounced follow-up on an incident report concerning a resident with an infected wound.
Findings
The facility has a resident recently hospitalized due to cellulitis on bilateral lower extremities and currently receiving treatment at a wound clinic. The facility plans to reassess the resident prior to their return after treatment completion. The licensing program analyst will return later to follow up on the discharge plan and reassessment.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Burke | Administrator/Director | Met with during the inspection and mentioned in the report. |
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced follow-up visit on the incident report. |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager in the report. |
Inspection Report
Follow-Up
Capacity: 81
Deficiencies: 3
Dec 13, 2024
Visit Reason
The visit was an unannounced Plan of Correction (POC) follow-up to verify correction of citations issued during case management visits, annual inspections, and complaint investigations.
Findings
Deficiencies cited under Title 22 Regulations have been cleared, and the licensee complied with the terms of all Plans of Correction. However, two citations remain under appeal from 3/14/2024 and were not cleared during this visit.
Deficiencies (3)
| Description |
|---|
| Citation under Section 87464(f)(1) requiring submission of a plan of correction to maintain compliance. |
| Citation under Section 87705(c)(5) requiring scheduling assessments for residents diagnosed with dementia. |
| Citation under Section 87203 requiring inspection or plan for fire equipment and submission of proof of compliance. |
Report Facts
Capacity: 81
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced Plan of Correction visit |
| Lisa Rios | Licensing Program Manager | Named in exit interview |
| Tracy Burke | Administrator | Facility administrator met during inspection |
Inspection Report
Annual Inspection
Census: 72
Capacity: 81
Deficiencies: 1
Aug 19, 2024
Visit Reason
An unannounced annual inspection was conducted to evaluate the facility's compliance with health, safety, and regulatory standards.
Findings
The facility was generally well maintained with sufficient safety equipment and proper medication storage. However, citations were issued for fire clearance violations related to an outdated Ansul/Fixed fire suppression system in the kitchen that was overdue for semi-annual service. Advisories were also given for an out-of-service elevator, a food handler's card issue, and low gas levels in two generators.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The 'Fixed System' or 'Ansul System' in the kitchen was overdue for semi-annual maintenance, last serviced on 9/27/2023, posing an immediate health and safety risk. | Type A |
Report Facts
Client files reviewed: 20
Staff files reviewed: 5
Fire drill date: Jul 17, 2024
POC Due Date: Aug 20, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the inspection and authored the report |
| Tracy Burke | Administrator/Director | Facility representative met during inspection |
| Lisa Rios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 79
Capacity: 81
Deficiencies: 0
Jul 5, 2024
Visit Reason
The inspection visit was an unannounced follow-up on a request for an exception for a prohibited health condition related to a resident with an unstageable pressure injury to the right heel.
Findings
The facility retained a resident with a prohibited health condition involving an unstageable pressure injury. Home health services had been provided but were discontinued. The facility lacked documentation for self-medication evaluation and treatment plans for the pressure injuries. An exception request for the resident was submitted on 7/3/2024.
Report Facts
Facility capacity: 81
Resident census: 79
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Burke | Administrator/Director | Met with during inspection |
| Lisa Rios | Licensing Program Manager | Named in report |
| Albert Johnson | Licensing Program Analyst | Named in report |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 81
Deficiencies: 2
May 13, 2024
Visit Reason
An unannounced case management visit was conducted due to incidents of unwitnessed and witnessed falls involving residents R1, R2, and R3.
Findings
The facility failed to provide adequate care and supervision, including a required two-person assist during transfers, resulting in a resident sustaining a fracture. Additionally, an outdated physician's report was found for a resident with dementia, posing potential health and safety risks.
Complaint Details
The visit was complaint-related due to incidents of unwitnessed and witnessed falls. An immediate civil penalty of $500 was assessed for violation of California Code of Regulations Section 87464(f)(1). An enhanced civil penalty was pending review.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not provide adequate care and supervision including a two person assist which resulted in R1 sustaining a fracture from a fall while transferring. | Type A |
| Residents with dementia did not have an annual medical assessment and reappraisal; observed outdated physician report for R3. | Type B |
Report Facts
Civil penalty: 500
Capacity: 81
Census: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report. |
| Tracy Burke | Administrator | Facility administrator met during the inspection; involved in transfer incident. |
Inspection Report
Census: 80
Capacity: 81
Deficiencies: 0
May 10, 2024
Visit Reason
The visit was an unannounced case management incident inspection conducted to evaluate the facility's compliance and incident management.
Findings
The report was amended to change the plan of correction date from 05/11/2024 to 05/15/2024. No other findings or deficiencies are explicitly stated in the report.
Inspection Report
Census: 72
Capacity: 81
Deficiencies: 0
Apr 4, 2024
Visit Reason
The visit was an unannounced Case Management visit conducted due to two incident reports: a medication error on 3/28/2024 and an unwitnessed fall on 4/2/2024.
Findings
The department investigated both incidents and confirmed the facility addressed the issues with in-service training for Med-techs and ongoing service planning. No deficiencies were cited during this visit, but advisories were given.
Report Facts
Incident reports: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced Case Management visit and investigation |
| Tracy Burke | Administrator | Interviewed about the medication error and resident fall |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 81
Deficiencies: 3
Mar 14, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to multiple allegations including failure to seek timely medical care, lack of required staff training, and failure to administer resident medication.
Findings
The investigation substantiated that staff did not seek timely medical care for a resident after a fall, staff lacked required training leading to medication shortages, and staff failed to administer medications to a resident. Other allegations regarding moldy food, rough handling of residents, and improper cleaning were unsubstantiated.
Complaint Details
The complaint investigation was substantiated. Allegations included failure to seek timely medical care for a resident after a fall, staff lacking required training resulting in medication shortages, and failure to administer medication to a resident. Other allegations about moldy food, rough handling, and improper cleaning were unsubstantiated.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility did not meet requirements for arranging transportation and medical care as specified in CCR 87464(f)(6). | Type B |
| Failure to ensure physician was efficiently notified for medication order clarification, posing immediate health and safety risk. | Type B |
| Insufficient and incompetent facility personnel to meet resident needs as required by CCR 87411(a). | Type B |
Report Facts
Capacity: 81
Census: 70
Medication shortage duration: 7
Plan of Correction Due Date: Mar 22, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Lisa Rios | Licensing Program Manager | Oversaw the complaint investigation and signed the report |
| Patricia Holguin | Administrator | Facility administrator named in the report |
| Nadya Rosales | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 81
Deficiencies: 2
Jan 16, 2024
Visit Reason
An unannounced visit was made to open a complaint and verify that the facility has a qualified administrator following the departure of the previous administrator on 2024-01-12.
Findings
The facility did not have a qualified and currently certified administrator of record, and the interim administrator was not associated with the facility in the Licensing Information System. The facility failed to provide required documentation for the transfer of administrator responsibilities, posing an immediate risk to operations and resident care.
Complaint Details
Complaint opened due to lack of a qualified administrator and failure to provide required documentation for administrator transfer. The interim administrator was not confirmed in the Licensing Information System as associated with the facility as of 2024-01-16.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| All facilities shall have a qualified and currently certified administrator; this requirement was not met, posing an immediate risk to operations and care of residents. | Type A |
| Licensee did not ensure all staff were associated to the facility; the interim administrator was not associated, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 81
Census: 78
Deficiencies cited: 2
Plan of Correction Due Date: Jan 17, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced visit and cited deficiencies |
| Patricia Holguin | Administrator | Former administrator whose last day was 2024-01-12 |
| Lisa Rios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 81
Deficiencies: 0
Nov 14, 2023
Visit Reason
Unannounced complaint investigation visit conducted in response to multiple allegations received on 09/27/2023 regarding resident hygiene, clothing, food contamination, and activity provision.
Findings
The investigation found the allegations of unmet hygiene needs, residents left in dirty clothing, contaminated food, and inadequate activities to be unsubstantiated based on records review, interviews, and observations. One separate allegation regarding failure to notify appropriate parties of a resident having scabies was substantiated in a prior report and not re-cited.
Complaint Details
The complaint investigation was unannounced and addressed allegations including failure to meet resident hygiene needs, leaving residents in dirty clothing, serving contaminated food, and inadequate activities. All were found unsubstantiated except for a prior substantiated issue about failure to notify parties of scabies, which was not re-cited.
Report Facts
Capacity: 81
Census: 77
Estimated Days of Completion: 0
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the complaint investigation |
| Patricia Holguin | Administrator | Facility administrator met during investigation |
| Lisa Rios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 81
Deficiencies: 1
Oct 30, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 09/25/2023 alleging that facility staff mismanage medications.
Findings
The investigation substantiated the allegation of medication mismanagement. The facility was previously cited for similar issues related to medication availability for resident R1 during specific periods in 2022, and the department confirmed the citation with a plan of correction.
Complaint Details
The complaint was substantiated based on the preponderance of evidence. The facility had a prior citation dated 8/28/2023 for medication mismanagement related to resident R1 from 1/4/2022 thru 1/13/2022 and 2/6/22 thru 2/8/22. The department will not re-issue a citation as a plan of correction was already in place.
Deficiencies (1)
| Description |
|---|
| Facility staff mismanage medications, including two occasions where medications were ordered but not available on-site for resident R1. |
Report Facts
Capacity: 81
Census: 77
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Patricia Holguin | Administrator | Facility administrator met during the investigation |
| Stephenie Doub | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 58
Capacity: 81
Deficiencies: 0
Sep 21, 2023
Visit Reason
A case management visit was conducted regarding complaint control #27-AS-20230807125824 related to an allegation that staff do not administer residents’ medication as prescribed.
Findings
The information provided during this visit did not change or add to the original complaint. The facility had been previously cited for this violation and a plan of correction was completed. There were no deficiencies found during this visit.
Complaint Details
The visit was related to a complaint alleging improper medication administration by staff. The complaint was previously investigated, and the facility was cited with a plan of correction completed. No new deficiencies were found during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Patricia Holguin | Administrator | Met with during the case management visit |
| Albert Johnson | Licensing Program Analyst | Named in the report as Licensing Program Analyst |
| Stephenie Doub | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 70
Capacity: 81
Deficiencies: 1
Sep 13, 2023
Visit Reason
An unannounced Plan of Correction (POC) visit was conducted to verify correction of citations issued during the complaint investigation conducted on 2023-08-28.
Findings
Deficiency cited under Title 22 Regulations have been cleared. The licensee complied with the terms of the Plan of Correction.
Complaint Details
The visit was a follow-up to a complaint investigation conducted on 2023-08-28. The deficiencies cited during that investigation have been cleared.
Deficiencies (1)
| Description |
|---|
| Deficiency cited under Title 22 Regulations related to following Physician's orders and documenting correctly when medications are missed. |
Report Facts
Section Cited: 87465
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced POC visit and verified correction of citations. |
| Patricia Holguin | Administrator | Facility administrator involved in Plan of Correction. |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 81
Deficiencies: 1
Aug 28, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2023-08-07 regarding medication administration, response to call buttons, portable oxygen provision, and facility cleanliness.
Findings
The investigation substantiated that staff did not administer resident medications as prescribed due to medication unavailability on two occasions. Other allegations regarding timely response to call buttons, provision of portable oxygen, and facility cleanliness were found unsubstantiated or unfounded.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not administer resident's medications as prescribed, with evidence showing medications were ordered but not available on-site for resident R1 during specified periods. Other allegations about call button response, portable oxygen provision, and facility cleanliness were unsubstantiated or unfounded.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff did not ensure medications ordered for residents were given as prescribed, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 81
Census: 70
Deficiencies cited: 1
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the complaint investigation |
| Stephenie Doub | Licensing Program Manager | Oversaw the complaint investigation |
| Patricia Holguin | Administrator | Facility administrator named in the report |
Inspection Report
Plan of Correction
Census: 49
Capacity: 81
Deficiencies: 1
Jul 26, 2023
Visit Reason
The visit was conducted as a Plan of Correction (POC) unannounced visit to verify the correction of previously cited deficiencies.
Findings
The deficiencies initially cited during the visit on 07/17/2023, specifically related to kitchen and food storage area cleanliness, have been cleared as of 07/26/2023 following a deep cleaning and staff changes.
Deficiencies (1)
| Description |
|---|
| Deficiency related to kitchen and food storage area cleanliness (Section 87555(b)(9)) |
Report Facts
Deficiencies cleared: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Patricia Holguin | Administrator | Facility administrator met during the inspection and referenced in the plan of correction |
| Stephenie Doub | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Albert Johnson | Licensing Program Analyst | Named as Licensing Program Analyst on the report |
Inspection Report
Annual Inspection
Census: 70
Capacity: 81
Deficiencies: 1
Jul 17, 2023
Visit Reason
An unannounced case management annual continuation inspection was conducted as part of the facility's annual survey initiated on 2023-07-11.
Findings
During the inspection, expired food, uncovered food, missing temperature checks for foods served, and unlabeled prepared food items were observed in the kitchen. Type B deficiencies were cited related to food service safety and sanitation.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Expired food in the main kitchen area, uncovered food, missing temperature checks for foods served, and no labels on prepared food items stored in refrigerators. | Type B |
Report Facts
Plan of Correction Due Date: Jul 24, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Patricia Holguin | Administrator | Assisted with the annual survey and was present during the inspection |
| Stephenie Doub | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 80
Capacity: 81
Deficiencies: 0
Jul 11, 2023
Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Albert Johnson to evaluate compliance with licensing requirements.
Findings
Fire extinguishers were current and in compliance with fire safety; a carbon dioxide monitor was present. Twenty resident and ten staff files, including criminal record clearances, were reviewed. The annual survey will need to be continued and the Licensing Program Analyst was re-directed.
Report Facts
Residents reviewed: 20
Staff files reviewed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Patricia Holguin | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Capacity: 81
Deficiencies: 0
Apr 10, 2023
Visit Reason
The Licensing Program Analyst conducted a Case Management visit due to multiple incidents involving resident falls.
Findings
Multiple residents experienced falls resulting in emergency room visits; follow-up care was inconsistently arranged by the facility. No citations were issued during this visit.
Report Facts
Facility capacity: 81
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the Case Management visit |
| Patricia Holguin | Administrator | Facility administrator met during the visit |
Inspection Report
Census: 55
Capacity: 81
Deficiencies: 0
Jan 3, 2023
Visit Reason
A case management visit was conducted regarding case closure for a background check on an individual who did not pass an exemption or did not submit all required information within the specified timeframe.
Findings
No deficiencies were identified during the visit. The report notes that individuals who fail to obtain criminal record clearance are not allowed on the facility premises or to have contact with clients.
Report Facts
Facility capacity: 81
Census: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the case management visit |
| Stephenie Doub | Licensing Program Manager | Named in the report header |
| Patricia Holguin | Administrator | Facility administrator met during the visit |
Inspection Report
Annual Inspection
Census: 66
Capacity: 81
Deficiencies: 0
Jul 11, 2022
Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Albert Johnson to evaluate compliance with regulatory standards.
Findings
The inspection found no deficiencies. The facility was compliant with fire safety, medication storage, staff clearances, and physical plant conditions, though an advisory was given for hot water temperature slightly below the required range.
Report Facts
Residents reviewed: 10
Staff files reviewed: 5
Hot water temperature: 103.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the inspection and met with the Administrator |
| Patricia Holguin | Administrator | Facility Administrator met with Licensing Program Analyst during inspection |
Inspection Report
Follow-Up
Census: 66
Capacity: 81
Deficiencies: 0
Jul 11, 2022
Visit Reason
An unannounced plan of correction (POC) visit was conducted to verify correction of citations issued during previous licensing inspections on 5/31/2022 and 4/29/2022.
Findings
Deficiencies cited under Title 22 Regulations have been cleared. The licensee complied with the terms of the POC by the due date, and the facility was provided a POC cleared letter.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced POC visit to verify correction of citations. |
| Stephenie Doub | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 81
Deficiencies: 1
May 31, 2022
Visit Reason
The visit was a case management incident investigation conducted in response to an incident report received on 2022-05-22 regarding a resident who was unaccounted for and unsupervised outside the facility.
Findings
The investigation found that Resident 1 (R1) left the facility unsupervised due to the absence or failure of the Paid Personal Assistant/Companion to report leaving. This posed an immediate health and safety risk. Deficiencies were cited related to failure in supervision and care.
Complaint Details
The visit was triggered by a complaint/incident report received on 2022-05-22 regarding R1 being AWOL and unsupervised. The complaint was substantiated by the findings.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate care and supervision as evidenced by R1's Companion not being present or reporting leaving, resulting in R1 being unaccounted for and unsupervised in the community. | Type A |
Report Facts
Deficiency count: 1
Plan of Correction due date: Jun 1, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Evaluator | Conducted the case management visit and signed the report |
| Stephenie Doub | Licensing Program Manager | Supervisor and Licensing Program Manager named in the report |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 81
Deficiencies: 2
Apr 29, 2022
Visit Reason
Unannounced complaint investigation conducted due to allegations of a scabies outbreak at the facility and failure to notify responsible parties of the outbreak.
Findings
The investigation substantiated that multiple residents were treated for scabies and the facility failed to notify responsible parties about the outbreak. The facility also failed to implement adequate infection response protocols, posing an immediate health and safety risk.
Complaint Details
The complaint investigation was substantiated. The facility had a scabies outbreak and did not notify responsible parties of the outbreak. The department concluded the preponderance of evidence standard was met.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to perform enhanced environmental cleaning and disinfection and failure to wear appropriate PPE to prevent exposure to communicable disease. | Type A |
| Failure to address infection response protocols, posing an immediate health and safety risk to residents. | Type A |
Report Facts
Capacity: 81
Census: 65
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the complaint investigation and named in findings |
| Stephenie Doub | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 66
Capacity: 81
Deficiencies: 0
Apr 12, 2022
Visit Reason
An unannounced plan of correction (POC) visit was made to verify correction of citations issued during the post licensing inspection conducted on 2021-12-01.
Findings
Deficiencies cited under Title 22 Regulations have been cleared. The licensee complied with the terms of the POC by the due date, and the facility was provided a POC cleared letter.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Made the unannounced POC visit to verify correction of citations. |
| Stephenie Doub | Licensing Program Manager | Named in the report as Licensing Program Manager. |
| Patricia Holguin | Administrator | Facility administrator met during the visit. |
Inspection Report
Capacity: 81
Deficiencies: 1
Dec 1, 2021
Visit Reason
An unannounced Post Licensing inspection/case management visit was conducted due to multiple falls for resident R1 and a medication error for resident R2.
Findings
The inspection found that resident R1 was sent out for a fall and diagnosed with kidney failure/kidney injury and lacks a current TB test on file, posing a potential health and safety risk. Resident R2 was admitted to hospice. Required postings were observed at the facility entrance.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| R1 does not have a current TB test on file, which poses a potential health and safety risk to residents in care. | Type B |
Report Facts
Capacity: 81
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the Post Licensing inspection and case management visit |
| Stephenie Doub | Licensing Program Manager | Supervisor of the inspection |
| Patricia Holguin | Administrator | Facility administrator met during the inspection |
Inspection Report
Census: 68
Capacity: 81
Deficiencies: 0
Oct 22, 2021
Visit Reason
An unannounced case management visit was conducted to clarify an incident reported on 10/09/2021 regarding medication orders and treatment for a resident.
Findings
The facility complied with the doctor's orders after receiving clarification and signed documents. No deficiencies were cited during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the unannounced case management visit and reviewed documentation related to the incident. |
| Patricia Holguin | Administrator | Met with the Licensing Program Analyst during the visit. |
Inspection Report
Original Licensing
Census: 68
Capacity: 81
Deficiencies: 0
Jul 27, 2021
Visit Reason
This was a prelicensing unannounced inspection visit to evaluate the facility's readiness for licensing as a Residential Care Facility for the Elderly (RCFE).
Findings
The facility was found to be in substantial compliance with minimum requirements for an RCFE license. The physical plant, food service, medication storage, and memory care unit were inspected and found to be clean, safe, and in good repair. Emergency food supplies and fire clearance were verified.
Report Facts
Emergency food supply days: 7
Emergency food supply days: 2
Water temperature: 108.7
Water temperature: 106.9
Bedridden residents allowed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Johnson | Licensing Program Analyst | Conducted the inspection and met with the Administrator |
| Patricia Holguin | Administrator/Executive Director | Facility Administrator who assisted in conducting the inspection |
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