Inspection Report Summary
Most inspections found no deficiencies, with several annual and routine visits showing compliance with regulations and proper facility maintenance. However, multiple complaint investigations substantiated issues primarily related to medication mismanagement, inadequate assistance with activities of daily living such as bathing and incontinence care, and insufficient staffing leading to delayed responses to residents’ needs. Some investigations also found failures in emergency procedures, including inadequate staff training on evacuation protocols and not calling 9-1-1 after resident falls with potential head injuries. The facility received several civil penalties, including a $500 fine in August 2023 for serious bodily injury related to pressure wounds and repeated $250 fines for medication errors and PPE violations. The most recent inspection on September 29, 2025, was clean with no deficiencies, indicating some improvement after prior issues.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 92
Capacity: 128
Deficiencies: 0
Sep 29, 2025
Visit Reason
The inspection visit was a case management health and safety check conducted to ensure compliance with Title 22 regulations.
Findings
The Licensing Program Analyst reviewed staff files, observed staff training, conducted medication counts for four residents, and observed medication administration. No deficiencies were cited during this visit.
Report Facts
Staff files reviewed: 5
Residents medication count: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during the inspection |
| Michael Hood | Licensing Program Analyst | Conducted the case management health and safety check |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 128
Deficiencies: 1
Aug 14, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2025-05-29 regarding medication mismanagement, failure to provide assistance with ADLs, and retaining residents beyond a level of care the facility can provide.
Findings
The investigation substantiated the allegation that facility staff mismanaged residents' medications, citing deficiencies related to medication counts and records. The allegation that staff were not providing assistance with ADLs was unsubstantiated based on interviews and observations. The allegation that the facility was retaining residents beyond a level of care they can provide was found to be unfounded after review of records and interviews.
Complaint Details
The complaint investigation was substantiated for medication mismanagement, unsubstantiated for failure to provide assistance with ADLs, and unfounded for retaining residents beyond a level of care the facility can provide.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure that residents R1, R2, R3, and R4 were receiving medications as prescribed, posing an immediate health, safety, and personal rights risk. | Type A |
Report Facts
Capacity: 128
Census: 89
Deficiency citations: 1
Plan of Correction Due Date: Aug 15, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Anthony Perez | Licensing Program Manager | Oversaw the complaint investigation |
| Pouya Ansari | Administrator | Facility administrator met during investigation and named in findings |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 128
Deficiencies: 1
Aug 7, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to allegations received on 2025-04-29 regarding the facility not addressing resident sustaining falls and other related complaints.
Findings
The investigation substantiated that the facility failed to immediately call 9-1-1 after a resident sustained falls with potential head injuries on two occasions, posing an immediate health and safety risk. Other allegations regarding cleanliness, catheter assistance, food services, and hygiene assistance were found to be unsubstantiated based on interviews, observations, and record reviews.
Complaint Details
The complaint investigation was substantiated regarding the facility's failure to address resident falls properly, specifically not calling 9-1-1 after falls with potential head injuries. Other allegations about cleanliness, catheter care, food services, and hygiene assistance were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure to contact 9-1-1 after resident sustained falls with potential head injuries on two occasions. | Type A |
Report Facts
Capacity: 128
Census: 88
Deficiency count: 1
Plan of Correction Due Date: Aug 8, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Investigator who conducted the complaint investigation and delivered findings |
| Pouya Ansari | Executive Director | Facility representative interviewed during investigation |
| Anthony Perez | Licensing Program Manager | Manager overseeing the licensing program and investigation |
Inspection Report
Census: 88
Capacity: 128
Deficiencies: 1
Jun 19, 2025
Visit Reason
A non-compliance conference was conducted to address non-compliance at the facility following issuance of 7 Type A citations and 23 substantiated complaint allegations since licensing on July 27, 2021.
Findings
The facility had repeat violations related to medication errors and medication management. The facility committed to enforcing quality assurance systems for medication management and ensuring staff competency through required training.
Complaint Details
23 substantiated complaint allegations since licensing on July 27, 2021.
Severity Breakdown
Type A: 7
Deficiencies (1)
| Description | Severity |
|---|---|
| 7 Type A citations issued related to medication errors and medication management | Type A |
Report Facts
Type A citations issued: 7
Substantiated complaint allegations: 23
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Administrator | Facility Administrator present at non-compliance conference |
| Alycia Rayner | Regional Manager | CCLD staff present at non-compliance conference |
| Lauren Crocker | Licensing Program Manager | CCLD staff present at non-compliance conference |
| Michael Hood | Licensing Program Analyst | CCLD staff present at non-compliance conference |
| Terry Ervin | Vice President of Operations | Facility staff present at non-compliance conference |
| Scott Carlson | Senior Vice President of Operations | Facility staff present at non-compliance conference |
| Sue McPherson | Vice President of Quality Assurance and Regulatory Affairs | Facility staff present at non-compliance conference |
| Kevin Wrigley | Regulatory Director of Quality Assurance | Facility staff present at non-compliance conference |
| Melissa Malek | Northern California Director of Health Services | Facility staff present at non-compliance conference |
| Joel Goldman | Partner at Hanson Bridgett Law Firm | Facility staff present at non-compliance conference |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 128
Deficiencies: 1
May 22, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the licensee was not ensuring staff were adequately trained on emergency evacuation protocols following a fire incident on February 1, 2025.
Findings
The investigation substantiated the allegation that staff were not properly trained on emergency evacuation protocols. Interviews with staff revealed inadequate training and participation in drills. The fire was contained to the laundry room with no injuries, but some residents were not evacuated properly. The facility's Plan of Operation lacked specific training objectives and documentation did not comply with Title 22 regulations.
Complaint Details
The complaint was substantiated. The allegation was that staff were not adequately trained on emergency evacuation protocols following a fire on February 1, 2025. Interviews and documentation review confirmed inadequate training and incomplete evacuation during the fire.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure adequate records that staff were trained in Emergency and Disaster Plan in accordance with the facility's Plan of Operation, posing a potential health, safety, and personal rights risk to residents. | Type B |
Report Facts
Census: 82
Total Capacity: 128
Fire incident date: Feb 1, 2025
Fire alarm activation time: 556
Firefighters arrival time: 602
Fire clearance time: 729
Staff work duration: 2.5
Quarterly drills attended: 1
Plan of Correction Due Date: Jun 27, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation and signed report |
Inspection Report
Annual Inspection
Census: 82
Capacity: 128
Deficiencies: 0
May 21, 2025
Visit Reason
The inspection was an unannounced annual continuation visit conducted to ensure compliance with Title 22 regulations following the Required-1 Year Inspection conducted on 5/20/2025.
Findings
The inspection found the facility to be in compliance with regulations, with properly furnished apartments, sanitary bathrooms, appropriate food storage, and operational safety equipment. No deficiencies were cited during this visit.
Report Facts
Food supply: 2
Food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection |
| Pouya Ansari | Executive Director | Met with during inspection |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 82
Capacity: 128
Deficiencies: 0
May 20, 2025
Visit Reason
The inspection was an unannounced Required-1 Year Inspection conducted to ensure compliance with Title 22 regulations.
Findings
No deficiencies were cited during this inspection. The Licensing Program Analyst reviewed resident and staff files, medications, and verified the facility's certificate of liability insurance.
Report Facts
Resident files reviewed: 5
Staff files reviewed: 4
Residents' medications reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection and cited no deficiencies |
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 86
Capacity: 128
Deficiencies: 0
Jan 3, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that facility staff were not assisting a resident with oxygen.
Findings
The investigation included facility tour, interviews, and record reviews. The allegation that staff were not assisting the resident with oxygen was found to be unsubstantiated based on observations, interviews with the resident and staff, and documentation review.
Complaint Details
The complaint alleged that facility staff were not ensuring that resident R1's portable oxygen was charged and operable when ambulating. The investigation found that R1 was observed wearing nasal cannula and portable oxygen was plugged in and charged. Staff confirmed they ensure R1 wears oxygen while ambulating. The allegation was unsubstantiated.
Report Facts
Facility capacity: 128
Census: 86
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Anthony Perez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 84
Capacity: 128
Deficiencies: 1
May 21, 2024
Visit Reason
The visit was a case management follow-up to address deficiencies identified after a previous inspection, specifically regarding the administrator's certification status.
Findings
The facility was found to have an administrator without an active Administrator certificate, which poses a potential health, safety, and personal rights risk to residents in care.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure that Administrator had an active Administrator certificate, posing potential health, safety, and personal rights risk to residents. | Type B |
Report Facts
Capacity: 128
Census: 84
Plan of Correction Due Date: Jun 3, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during inspection; named in deficiency regarding administrator certification |
| Michael Hood | Licensing Program Analyst | Conducted the inspection and cited deficiency |
| Anthony Perez | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 128
Deficiencies: 0
May 10, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff were not following residents' care plans.
Findings
Based on interviews, observations, and record reviews, the allegation that staff were not following residents' care plans was found to be unfounded, meaning the allegation was false or without reasonable basis.
Complaint Details
The complaint alleged that staff were not following residents' care plans. The investigation included interviews with staff and residents, observations of lift equipment use, and review of care plans. The allegation was determined to be unfounded.
Report Facts
Number of hoyer lifts on site: 4
Number of sit-to-stand lifts on site: 1
Number of residents receiving assistance with lifts: 4
Facility capacity: 128
Facility census: 88
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst and participated in exit interview |
| Michael Hood | Licensing Program Analyst | Conducted complaint investigation |
| Anthony Perez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 88
Capacity: 128
Deficiencies: 0
May 10, 2024
Visit Reason
The inspection was an unannounced annual continuation visit conducted to ensure compliance with Title 22 regulations following the Required-1 Year Inspection conducted on 2024-05-09.
Findings
No deficiencies were cited during the inspection. The Licensing Program Analyst observed four apartments in Assisted Living and interviewed five residents. An exit interview was conducted and a copy of the report was given at the conclusion of the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection and cited no deficiencies. |
| Pouya Ansari | Executive Director | Met with the Licensing Program Analyst during the inspection. |
Inspection Report
Annual Inspection
Census: 88
Capacity: 128
Deficiencies: 0
May 9, 2024
Visit Reason
The inspection was an unannounced Required-1 Year Inspection conducted to ensure compliance with Title 22 regulations at the care home.
Findings
The inspection found the facility to be in compliance with regulations, with properly furnished apartments, sanitary bathrooms, operational safety features, adequate food supplies, and secure medication storage. No deficiencies were cited during this visit.
Report Facts
Food supply: 2
Food supply: 7
Resident files reviewed: 5
Staff files reviewed: 4
Hot water temperature: 114.8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection and authored the report |
| Pouya Ansari | Executive Director | Met with the Licensing Program Analyst during the inspection |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 1
Jan 31, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff were not meeting a resident's oxygen needs while in care, as well as other complaints regarding call button functionality, care and supervision, and planned activities.
Findings
The investigation substantiated that staff failed to ensure a resident used oxygen as ordered, posing an immediate health and safety risk. Other allegations regarding a defective call button, inadequate care and supervision, and lack of planned activities were found to be unsubstantiated based on interviews, observations, and documentation.
Complaint Details
The complaint investigation was substantiated for the allegation that staff were not meeting a resident's oxygen needs while in care. The other allegations regarding a defective call button, inadequate care and supervision, and lack of planned activities were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure that PRN order for resident's oxygen was followed, posing an immediate health, safety, and personal rights risk. | Type A |
Report Facts
Capacity: 128
Census: 76
Plan of Correction Due Date: Feb 1, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation and signed report |
Inspection Report
Census: 76
Capacity: 128
Deficiencies: 0
Oct 20, 2023
Visit Reason
The visit was conducted for Case Management - Other, specifically to obtain a signature relative to amending a report for an inspection conducted on 10/18/2023.
Findings
The Licensing Program Analyst met with the Executive Director to obtain a signature for an amended report. An exit interview was conducted and a copy of the report was provided to the Executive Director.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during visit and signed amended report. |
| Michael Hood | Licensing Program Analyst | Conducted visit and obtained signature for amended report. |
| Anthony Perez | Licensing Program Manager | Named in report header. |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 2
Oct 18, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not give resident's medication as prescribed and that the facility was not providing PPE to staff in direct contact with residents with a contagious disease.
Findings
The investigation substantiated that the facility failed to ensure resident R1 received medications as prescribed and that staff did not consistently wear full PPE when caring for residents in isolation due to COVID-19. Two civil penalties of $250 each were assessed for repeated violations.
Complaint Details
The complaint was substantiated based on interviews, medication count, observation, and records review. The allegations involved medication administration errors and inadequate PPE provision to staff. Two civil penalties were assessed for repeat violations within 12 months.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not ensure that resident R1 was receiving medications as prescribed, posing an immediate health, safety, and personal rights risk. | Type A |
| Facility did not ensure that staff were wearing full PPE when working with residents on isolation for COVID-19, posing a potential health, safety, and personal rights risk. | Type B |
Report Facts
Civil penalty amount: 250
Civil penalty amount: 250
Capacity: 128
Census: 76
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Census: 74
Capacity: 128
Deficiencies: 0
Sep 20, 2023
Visit Reason
The visit was conducted for case management purposes related to obtaining a signature for amending a prior inspection report dated 08/29/2023.
Findings
The Licensing Program Analyst met with the Executive Director to obtain a signature for an amended report. An exit interview was conducted and a copy of the report was provided to the Executive Director.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during visit and signed amended report. |
| Michael Hood | Licensing Program Analyst | Conducted visit and obtained signature for amended report. |
| Anthony Perez | Licensing Program Manager | Named in report header. |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 128
Deficiencies: 1
Sep 20, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff mismanaged a resident's medication.
Findings
The investigation found that resident R1 did not receive new medications as prescribed after hospital discharge, with medication delivery delays and discrepancies in medication counts. The allegation was substantiated, and a deficiency was cited for failure to assist residents with self-administered medications.
Complaint Details
The complaint was substantiated. The investigation included interviews, medication counts, and record reviews. A civil penalty of $250 was assessed for a repeat violation within 12 months.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure that resident R1 was receiving medications as prescribed, posing an immediate health, safety, and personal rights risk. | Type A |
Report Facts
Civil penalty amount: 250
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Census: 77
Capacity: 128
Deficiencies: 0
Aug 31, 2023
Visit Reason
The visit was conducted as a Case Management - Other type of visit, including obtaining signatures for amended documents related to a prior inspection conducted on 8/29/2023.
Findings
A civil penalty of $250 was assessed for a repeat violation within 12 months of a prior violation identified during an inspection on 5/12/2023. An exit interview was conducted with the Executive Director, and appeal rights were provided.
Report Facts
Civil penalty amount: 250
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met during visit and signed amended documents |
| Michael Hood | Licensing Program Analyst | Conducted visit and obtained signatures |
| Anthony Perez | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 2
Aug 29, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including resident pressure injuries, lack of timely medical care, inadequate assistance with incontinence care and medications, lack of supervision resulting in falls, failure to safeguard personal property, lack of feeding assistance, and unclean living conditions.
Findings
The investigation substantiated that the facility failed to provide proper care and medical attention for pressure injuries, resulting in serious bodily injury and a $500 civil penalty. Medication mismanagement and inadequate incontinence care were also substantiated. Other allegations including lack of supervision causing falls, failure to safeguard personal property, lack of feeding assistance, and unclean conditions were found unsubstantiated based on interviews, observations, and record reviews.
Complaint Details
The complaint investigation was substantiated. Allegations included resident sustaining pressure injuries without timely medical care, lack of assistance with incontinence care and medications, and medication mismanagement. The investigation found that resident R1 had unstageable pressure wounds that were not properly treated, and medication errors occurred. An immediate civil penalty of $500 was assessed due to serious bodily injury. Other allegations such as lack of supervision causing falls, failure to safeguard personal property, lack of feeding assistance, and unclean conditions were unsubstantiated.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Observation of Resident - The licensee shall ensure that residents are regularly observed for changes in physical functioning and that appropriate assistance is provided when such observation reveals unmet needs. | Type A |
| Incidental Medical and Dental Care - The licensee shall arrange or assist in arranging for medical care appropriate to the conditions and needs of residents. | Type A |
Report Facts
Capacity: 128
Census: 76
Civil penalty: 500
Medication discrepancies: 3
Plan of Correction Due Date: Aug 30, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Michael Hood | Licensing Program Analyst | Conducted complaint investigation and medication audits |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation report |
| Belinda Prunty | Memory Care Director | Reported to have been informed about resident's pressure wound |
| Laurel Sanders | Health Services Director, LVN | Reported seeing resident's wound and contacting Memory Care Director |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 2
Aug 29, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that residents were not given showers and staff were not dispensing medications to residents.
Findings
The investigation substantiated the allegations that facility staff failed to assist residents with bathing, with one resident going 5 to 6 weeks without a shower despite requiring hands-on assistance. Medication mismanagement was also found, including discrepancies in medication counts and improper documentation of medication administration.
Complaint Details
The complaint investigation was substantiated. Allegations included residents not receiving showers and staff not dispensing medications. Evidence included interviews, medication audits, medication counts, and review of resident assessments and facility documentation.
Deficiencies (2)
| Description |
|---|
| Residents were not given showers as required, with inconsistent documentation of bathing and bed baths. |
| Medication mismanagement including missing medication, improper approval of injectable medication not authorized for use, and discrepancies in medication counts. |
Report Facts
Medication discrepancies: 3
Resident census: 76
Facility capacity: 128
Duration without shower: 30
Duration without shower: 30
Bed baths documented: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and medication audits. |
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and provided information about resident care and shower chair issues. |
| Belinda Prunty | Memory Care Director | Approved medication listed as 'injected' despite facility not authorized to administer injectable medications. |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 2
Aug 29, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 03/09/2023 regarding medication mismanagement, lack of assistance with incontinence care, and lack of assistance with bathing at the facility.
Findings
The investigation substantiated the allegations that facility staff mismanaged medications and failed to provide timely assistance with incontinence care and bathing to resident R1. Documentation and interviews revealed inconsistent care and delays in providing necessary equipment such as a shower chair, posing potential health, safety, and personal rights risks to residents.
Complaint Details
The complaint investigation was substantiated. Allegations included staff mismanaging medications, not assisting residents with incontinence care, and not assisting residents with bathing. Evidence included medication audits, interviews with residents and staff, and review of resident assessments and facility documentation.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not ensure resident R1 received a shower chair timely to assist with providing incontinence care and shower assistance. | Type B |
| Facility did not ensure resident R1 was receiving incontinence care and shower assistance. | Type B |
Report Facts
Capacity: 128
Census: 76
Medication count discrepancy: 3
Plan of Correction Due Date: Sep 13, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and provided information regarding resident care and equipment |
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and medication audits |
| Belinda Prunty | Memory Care Director | Approved medication administration that was found to be inaccurate during investigation |
| Angela Hood | Licensing Program Analyst | Assisted in medication count during visit on 5/17/2023 |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation and signed report |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 3
Aug 29, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations including staff not meeting residents' care needs, insufficient staffing, lack of oxygen use signage, medication mismanagement, and inadequate staff training.
Findings
The investigation substantiated several allegations including failure to provide adequate incontinence care and bathing assistance, insufficient staffing leading to delayed response times, lack of proper oxygen signage, medication mismanagement including inaccurate medication counts and improper approvals, and inadequate staff training hours. Some allegations regarding food quality, visitation, and facility cleanliness were found unsubstantiated.
Complaint Details
The complaint investigation was substantiated. Allegations included failure to meet residents' care needs, insufficient staffing, lack of oxygen signage, medication mismanagement, and inadequate staff training. Some allegations about food quality, visitation, and cleanliness were unsubstantiated.
Deficiencies (3)
| Description |
|---|
| Facility did not ensure that resident R1 was receiving medications as prescribed, posing an immediate health, safety, and personal rights risk. |
| Facility did not ensure 'No Smoking-Oxygen in Use' signs were posted on every apartment door with a resident using oxygen, posing a potential health, safety, and personal rights risk. |
| Facility failed to ensure staff acquired all required trainings per Health and Safety Code, posing a potential health, safety, and personal rights risk. |
Report Facts
Capacity: 128
Census: 76
Civil penalty amount: 250
Medication discrepancies: 3
Training hours: 6
Training hours: 4
Training hours: 5
Training hours: 13.25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation |
| Anthony Perez | Licensing Program Manager | Oversaw complaint investigation report |
| Belinda Prunty | Memory Care Director | Named in medication mismanagement finding related to medication audit and approval |
Inspection Report
Annual Inspection
Census: 81
Capacity: 128
Deficiencies: 0
Jul 21, 2023
Visit Reason
The Licensing Program Analyst conducted an unannounced annual continuation visit to ensure compliance with Title 22 regulations following the Required-1 Year Inspection conducted on 07/06/2023.
Findings
The inspection found the care home perimeter free of clutter and debris, delayed egress in Memory Care operational, and reviewed resident and staff files. No deficiencies were cited per California Code of Regulations, Title 22.
Report Facts
Resident files reviewed: 3
Staff files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection and authored the report |
| Pouya Ansari | Administrator | Facility administrator met during inspection |
| Anthony Perez | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 78
Capacity: 128
Deficiencies: 0
Jul 6, 2023
Visit Reason
The inspection was an unannounced Required-1 Year Inspection to ensure compliance with Title 22 regulations at the care home.
Findings
The inspection found the facility to be in compliance with regulations, with no deficiencies cited. The apartments, bathrooms, kitchen, outdoor areas, and medication storage were all observed to be properly maintained and safe.
Report Facts
Food supply: 2
Food supply: 7
Apartments inspected: 3
Apartments inspected: 2
Bathrooms inspected: 6
Hot water temperature: 115
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted inspection and named in report |
| Angela Hood | Licensing Program Analyst | Conducted inspection and named in report |
| Anthony Perez | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 128
Deficiencies: 1
May 12, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the facility does not have adequate staffing to meet residents' needs.
Findings
The investigation found substantiated evidence that the facility did not ensure timely response to residents' call buttons, with response times reaching as long as 42 minutes, posing potential health, safety, and personal rights risks to residents.
Complaint Details
The complaint alleged inadequate staffing to meet residents' needs. The allegation was substantiated based on interviews with staff and residents, and review of call button response time records showing delays up to 42 minutes.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by failure to respond to call buttons in a timely manner, with response times reaching as long as 42 minutes. | Type B |
Report Facts
Capacity: 128
Census: 76
Deficiency due date: May 31, 2023
Maximum call button response time (minutes): 42
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Pouya Ansari | Executive Director | Facility representative interviewed during investigation |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Census: 83
Capacity: 128
Deficiencies: 1
Oct 6, 2022
Visit Reason
The visit was conducted as a Case Management - Health Checks due to a COVID-19 outbreak at the facility.
Findings
The Licensing Program Analyst observed that residents' care needs were being met, PPE supplies and staffing were sufficient, and infection prevention measures were generally adequate. However, a deficiency was cited for failure to report COVID-19 positive cases to the licensing agency within 24 hours as required by regulations.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure to report COVID-19 positive cases to CCLD within 24 hours, posing a potential health, safety, and personal rights risk to residents in care. | Type B |
Report Facts
Deficiency due date: Oct 21, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Hood | Licensing Program Analyst | Conducted the inspection and authored the report |
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during the visit and acknowledged receipt of report |
| Cherish Mendoza | Infection Preventionist | Provided infection prevention recommendations during the visit |
| Kristin Brady | Sacramento County Public Health Nurse | Present during the inspection visit |
| Anthony Perez | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 128
Deficiencies: 2
Sep 14, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 05/04/2022 regarding staff failing to respond to resident's call button, leaving resident unattended, and untrained staff.
Findings
The investigation substantiated allegations that staff failed to respond timely to a resident's call pendant on multiple occasions, leaving the resident unattended for extended periods, and that some staff lacked required initial or annual training. One allegation regarding a resident fall was found to be unfounded.
Complaint Details
The complaint was substantiated. Allegations included staff failing to respond to resident's call button, leaving resident unattended for hours after a fall, and untrained staff. The investigation found evidence supporting these allegations based on interviews, documentation review, and pendant response records. One allegation about a resident fall was unfounded.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility personnel were not sufficient in numbers and competent to provide necessary services, resulting in untimely responses to resident calls. | Type A |
| Staff training was incomplete; three of five staff did not have required initial or annual training completed. | Type B |
Report Facts
Capacity: 128
Census: 73
Staff training records reviewed: 5
Staff without required training: 3
NOC shift staff: 2
Fall incident date: Apr 20, 2022
Fall incident date: May 9, 2022
Response time: 15
Response delay: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sabrina Calzada | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Maribeth Senty | Licensing Program Manager | Oversaw the complaint investigation |
| Pouya Ansari | Administrator / Executive Director | Facility administrator interviewed during investigation |
| Nathan Condie | Administrator | Facility administrator named in report header |
| S1 | Staff working NOC shift on 4/20-4/21/2022 involved in call response | |
| S2 | Staff working NOC shift on 4/20-4/21/2022 involved in call response and training |
Inspection Report
Census: 82
Capacity: 128
Deficiencies: 0
Aug 30, 2022
Visit Reason
The inspection was conducted as a case management visit to issue a related deficiency to a prior complaint that was opened and closed under the facility's previous license. The purpose was to document the inspection under the current license and issue a penalty related to a prior violation.
Findings
No deficiencies were issued during this inspection. A $500 penalty was issued for a violation that resulted in injury or illness of a resident occurring between February 2020 and August 2020.
Report Facts
Penalty amount: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Administrator | Met with Licensing Program Analyst during inspection |
| Sabrina Calzada | Licensing Program Analyst | Conducted the inspection and issued the penalty |
| Maribeth Senty | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 87
Capacity: 128
Deficiencies: 0
Jul 29, 2022
Visit Reason
Licensing Program Analyst Sabrina Calzada arrived unannounced to conduct a required annual inspection of the facility.
Findings
The facility was observed to be clean, in good repair, odor free, and compliant with COVID-19 protocols. No deficiencies were observed during the inspection.
Report Facts
Licensed non-ambulatory residents capacity: 128
Bedridden residents capacity: 8
Hospice waiver capacity: 15
Current census: 87
Fire extinguisher last serviced date: Feb 8, 2022
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Emergency food/water supply duration: 7
Hand sanitizers observed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pouya Ansari | Executive Director | Met with Licensing Program Analyst during inspection |
| Sabrina Calzada | Licensing Program Analyst | Conducted the annual inspection |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 128
Deficiencies: 0
Nov 4, 2021
Visit Reason
An unannounced complaint investigation was conducted based on allegations received on 10/27/2021 regarding failure to follow physician's orders and safeguarding resident's personal property.
Findings
The investigation found the allegations to be unfounded, meaning the allegations were false, could not have happened, or lacked a reasonable basis. The facility had no COVID-19 positive cases at the time of the visit.
Complaint Details
The complaint involved allegations that facility staff did not follow physicians' orders to obtain a resident's contact lenses and did not safeguard the resident's personal property. The allegations were found to be unfounded.
Report Facts
Capacity: 128
Census: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angela Hood | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Hood | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Ricky David | Executive Director | Met with investigators during complaint investigation |
Inspection Report
Original Licensing
Census: 67
Capacity: 128
Deficiencies: 0
Jul 21, 2021
Visit Reason
The inspection was a pre-licensing visit related to the facility's change of ownership to assess readiness for licensing.
Findings
The facility was observed to be ready for licensing with no deficiencies noted. The inspection included a tour of the facility, review of emergency supplies, medication logs, and COVID-19 protocols. A component III was waived and the report will be submitted for final approval.
Report Facts
Fire Clearance Capacity: 128
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nathan Condie | Executive Director | Met with Licensing Program Analyst during pre-licensing inspection |
| Praveen Singh | Licensing Program Analyst | Conducted the pre-licensing inspection |
| Laura Munoz | Licensing Program Manager | Named as Licensing Program Manager on report |
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