Inspection Report Summary
Most inspections found no deficiencies, including the two most recent visits on October 20 and October 30, 2025, which were both clean but incomplete due to time constraints. Earlier reports showed some substantiated complaints related to housekeeping shortages causing odors in resident rooms in early 2024 and issues with food quality in February 2025. There were also isolated medication administration errors in 2021 and 2023, and a serious incident in late 2022 involving lack of supervision that led to resident injury. Several complaint investigations, including those concerning medication and alleged neglect, were unsubstantiated. The facility appears to have addressed prior deficiencies, with the most recent inspections showing no new issues.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 98
Capacity: 165
Deficiencies: 0
Oct 30, 2025
Visit Reason
An unannounced case management visit was conducted to continue the annual inspection started on 10/20/2025.
Findings
During the visit, residents were observed, facility records reviewed, and the facility toured. Due to time constraints, the annual inspection could not be completed and a return visit is needed. No deficiencies were cited on this date.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristel Johnson | Executive Director | Met during the visit and participated in the exit interview. |
| Rebecca Borunda | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Nishimwe Valentin | Business Office Manager | Present during the visit when the Licensing Program Analyst explained the purpose. |
Inspection Report
Annual Inspection
Census: 107
Capacity: 165
Deficiencies: 0
Oct 20, 2025
Visit Reason
The inspection was an unannounced Required 1-Year visit conducted to evaluate the facility's compliance with licensing requirements.
Findings
During the visit, residents were observed and facility records reviewed. Due to time constraints, the annual inspection was not completed and a return visit is needed. No deficiencies were cited on the date of the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristel Angela Johnson | Executive Director | Met with Licensing Program Analyst during the inspection and participated in the exit interview. |
| Rebecca A Borunda | Licensing Program Analyst | Conducted the unannounced Required 1-Year visit. |
Inspection Report
Follow-Up
Census: 111
Capacity: 165
Deficiencies: 0
May 22, 2025
Visit Reason
An unannounced case management visit was conducted to follow up regarding an incident report involving a resident found unresponsive and pronounced dead.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst observed residents and reviewed facility records, requesting a copy of the resident's death certificate for further investigation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristel Johnson | Executive Director | Met with during the visit and named in the incident report follow-up. |
| Rebecca Borunda | Licensing Program Analyst | Conducted the unannounced case management visit. |
Inspection Report
Complaint Investigation
Census: 110
Capacity: 165
Deficiencies: 2
Feb 27, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not ensure that residents' rooms were kept clean and free from odors.
Findings
The investigation found that during April and May 2024, the facility experienced a housekeeping staff shortage resulting in missed and incomplete housekeeping services, causing some residents' rooms to be unclean and have odors from soiled incontinence briefs. These allegations were substantiated based on interviews, records review, and observations.
Complaint Details
The complaint was substantiated. The investigation confirmed that housekeeping services were missed or incomplete due to staffing shortages in April and May 2024, and that odors from soiled incontinence briefs were present in residents' rooms, specifically Resident 1's room.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility personnel were not sufficient in numbers to provide weekly housekeeping services as required, posing a personal rights risk to all 110 residents in care. | Type B |
| The facility did not ensure that resident apartments remained free from odors caused by soiled incontinence briefs, posing a personal rights risk to all 110 residents in care. | Type B |
Report Facts
Residents in care: 110
Capacity: 165
Plan of Correction Due Date: Mar 28, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristel Johnson | Executive Director | Met during investigation and named in findings related to housekeeping and odor deficiencies |
| Rebecca A Borunda | Licensing Program Analyst | Conducted the complaint investigation |
| Jennifer Lott | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 111
Capacity: 165
Deficiencies: 0
Feb 25, 2025
Visit Reason
The visit was an announced case management visit initiated by the licensee to provide guidance and consultation regarding facility documentation, reporting requirements, staffing, and eviction procedures.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst provided consultation and guidance to the Executive Director.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristel Johnson | Executive Director | Met with during the visit and provided guidance and consultation. |
| Rebecca Borunda | Licensing Program Analyst | Conducted the announced case management visit. |
| Jaqueline Banks | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Complaint Investigation
Census: 101
Capacity: 165
Deficiencies: 1
Feb 20, 2025
Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff did not provide food of good quality, including reports of food being cold, overcooked, or undercooked.
Findings
The investigation substantiated the allegation that food quality was poor, with multiple sources confirming issues such as food being cold, over seasoned, undercooked, or overcooked, making it inedible. The deficiency was cited and a plan of correction was formulated with the Executive Director.
Complaint Details
The complaint was substantiated. The allegation was that staff did not provide food of good quality, with reports of food being cold, overcooked, or undercooked. Interviews and evidence confirmed these issues.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure food provided to residents was of good quality, posing potential health, safety, and personal rights risks. | Type B |
Report Facts
Capacity: 165
Census: 101
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sabel Martinez | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Kristel Johnson | Executive Director | Facility representative involved in the investigation and plan of correction |
| Jaqueline Banks | Administrator | Named as facility administrator |
| Lizzette Tellez | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Follow-Up
Census: 101
Capacity: 165
Deficiencies: 0
Nov 14, 2024
Visit Reason
An unannounced case management visit was conducted to follow up regarding an incident report involving a resident who sustained multiple injuries after being found outside in the internal courtyard.
Findings
During the visit, a health and safety check was conducted, residents were observed, and facility records were reviewed. No deficiencies were cited on the date of the visit.
Report Facts
Time of incident: 445
Census: 101
Total capacity: 165
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met during inspection and involved in incident report follow-up |
| Rebecca Ruiz | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 165
Deficiencies: 0
Sep 16, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations including a questionable death and staff not administering medications as prescribed.
Findings
The investigation included interviews, records review, and a facility tour. The evidence did not substantiate the allegations; the resident's death was due to cerebral atherosclerosis and heart failure, and no narcotic medications were administered by staff. Narcotic counts were consistent with no discrepancies found.
Complaint Details
The complaint involved allegations of a questionable death and failure to administer medications as prescribed. The investigation found these allegations unsubstantiated based on interviews, record reviews, and medical professional input.
Report Facts
Capacity: 165
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rebecca A Ruiz | Licensing Program Analyst | Conducted the complaint investigation |
| Virginia Rodriguez | Business Office Manager | Met with investigators during the visit and participated in exit interview |
| Jennifer Lott | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 103
Capacity: 165
Deficiencies: 0
Aug 26, 2024
Visit Reason
An unannounced Case Management - Annual Continuation visit was conducted to review the facility file, inspect the premises, and assess compliance with licensing requirements.
Findings
The facility was found to be clean, safe, and in good repair with no pathway obstructions. Resident and staff records were complete and up to date. No deficiencies were cited during the inspection.
Report Facts
Water temperature readings: 105.7
Water temperature readings: 108
Water temperature readings: 109.9
Water temperature readings: 114.6
Water temperature readings: 115.3
Internal temperature readings: 73
Internal temperature readings: 74
Facility refrigerator temperature: 37
Facility freezer temperature: -7
Licensed capacity: 165
Current census: 103
Waiver for hospice residents: 15
Bedridden residents capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met during inspection and responsible for facility administration |
| Rebecca Ruiz | Licensing Program Analyst | Conducted the inspection visit |
| Kristel Johnson | Resident Care Director | Explained purpose of visit to LPA |
Inspection Report
Annual Inspection
Census: 92
Capacity: 165
Deficiencies: 0
Aug 15, 2024
Visit Reason
The inspection was an unannounced Required 1-Year visit conducted to review facility records and observe residents in care.
Findings
No deficiencies were cited during the visit. Due to time constraints, the annual inspection could not be completed and a return visit is needed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met with during the inspection and participated in the exit interview. |
| Rebecca Ruiz | Licensing Program Analyst | Conducted the unannounced Required 1-Year visit. |
Inspection Report
Complaint Investigation
Census: 112
Capacity: 165
Deficiencies: 3
Dec 8, 2023
Visit Reason
The visit was conducted in response to a Report of Suspected Dependent Adult/Elder Abuse involving Resident #1 and three staff members, following a self-submitted report by the licensee.
Findings
The investigation found that staff violated Resident #1's personal rights to dignity and privacy by filming and using profanities, including a racial slur, during incontinence care. The licensee also failed to have an updated medical assessment for the resident diagnosed with dementia. Three deficiencies were cited and plans of correction were developed.
Complaint Details
The visit was complaint-related, triggered by a self-submitted SOC341 Report of Suspected Dependent Adult/Elder Abuse involving Resident #1 and three staff members. The complaint was substantiated based on evidence including a video showing inappropriate staff behavior and failure to maintain required medical assessments.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Licensee’s staff did not accord 1 of 112 residents dignity, posing an immediate personal rights risk. | Type A |
| Licensee’s staff did not uphold the personal privacy of 1 of 112 residents, posing an immediate personal rights risk. | Type A |
| Licensee did not ensure that 1 of 112 residents with dementia had a medical assessment performed within the last year, posing a potential health, safety, and personal rights risk. | Type B |
Report Facts
Deficiencies cited: 3
Resident count: 112
Total capacity: 165
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaqueline Banks | Administrator | Facility administrator involved in the investigation |
| Jiovanni Anderson-Diaz | Sales Director | Met with Licensing Program Analyst during visit |
| Fina Tuisee | Business Office Manager | Met with Licensing Program Analyst during visit and exit interview |
| Dang Nguyen | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit |
| Lizzette Tellez | Licensing Program Manager | Supervisor overseeing the investigation |
Inspection Report
Annual Inspection
Census: 113
Capacity: 165
Deficiencies: 0
Oct 25, 2023
Visit Reason
An unannounced required One-Year Inspection was conducted to ensure substantial compliance with Title 22 regulations.
Findings
The facility was found to be in substantial compliance with regulations, with operational signal systems, sanitary and equipped resident rooms, proper food storage, and sufficient staffing. Some certificates such as current First Aid and CPR could not be produced at the time of visit.
Report Facts
Approved hospice waiver: 15
Bedridden residents allowed: 6
Food supply: 2
Food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Amy Rodgers | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jiovani Anderson-Diaz | Sales Director | Facility representative who accompanied the inspection and participated in exit interview |
| Jaqueline Banks | Administrator | Facility administrator mentioned in report header |
Inspection Report
Complaint Investigation
Census: 108
Capacity: 165
Deficiencies: 1
Jun 16, 2023
Visit Reason
The visit was conducted in response to an LIC624 Incident Report regarding medication errors by a staff member that led to a resident receiving an extra dose of medication beyond the prescribed amount during 05/01/2023 through 05/12/2023.
Findings
The investigation found that the medication errors caused increased sleepiness and decreased appetite for the resident but did not result in serious injury or hospitalization. One deficiency was cited for failure to assist the resident with self-administered medications as needed, and one technical violation regarding reporting requirements was identified. A Plan of Correction was developed with the licensee.
Complaint Details
The complaint was substantiated as medication errors were confirmed. The licensee timely notified the resident's physician and responsible person, increased observation, and removed the staff member from medication duties. The staff member later resigned.
Deficiencies (1)
| Description |
|---|
| The licensee's staff did not assist one resident with self-administered medications as needed, posing a potential health risk. |
Report Facts
Medication errors: 12
Deficiencies cited: 1
Technical violations: 1
Plan of Correction due date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met during visit and participated in exit interview |
| Dang Nguyen | Licensing Program Analyst | Conducted the inspection and authored the report |
| Lizzette Tellez | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 108
Capacity: 165
Deficiencies: 0
Jun 13, 2023
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that staff did not administer medications as prescribed.
Findings
The investigation included interviews, records review, and facility tour. It was found that the allegation was unsubstantiated as the facility staff followed prescribing orders, made multiple attempts to obtain physician discontinuation orders, and explained residents' rights to refuse medications.
Complaint Details
The complaint alleged that staff did not administer medications as prescribed. The allegation was investigated and deemed unsubstantiated based on interviews and records review.
Report Facts
Capacity: 165
Census: 108
Estimated Days of Completion: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rebecca A Ruiz | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jackie Banks | Executive Director | Facility representative met during the investigation and exit interview |
| Jennifer Gephart | Resident Services Director | Interviewed during the investigation regarding medication administration |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 165
Deficiencies: 0
Dec 8, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 04/29/2022 regarding staff neglect resulting in malnourishment, pressure injuries, inadequate incontinence care, facility odor issues, unclean resident rooms, carpet disrepair, and vermin presence.
Findings
The investigation found that the resident (R1) was under hospice care addressing malnutrition and pressure injuries, with care provided by both hospice and facility staff. Observations and interviews revealed no evidence supporting neglect allegations related to incontinence care, odors, cleanliness, carpet condition, or vermin. The allegations were determined to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included neglect causing malnourishment and pressure injuries, failure to assist with incontinence, failure to maintain odor-free environment, failure to clean resident rooms, carpet disrepair, and vermin presence. The investigation included record reviews, interviews, and facility visits, concluding insufficient evidence to support the allegations.
Report Facts
Complaint Control Number: 08-AS-20220429135000
Facility Capacity: 165
Census: 102
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daniel Pena | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Jennifer Gephart | Resident Services Director | Met with Licensing Program Analyst during investigation and exit interview |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 165
Deficiencies: 1
Nov 28, 2022
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that lack of supervision resulted in serious injury to a resident.
Findings
The investigation found that staff member S1 abandoned their post, leaving Resident 1 unsupervised, which resulted in a serious injury (nasal bone fracture). The allegation was substantiated and a deficiency was cited for failure to provide adequate supervision.
Complaint Details
The complaint alleged that lack of supervision resulted in serious injury to a resident. The investigation included facility visits, record reviews, and interviews. The allegation was substantiated based on sufficient evidence.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide supervision as defined in Section 87101 (c)(3) for 1 of 104 persons in care. | Type A |
Report Facts
Civil penalty: 500
Resident count: 113
Licensed capacity: 165
Persons in care affected: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daniel Pena | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Jenifer Gephart | Resident Services Director | Met with Licensing Program Analyst during investigation and received report. |
| Jaqueline Banks | Administrator | Facility administrator named in the report. |
Inspection Report
Annual Inspection
Census: 104
Capacity: 165
Deficiencies: 0
Oct 11, 2022
Visit Reason
The inspection was an unannounced required 1-year visit to evaluate the facility's compliance with licensing regulations and infection control measures.
Findings
No deficiencies were cited or observed during the visit. The Licensing Program Analyst provided technical assistance and evaluated the facility's COVID-19 Mitigation Plan including disinfection, testing, vaccination, screening protocols, and PPE use.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met with Licensing Program Analyst during the inspection and participated in the exit interview. |
| Rebecca Ruiz | Licensing Program Analyst | Conducted the unannounced required 1-year visit and evaluation. |
| Lizzette Tellez | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Census: 104
Capacity: 165
Deficiencies: 0
Oct 11, 2022
Visit Reason
The visit was an unannounced Case Management - Incident visit conducted following receipt of an incident report regarding a resident's suicidal ideations and hospital transport on 9/24/2022.
Findings
No deficiencies were observed or cited during the visit. The Licensing Program Analyst toured the facility, interviewed residents and staff, and reviewed facility documents.
Report Facts
Incident date: Sep 24, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Executive Director | Met with Licensing Program Analyst during the visit and involved in incident report |
| Rebecca Ruiz | Licensing Program Analyst | Conducted the unannounced Case Management Visit |
Inspection Report
Census: 94
Capacity: 165
Deficiencies: 0
May 12, 2022
Visit Reason
An unannounced case management visit was conducted to deliver an amended complaint investigation report for a prior visit conducted on 2022-05-04.
Findings
During the visit, the Licensing Program Analyst obtained the signature of the Resident Services Director on the amended complaint investigation report and provided a copy of the report and Licensee's Rights to the facility representative.
Complaint Details
The visit was related to an amended complaint investigation report (LIC 9099).
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Gephart | Resident Services Director | Met during the visit and signed the amended complaint investigation report. |
| Rebecca A Ruiz | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Lizzette Tellez | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 106
Capacity: 165
Deficiencies: 0
Sep 17, 2021
Visit Reason
An unannounced annual required licensing inspection was conducted to verify compliance with statutes, regulations, and other requirements relevant to protecting the health of residents and staff, including infection control practices.
Findings
No deficiencies were observed during the inspection. The facility was found to be in compliance with infection control practices, including COVID-19 mitigation strategies such as symptom screening, visitor policies, PPE availability, and physical distancing.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| Kristina Ryan | Licensing Program Analyst | Conducted the unannounced annual licensing inspection. |
| Simon Jacob | Licensing Program Manager | Named in report as Licensing Program Manager. |
Inspection Report
Census: 109
Capacity: 165
Deficiencies: 0
Aug 13, 2021
Visit Reason
An announced case management visit was conducted to perform a health and safety check and review COVID-19 mitigation strategies via a virtual FaceTime visit due to COVID-19 restrictions.
Findings
During the visit, the Licensing Program Analyst toured the facility and interviewed the Administrator. No deficiencies were issued during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jackie Banks | Administrator | Met with Licensing Program Analyst during the visit |
| Kristina Ryan | Licensing Program Analyst | Conducted the announced case management visit |
Inspection Report
Complaint Investigation
Census: 112
Capacity: 165
Deficiencies: 1
Jun 17, 2021
Visit Reason
An unannounced complaint investigation was conducted regarding allegations that staff failed to administer medications as prescribed to a resident.
Findings
The investigation substantiated that facility staff did not administer medications as prescribed to one resident, resulting in five medications being given incorrectly. The resident was taken to urgent care but did not suffer health ramifications from the error.
Complaint Details
The complaint was substantiated based on a preponderance of evidence. The facility self-reported the medication error involving Resident 1, and the investigation confirmed the failure to administer medications as prescribed.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility staff did not administer medications as prescribed for 1 out of 112 residents, posing a potential health risk. | Type B |
Report Facts
Residents present during inspection: 112
Total licensed capacity: 165
Medications administered incorrectly: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristina Ryan | Licensing Program Analyst | Conducted the complaint investigation |
| Simon Jacob | Licensing Program Manager | Conducted the complaint investigation |
| Jackie Banks | Executive Director | Met with investigators and received report |
| Jonetta Eads | Administrator | Named in investigation and received report |
Inspection Report
Capacity: 165
Deficiencies: 0
May 19, 2021
Visit Reason
The visit was a case management incident initiated due to self-reported incidents involving two residents that occurred in early April 2021.
Findings
During the visit, the Licensing Program Analyst reviewed resident records, conducted interviews, and toured the facility. No deficiencies were issued during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizzette Tellez | Licensing Program Analyst | Conducted the case management visit. |
| John Rante | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Jonetta Eads | Administrator | Facility Administrator mentioned in the report. |
| Zayra Carrasco | Business Office Manager | Met with Licensing Program Analyst during the visit and discussed the purpose of the visit. |
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