Inspection Report Summary
Most inspections found no deficiencies, with several complaint investigations determined to be unsubstantiated or unfounded. The facility had isolated issues related to cleanliness and failure to report a significant resident weight loss in an April 2, 2025 complaint investigation, and earlier concerns about staff qualifications and timely resident care in June 7, 2023, which included a finding of immediate health and safety risk due to unqualified personnel administering injections. Other deficiencies involved staff training and criminal record clearance noted in early 2024 but were minor and did not lead to enforcement actions or fines. The most recent inspection on October 16, 2025, was clean with no deficiencies cited, indicating improvement since prior findings. No fines, license suspensions, or severe enforcement actions were listed in the available reports.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 100
Capacity: 142
Deficiencies: 0
Oct 16, 2025
Visit Reason
The inspection was an unannounced case management visit conducted to obtain further information regarding a resident concern.
Findings
No deficiencies were cited during the inspection. The Licensing Program Analyst interviewed the Administrator and two residents, and an exit interview was conducted with a copy of the report provided.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Fleck | Administrator | Met with Licensing Program Analyst during inspection. |
| Bethany Mirlohi | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Troy Ordonez | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 142
Deficiencies: 0
May 15, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2025-04-30 regarding resident care and staffing issues at Oakmont of Westpark facility.
Findings
The investigation found that the allegations of improper incontinence care and insufficient staffing were unsubstantiated, with evidence showing care needs were met and staffing was sufficient. Additional allegations regarding following physician orders, medication management, and refund issuance were found to be unfounded.
Complaint Details
The complaint investigation addressed multiple allegations including failure to meet resident's incontinence care needs, insufficient staffing, failure to follow physician orders, medication mismanagement, and failure to issue refund. All allegations were either unsubstantiated or unfounded based on interviews, observations, and record reviews.
Report Facts
Capacity: 142
Census: 98
Complaint receipt date: Apr 30, 2025
Inspection start time: 1010
Inspection end time: 1040
Resident reassessment interval: 6
Move out date: Mar 17, 2025
Refund notice period: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Fleck | Executive Director | Met with Licensing Program Analyst and involved in investigation findings |
| Cassandra Mikkelson | Licensed Program Analyst | Conducted the complaint investigation |
| Laura Munoz | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 142
Deficiencies: 2
Apr 2, 2025
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations that staff did not keep the facility clean, sanitary, and free from odor, and that staff did not report a change in a resident's condition.
Findings
The investigation substantiated the allegations that staff failed to maintain cleanliness and odor control in a resident's room and did not report a significant 30-pound weight loss of the resident to the primary care physician or responsible party.
Complaint Details
The complaint investigation was substantiated. Allegations included failure to keep the facility clean and sanitary and failure to report a resident's change in condition. Evidence included interviews, observations, and document reviews confirming the validity of the allegations.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility was not kept clean, safe, sanitary, and in good repair; resident's room had strong urine odor and was unclean. | Type B |
| Facility failed to observe and report changes in resident's condition, specifically a 30-pound weight loss, to the responsible party or medical professional. | Type B |
Report Facts
Resident weight loss: 30
Capacity: 142
Census: 104
Plan of Correction Due Date: Apr 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cassandra Mikkelson | Licensed Program Analyst | Conducted the complaint investigation and delivered findings. |
| Laura Munoz | Licensing Program Manager | Named in relation to the licensing program management and report. |
| Barbara Fleck | Administrator | Met with the investigator during the unannounced visit. |
Inspection Report
Complaint Investigation
Capacity: 142
Deficiencies: 0
Mar 5, 2025
Visit Reason
An unannounced complaint investigation was conducted regarding allegations that a resident sustained frequent falls and bruises while in care at the facility.
Findings
The investigation included interviews, facility tour, and record reviews. The facility had appropriately assessed the resident for fall risks and implemented measures to prevent falls. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that a resident sustained frequent falls and bruises while in care. The investigation found the allegation unsubstantiated based on interviews, observations, and record reviews.
Report Facts
Facility capacity: 142
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cassandra Mikkelson | Licensed Program Analyst | Conducted the complaint investigation and authored the report |
| Barbara Fleck | Administrator | Met with the investigator and participated in interviews |
| Laura Munoz | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 98
Capacity: 142
Deficiencies: 0
Feb 12, 2025
Visit Reason
The inspection was a Required - 1 Year unannounced visit to ensure compliance with Title 22 regulations at the care facility.
Findings
The inspection found the facility to be in compliance with regulations, with no deficiencies cited. Areas inspected included apartments, common areas, kitchen, medication storage, and safety equipment, all found to be properly maintained and operational.
Report Facts
Apartments inspected: 6
Common area bathrooms inspected: 2
Resident files reviewed: 6
Staff files reviewed: 4
Perishable food supply: 2
Non-perishable food supply: 7
Hot water temperature: 116.7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Fleck | Administrator | Met with during the inspection. |
| Cassandra Mikkelson | Licensing Program Analyst | Conducted the inspection. |
| Laura Munoz | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 101
Capacity: 142
Deficiencies: 0
Nov 13, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that a staff member handled a resident in a rough manner.
Findings
The investigation included interviews with staff, residents, and a witness. Conflicting statements were found, and there was no preponderance of evidence to substantiate the allegation. The complaint was determined to be unsubstantiated.
Complaint Details
Allegation that a staff member handled a resident in a rough manner was investigated and found to be unsubstantiated due to conflicting information and lack of evidence.
Report Facts
Capacity: 142
Census: 101
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lisa Velasco | Health Services Director | Met with the Licensing Program Analyst during the inspection |
| Haley Thomas | Administrator | Facility administrator named in the report |
| Troy Ordonez | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 142
Deficiencies: 0
Aug 13, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-07-08 regarding staff mistreatment of residents.
Findings
The investigation found the allegations that a staff member did not treat residents with dignity and respect and handled residents in a rough manner to be unsubstantiated and unfounded based on interviews with staff, residents, and family members.
Complaint Details
The complaint alleged that a staff member did not treat residents with dignity and respect and handled residents in a rough manner. The investigation included interviews with staff, residents, and family members. Most staff and residents denied observing inappropriate behavior. The findings were unsubstantiated and unfounded, meaning there was no preponderance of evidence to prove the allegations.
Report Facts
Capacity: 142
Census: 84
Staff interviewed: 13
Residents interviewed: 5
Staff interviewed: 13
Residents interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analyst during inspection |
| Bethany Mirlohi | Licensing Program Analyst | Conducted complaint investigation |
| Troy Ordonez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 142
Deficiencies: 0
Aug 13, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-06-12 regarding failure to ensure care, overmedication of a resident, and unqualified staff performing registered nurse tasks.
Findings
The Licensing Program Analyst investigated the allegations by interviewing staff, residents, and family members, and reviewing documentation. All allegations were found to be unfounded based on the evidence gathered, including staff and family statements and medication records.
Complaint Details
The complaint investigation addressed three allegations: 1) Facility failed to ensure care to resident, 2) Staff overly medicated resident, and 3) Staff is not qualified to conduct registered nurses' tasks. All allegations were found to be unfounded.
Report Facts
Number of staff interviewed: 13
Number of residents interviewed: 5
Facility capacity: 142
Facility census: 84
Number of staff interviewed: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Haley Thomas | Administrator | Met with Licensing Program Analyst during inspection |
| Troy Ordonez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 85
Capacity: 142
Deficiencies: 0
May 15, 2024
Visit Reason
The inspection was an unannounced case management visit to discuss an incident report received from the facility.
Findings
The facility appeared to have followed proper protocol and regulation regarding the incident. No deficiencies were cited during the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analyst during inspection and discussed incident report. |
| Bethany Mirlohi | Licensing Program Analyst | Conducted the unannounced case management visit and interview. |
Inspection Report
Annual Inspection
Census: 83
Capacity: 142
Deficiencies: 1
Jan 25, 2024
Visit Reason
The inspection visit was an unannounced continuation of the annual case management inspection to ensure the health and safety of residents in care.
Findings
The Licensing Program Analyst toured multiple areas of the facility and found no immediate health, safety, or personal rights violations. However, deficiencies were cited related to criminal record clearance for staff.
Deficiencies (1)
| Description |
|---|
| Based on record review, the licensee did not comply with criminal record clearance requirements for 1 out of 10 persons, posing a potential health, safety, or personal rights risk to persons in care. |
Report Facts
Deficiencies cited: 1
Plan of Correction Due Date: Feb 1, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analyst during inspection and agreed to plan of correction |
| Bethany Mirlohi | Licensing Program Analyst | Conducted the inspection and authored the report |
| Troy Ordonez | Licensing Program Manager | Named as supervisor and licensing program manager |
Inspection Report
Annual Inspection
Census: 83
Capacity: 142
Deficiencies: 1
Jan 24, 2024
Visit Reason
The inspection was an unannounced annual inspection conducted by the Licensing Program Analyst to evaluate compliance with regulatory requirements.
Findings
The Licensing Program Analyst reviewed resident and staff files, noting that staff training was completed and liability insurance was current. However, not all care staff had updated CPR and first aid certificates. The inspection was not completed due to time constraints and will be continued at a later date.
Deficiencies (1)
| Description |
|---|
| Not all care staff had updated CPR and first aid certificates |
Report Facts
Resident hospice care count: 6
Resident files reviewed: 10
Staff files reviewed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analyst during inspection |
| Bethany Mirlohi | Licensing Program Analyst | Conducted the annual inspection |
| Troy Ordonez | Licensing Program Manager | Named in report header |
Inspection Report
Census: 86
Capacity: 142
Deficiencies: 0
Oct 16, 2023
Visit Reason
An unannounced case management visit was conducted to confirm orders for immediate exclusion of an individual from all facilities.
Findings
The facility was informed that an individual (S1) is immediately excluded effective 10/16/2023 and cannot work, live in, or have contact with clients in any residential facility licensed by the California Department of Social Services. The facility was ordered to remove S1 from any contact with clients and not allow physical presence in the facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analysts during the visit and acknowledged the immediate exclusion order. |
Inspection Report
Census: 86
Capacity: 142
Deficiencies: 0
Oct 16, 2023
Visit Reason
An unannounced case management visit was conducted in response to a death report submitted by the facility on 2023-10-08.
Findings
The Licensing Program Analysts met with the facility administrator, reviewed the resident's file, and determined that further investigation by the Community Care Licensing Division is required. No deficiencies were cited during this visit.
Report Facts
Capacity: 142
Census: 86
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Haley Thomas | Administrator | Met with Licensing Program Analysts during the visit |
| Kerry Hiratsuka | Licensing Program Analyst | Conducted the unannounced case management visit |
| Lavinia Muscan | Licensing Program Analyst | Conducted the unannounced case management visit |
| Troy Ordonez | Licensing Program Manager | Named in the report |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 142
Deficiencies: 0
Jul 26, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff were not ensuring a healthful environment for residents in care.
Findings
The Licensing Program Analyst conducted a facility tour and observed that resident common areas and staff areas were clean and free from odor. The allegation was found to be unfounded based on observations and information gathered.
Complaint Details
The complaint was investigated and found to be unfounded.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and facility tour. |
| Jessica Pryor | Administrator | Met with the Licensing Program Analyst during the inspection. |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 142
Deficiencies: 0
Jun 29, 2023
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by a complaint received on 2023-06-06 regarding the facility's failure to provide requested records to a resident's responsible party.
Findings
The Licensing Program Analyst investigated the complaint by interviewing the administrator and relevant party. It was found that the requested documents were delayed but eventually released, leading to the allegation being unsubstantiated.
Complaint Details
The complaint alleged that the facility did not provide requested records to the resident's responsible party. The allegation was found to be unsubstantiated after investigation.
Report Facts
Complaint Control Number: 59
Capacity: 142
Census: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Antonette Edwards | Administrator | Met with Licensing Program Analyst during inspection and provided information regarding document release |
| Troy Ordonez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 101
Capacity: 142
Deficiencies: 2
Jun 7, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to allegations received on 2023-03-06 regarding improper administration of injections and glucose testing, untimely response to residents' needs, and mishandling of medications.
Findings
The investigation substantiated allegations that injections and glucose testing were not administered by appropriately skilled professionals and that the facility was not responding timely to residents' needs, posing health and safety risks. The allegation of mishandling medications was found unsubstantiated due to lack of sufficient evidence.
Complaint Details
The complaint investigation was substantiated for allegations that injections and glucose testing were not administered by appropriately skilled professionals and that the facility was not responding timely to residents' needs. The allegation of mishandling medications was unsubstantiated due to insufficient evidence.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Licensee did not provide an appropriately skilled professional for R1's injections, posing an immediate health and safety risk. | Type A |
| Facility personnel were insufficient in numbers and not competent to meet resident needs, posing a potential health and safety risk. | Type B |
Report Facts
Capacity: 142
Census: 101
Deficiency due date: Jun 12, 2023
Deficiency due date: Jun 19, 2023
Staff response wait times (minutes): 40
Staff response wait times (minutes): 35
Staff response wait times (minutes): 33
Staff response wait times (minutes): 29
Staff response wait times (minutes): 26
Staff response wait times (minutes): 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Troy Ordonez | Licensing Program Manager | Oversaw the complaint investigation |
| Lisa Velasco | Health Services Director | Met with Licensing Program Analyst during inspection |
| Antonette Edwards | Administrator | Facility administrator mentioned in relation to medication mishandling allegation |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 142
Deficiencies: 0
Apr 19, 2023
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 2023-02-06 alleging that the facility does not have sufficient staff to meet the needs of the residents in care.
Findings
The investigation determined that the allegations regarding insufficient staffing were made prior to the licensure of the facility and do not apply to the current licensee. Therefore, the complaint was found to be unfounded.
Complaint Details
The complaint alleged insufficient staffing to meet resident needs. The complaint was investigated and found to be unfounded as the allegations predated the current licensee.
Report Facts
Facility capacity: 142
Census: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Antonette Edwards | Administrator | Met with Licensing Program Analyst during the visit |
| Troy Ordonez | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 142
Deficiencies: 0
Apr 19, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of staff financially abusing a resident.
Findings
The investigation determined that the alleged financial abuse occurred prior to the licensure of the facility and does not apply to the current licensee. Therefore, the complaint was found to be unfounded.
Complaint Details
The complaint alleged staff were financially abusing a resident. The complaint was investigated and found to be unfounded as the allegations predated the current licensee.
Report Facts
Capacity: 142
Census: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bethany Mirlohi | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Antonette Edwards | Administrator | Met with Licensing Program Analyst during the visit and acknowledged receipt of the report |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 142
Deficiencies: 0
Apr 19, 2023
Visit Reason
The visit was an unannounced collateral inspection related to allegations on a different facility license regarding complaint #59-AS-20230412130752. The allegation was not directed to this current facility.
Findings
No deficiencies were found during the inspection.
Complaint Details
The visit was related to allegations on a different facility license; no deficiencies or substantiated issues were found at this facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Antonette Edwards | Administrator | Met with Licensing Program Analyst during the inspection visit. |
Inspection Report
Original Licensing
Census: 103
Capacity: 142
Deficiencies: 0
Dec 9, 2022
Visit Reason
The visit was a pre-licensing inspection conducted to evaluate the facility's compliance using the Pre-licensing CARES Tool.
Findings
The facility was found to be in compliance with regulations, very clean, nicely furnished, and everything was in good condition. No deficiencies were noted during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Antonette Edwards | Executive Director | Met with Licensing Program Analyst during the pre-licensing visit. |
| Gabriel Morton | Maintenance Director | Participated in the facility tour during the pre-licensing visit. |
Inspection Report
Capacity: 142
Deficiencies: 0
Nov 28, 2022
Visit Reason
The visit was an office type evaluation related to a Change of Ownership (CHOW) application, including a Component II telephone call to verify the applicant/administrator's understanding of Title 22 regulations and facility operation.
Findings
The applicant/administrator successfully completed Component II via telephone call, confirming understanding of facility operation, staff qualifications, program policies, and application document review including criminal record clearance and other licensing requirements.
Report Facts
Capacity: 142
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Antonette Edwards | Administrator | Participant in COMP II telephone call and facility administrator |
| Mirella Quaranta | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Stefania Fonteno | Licensing Program Analyst | Named as Licensing Program Analyst on the report |
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