Inspection Report Summary
Most inspections found deficiencies related to resident safety, care, and regulatory compliance, though several complaint investigations were unsubstantiated. The facility has faced issues including failure to seek timely medical attention resulting in serious injury and fines, medication mismanagement, delayed staff response to resident calls, and lapses in resident rights such as locking memory care residents in rooms and charging for unrendered services. Other noted problems involved environmental safety risks like mold, unlocked medications and chemicals, and incomplete resident records. The most recent report from July 14, 2025, found deficiencies including unlocked topical cream posing immediate safety risk, improper food storage, and missing updated physician reports. While some recent complaint investigations were unsubstantiated, the overall trend shows ongoing challenges with care and safety compliance over time.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
6.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
63% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
49% occupied
Based on a July 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 54
Capacity: 110
Deficiencies: 0
Date: Jul 14, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2025-06-10 regarding medication mismanagement, staff training, supervision related to a resident fall, and overnight staff presence.
Complaint Details
The complaint included allegations of staff mismanaging resident medications, improper staff training for medication administration, lack of supervision resulting in a resident fall, and failure to ensure overnight staff presence. All allegations were investigated and found unsubstantiated.
Findings
All allegations were found to be unsubstantiated after review of relevant records, staff schedules, and interviews. The investigation concluded that medication management, staff training, supervision, and overnight staffing met regulatory requirements.
Report Facts
Capacity: 110
Census: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Ann Lagasca-Cruz | Administrator | Met with Licensing Program Analysts during investigation |
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 54
Capacity: 110
Deficiencies: 3
Date: Jul 14, 2025
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements.
Findings
The facility was found to have deficiencies including unlocked topical cream posing immediate safety risk, improperly stored and labeled food posing potential health risk, and lack of updated physician reports for residents. Safety equipment and environmental conditions were generally adequate.
Deficiencies (3)
Unlocked prescription of topical cream in resident R1's room posing immediate safety risk.
Food not properly stored and labeled posing potential health and safety risk.
Facility did not have updated physician's reports for residents posing potential health and safety risk.
Report Facts
Deficiencies cited: 3
POC Due Date: Jul 15, 2025
POC Due Date: Jul 29, 2025
POC Due Date: Aug 5, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Ann Lagasca-Cruz | Executive Director | Met during inspection and named in plan of correction for locking ointment and obtaining medical assessments. |
| Patricia Manalo | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 110
Deficiencies: 0
Date: May 29, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to multiple allegations including questionable death, inadequate assistance with bathing, residents left in soiled clothing, lack of clean clothing, and failure to assist with medication refills.
Complaint Details
The complaint investigation addressed allegations of questionable death, failure to assist residents with bathing, residents left in soiled clothing, lack of clean clothing, and failure to assist with medication refills. After review of records, interviews with staff, family members, and former executive director, and examination of schedules and documentation, the allegations were found unsubstantiated.
Findings
Based on interviews, record reviews, and observations, all five allegations were closed as unsubstantiated due to insufficient evidence to prove violations occurred. No deficiencies were cited.
Report Facts
Capacity: 110
Census: 52
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Marie Lagasca-Cruz | Executive Director | Met with Licensing Program Analyst during the investigation |
| Robert B Roby | Administrator | Facility Administrator named in report header |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 110
Deficiencies: 0
Date: Apr 24, 2025
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations including unexplained bruising of a resident, residents not being provided pendants, and the facility lacking an administrator during hours of operation.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included unexplained bruising of a resident, residents not provided pendants, and lack of an administrator during operating hours. The Licensing Program Analyst reviewed medical records, facility documents, and conducted interviews with staff and residents. The evidence did not support the allegations, and the complaint was closed as unsubstantiated.
Findings
The investigation found no substantiated evidence to support the allegations. Documentation and interviews indicated no unexplained bruising, pendants were provided to residents in Assisted Living but not Memory Care as per facility policy, and the facility always had an administrator available during hours of operation. No deficiencies were cited.
Report Facts
Facility capacity: 110
Resident census: 54
Complaint control number: 15-AS-20220607084551
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
| Joyce Latimer | Administrator | Facility Administrator named in report |
| Marie Lagasca | Executive Director | Met with Licensing Program Analyst during investigation |
| Tristan Reyes | Sales Director | Met with Licensing Program Analyst during investigation |
| Popotafea Aumua | Resident Services Coordinator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 110
Deficiencies: 0
Date: Jan 16, 2025
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to multiple allegations received on 09/25/2023 regarding staff response times, food availability, resident treatment, retaliation, nutrition, staffing levels, billing, and diet adherence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included untimely staff response to call buttons, insufficient food availability, staff mistreatment and retaliation, poor nutrition causing weight loss, insufficient staffing, improper billing for services, and failure to follow diet orders. Interviews with residents, staff, and document reviews did not support these allegations.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff generally responded timely to call buttons, sufficient food was available, residents were treated with dignity, no retaliation was observed, nutritional needs were met, staffing was adequate, and residents were generally charged appropriately. The facility followed diet orders, although one resident declined the provided mechanical soft diet. No deficiencies were cited.
Report Facts
Capacity: 110
Census: 60
Complaint control number: 15-AS-20230925101546
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Marie Lagasca-Cruz | Executive Director | Met with Licensing Program Analyst during investigation |
| Robert B Roby | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 110
Deficiencies: 0
Date: Jan 9, 2025
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations that a resident sustained an unexplained medication overdose and became severely dehydrated while in care.
Complaint Details
The complaint involved two allegations: 1) Resident (R1) sustained an unexplained medication overdose, and 2) Resident (R1) became severely dehydrated while in care. The investigation included interviews with staff, family members, and the resident, as well as review of medical and facility records. The complaint was found unsubstantiated.
Findings
The investigation found that the resident was admitted to the hospital with lithium toxicity and acute kidney injury caused by poor food and fluid intake. Staff reported the resident refused to eat, drink, and take medications consistently. The facility's medication administration records were in order and medications were provided as ordered. The allegations were determined to be unsubstantiated due to lack of evidence that the facility caused the conditions.
Report Facts
Facility capacity: 110
Resident census: 59
Days resident refused food and drink: 11
Dates resident refused medications: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation |
| Marie Lagasca-Cruz | Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 110
Deficiencies: 1
Date: Jan 9, 2025
Visit Reason
The visit was an unannounced case management inspection resulting from a complaint investigated by the Department regarding failure to seek immediate medical assistance for a resident.
Complaint Details
The complaint involved failure to seek immediate medical assistance for resident R1 between 1/14/23 and 1/21/23, despite the resident's declining condition and family refusal to send the resident to the hospital. The licensee did not communicate with the resident's doctor on 1/14/23 and delayed hospital transfer until 1/21/23.
Findings
The licensee failed to seek immediate medical assistance for resident R1, who was weak and refused to eat for several days before being sent to the hospital a week later. This posed an immediate risk to the health of the person in care.
Deficiencies (1)
Failure to seek immediate medical assistance for resident (R1) which posed an immediate risk to the health risk to person in care.
Report Facts
Capacity: 110
Census: 59
Plan of Correction Due Date: Jan 10, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Ann Lagasca-Cruz | Executive Director | Met during inspection and discussed deficiency and plan of correction |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and investigation |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 110
Deficiencies: 0
Date: Dec 9, 2024
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that the facility charged a resident for services that were not provided.
Complaint Details
The complaint alleged that the facility charged a resident for services not provided. The investigation found no preponderance of evidence to prove the violation, resulting in an unsubstantiated finding.
Findings
The allegation was found to be unsubstantiated after review of billing and service records and interviews with staff. The facility dropped all disputed charges, and the responsible party does not owe the facility.
Report Facts
Capacity: 110
Census: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Marie Lagasca-Cruz | Executive Director | Met with Licensing Program Analyst during investigation |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 110
Deficiencies: 1
Date: Dec 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2024-01-24 regarding resident care issues at Pacifica Senior Living Union City.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not notify the resident's authorized person of injury. Other allegations including resident fracture, inadequate feeding, shower provision, room cleanliness, and call system accessibility were unsubstantiated. The investigation included interviews with staff and witnesses, and review of medical and facility records.
Findings
The investigation substantiated that staff failed to notify a resident's authorized person of an injury, citing a violation of Title 22 California Code of Regulations. Other allegations including resident fracture, inadequate feeding, shower provision, room cleanliness, and call system accessibility were found unsubstantiated based on interviews and record reviews.
Deficiencies (1)
Failure to notify the responsible party of a resident injury in a timely manner, posing a potential health and safety risk.
Report Facts
Capacity: 110
Census: 57
Call pendent uses: 6
Plan of Correction Due Date: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Oversaw complaint investigation |
| Marie Lagasca-Cruz | Executive Director | Facility representative met during inspection |
| Robert B Roby | Administrator | Named in relation to reporting deficiency and plan of correction |
Inspection Report
Census: 62
Capacity: 110
Deficiencies: 1
Date: Oct 21, 2024
Visit Reason
The visit was a case management inspection conducted due to a letter received from the facility regarding intent to delicense the third floor and convert units for independent individuals aged 55 and older without proper approval from Community Care Licensing.
Findings
The facility was found to have changed its plan of operation by advertising for independent renters aged 55 and older without obtaining approval from Community Care Licensing, posing a potential health, safety, or personal rights risk to assisted living residents. A deficiency was cited for this violation.
Deficiencies (1)
Changed the plan of operation without Community Care Licensing Division approval, posing potential health, safety, or personal rights risk to persons in care.
Report Facts
Capacity: 110
Census: 62
Plan of Correction Due Date: Nov 4, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marie Lagasca-Cruz | Executive Director | Interviewed during the inspection regarding the facility's plan of operation and advertising |
| Kelly Nguyen | Licensing Program Analyst | Conducted the inspection and signed the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 56
Capacity: 110
Deficiencies: 0
Date: Oct 1, 2024
Visit Reason
The visit was a case management visit conducted in connection with an incident reported by the facility involving an elopement of a resident.
Findings
The Licensing Program Analyst found no deficiencies during the visit. The incident involved a resident who walked off from his wife's apartment, which was a new behavior, and staff promptly searched and found the resident near a senior center. The care plan was updated accordingly.
Report Facts
Capacity: 110
Census: 56
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marissa Baldomero | Resident Services Director | Met with Licensing Program Analyst during the visit |
| Kelly Nguyen | Licensing Program Analyst | Conducted the case management visit |
| Robert B Roby | Administrator/Director | Facility Administrator named in the report header |
Inspection Report
Census: 56
Capacity: 110
Deficiencies: 0
Date: Oct 1, 2024
Visit Reason
The visit was a case management visit related to a 30-day termination notice for resident R1 due to nonpayment of fees.
Findings
No deficiencies were noted during the visit. The facility is in the process of eviction for R1, who owes $7,321.67 and is awaiting a judge's decision.
Report Facts
Outstanding amount owed: 7321.67
Termination notice effective date: Jun 14, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marissa Baldomero | Resident Services Director | Met during the visit and provided information about the resident's termination notice |
| Kelly Nguyen | Licensing Program Analyst | Conducted the case management visit |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 110
Deficiencies: 1
Date: Aug 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to a complaint received on 2023-06-13 alleging that staff were charging a resident for services not rendered.
Complaint Details
The complaint was substantiated based on evidence that resident R1 was charged for level three care after an assessment indicated level one care. The allegation regarding failure to provide a copy of the admissions agreement was unsubstantiated.
Findings
The investigation substantiated the allegation that the facility charged resident R1 for a higher level of care than was assessed, constituting a potential personal rights violation. Another allegation regarding failure to provide a copy of the admissions agreement was unsubstantiated.
Deficiencies (1)
Facility charged resident R1 for services not rendered, violating personal rights of residents in privately operated facilities.
Report Facts
Capacity: 110
Census: 62
Deficiency Type: 1
Plan of Correction Due Date: Sep 6, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Marissa Baldeomero | Memory Care Director | Met with Licensing Program Analyst during investigation |
| Mandy Taylor | Administrator | Facility administrator named in the report |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 110
Deficiencies: 0
Date: Jul 31, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation of sexual abuse received on 07/26/2024.
Complaint Details
The complaint alleged sexual abuse. The resident interviewed did not recall the event and staff noted the resident's declining memory and possible hallucinations. The allegation was determined to be unsubstantiated.
Findings
The investigation included interviews with staff and a resident, and review of relevant records. The allegation of sexual abuse was found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 110
Census: 60
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Jeralyn May | Interim Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 58
Capacity: 110
Deficiencies: 1
Date: Jul 25, 2024
Visit Reason
The inspection visit occurred as a one annual inspection to evaluate compliance with regulations at the facility.
Findings
The inspection found that residents in the memory care unit were being locked inside their rooms during breakfast, which is a violation of residents' personal rights under California Code of Regulations, Title 22.
Deficiencies (1)
Licensee did not comply with the requirement that residents shall not be locked into any room, building, or on facility premises by day or night, specifically locking residents inside their rooms in the memory care unit.
Report Facts
Capacity: 110
Census: 58
Plan of Correction Due Date: Jul 26, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the inspection and signed the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
| Jeralyn May | Administrator | Facility administrator met during inspection |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 110
Deficiencies: 1
Date: Jul 25, 2024
Visit Reason
The visit was a case management inspection conducted in connection with an incident reported by the facility involving a resident elopement due to a gate that was supposed to be locked but was not.
Complaint Details
The visit was triggered by a complaint or incident report regarding a resident elopement caused by an unlocked gate that staff failed to monitor properly.
Findings
The inspection found deficiencies related to failure to have an auditory device or staff alert feature to monitor exits, which led to a resident elopement when staff did not notice the resident had exited through an unlocked gate.
Deficiencies (1)
Failure to have an auditory device or other staff alert feature to monitor exits, leading to a resident elopement when the gate was not locked and staff did not notice the resident had exited.
Report Facts
Capacity: 110
Census: 58
Plan of Correction Due Date: Aug 8, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jeralyn May | Administrator | Met with Licensing Program Analyst during the inspection and involved in the incident discussion |
| Kelly Nguyen | Licensing Program Analyst | Conducted the case management visit and evaluation |
| Bennett Fong | Licensing Program Manager / Supervisor | Named as Licensing Program Manager and Supervisor in the report |
Inspection Report
Annual Inspection
Census: 58
Capacity: 110
Deficiencies: 1
Date: Jul 25, 2024
Visit Reason
An unannounced annual 1-year required inspection was conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The facility was generally compliant with safety and sanitation standards, including fire clearance, temperature control, and hygiene supplies. However, a deficiency was cited because 5 out of 5 staff members did not have current First Aid or CPR training on file.
Deficiencies (1)
5 out of 5 staff did not have First Aid nor CPR training on file, posing a potential health, safety, or personal rights risk to persons in care.
Report Facts
Staff without First Aid or CPR: 5
Total apartments: 74
Fire clearance capacity: 100
Plan of Correction due date: Aug 1, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Nguyen | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
| Jeralyn May | Administrator | Facility administrator met during inspection |
Inspection Report
Census: 63
Capacity: 110
Deficiencies: 0
Date: Jun 17, 2024
Visit Reason
An unannounced case management visit was conducted to serve an immediate exclusion order to staff member S1.
Findings
The Executive Director confirmed that staff S1 had not been at the facility since May 16, 2024, and was terminated from the facility. The immediate exclusion order was served and explained to the Executive Director.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rob Roby | Executive Director | Spoke with Licensing Program Analyst regarding immediate exclusion order for staff S1. |
| Kelly Nguyen | Licensing Program Analyst | Conducted the unannounced case management visit and served the immediate exclusion order. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 66
Capacity: 110
Deficiencies: 2
Date: Jan 27, 2024
Visit Reason
An unannounced annual 1-year required inspection was conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The inspection found the facility generally compliant with safety and sanitation standards, including adequate lighting, temperature, and fire safety equipment. However, deficiencies were noted regarding unlocked cleaning supplies accessible to residents and inaccessible staff personnel files.
Deficiencies (2)
Unlocked disinfectants and cleaning solutions accessible in the laundry room, posing an immediate health and safety risk.
Staff personnel files were not assessable during the inspection.
Report Facts
Resident records reviewed: 8
Facility apartments: 74
Fire sprinkler last serviced: Nov 1, 2023
Fire extinguisher last serviced: Dec 6, 2023
Fire drill last conducted: Jan 1, 2024
Hot water temperature: 119.2
Food supply duration: 7
Food supply duration: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Administrator | Met with Licensing Program Analyst during inspection; named in plan of correction for deficiencies. |
| Carol Fowler | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 110
Deficiencies: 1
Date: Dec 11, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to allegations received on 2023-10-02 regarding mold presence and staff not providing a safe and comfortable environment at Pacifica Senior Living Union City.
Complaint Details
The complaint investigation was triggered by allegations received on 2023-10-02. One allegation regarding mold presence was substantiated, while the allegation that staff did not provide a safe and comfortable environment was unsubstantiated.
Findings
The allegation that staff did not provide a safe and comfortable environment was found to be unsubstantiated based on observations and interviews with residents and staff. The allegation of mold presence was substantiated, with evidence of mold found in various resident apartments, posing a health and safety risk. The facility was cited for violation of CCR 87303(a) related to maintenance and operation.
Deficiencies (1)
Facility has mold in various resident apartments which poses an immediate/potential Health, Safety or Personal Rights risk to persons in care.
Report Facts
Capacity: 110
Census: 64
Plan of Correction Due Date: Dec 20, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during investigation and named in findings |
| Paris Watson | Licensing Program Analyst | Conducted the complaint investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 63
Capacity: 110
Deficiencies: 0
Date: Dec 6, 2023
Visit Reason
The visit was a case management visit conducted in connection with an incident reported by the facility.
Findings
No deficiency was noted during the visit. The Licensing Program Analyst reviewed Resident 1's medical and service records and interviewed staff and the resident.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during the visit. |
| Luisa Fontanilla | Licensing Program Analyst | Conducted the case management visit. |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 110
Deficiencies: 2
Date: Nov 28, 2023
Visit Reason
The inspection was conducted unannounced on November 28, 2023, as a result of the Department receiving a priority 1 complaint (Complaint # 15-AS-20231122143232).
Complaint Details
The visit was triggered by a priority 1 complaint (Complaint # 15-AS-20231122143232).
Findings
The Licensing Program Analyst toured the facility and reviewed resident records, finding that the licensee failed to submit required Death and Unusual Incident Reports within seven days, posing potential personal rights risks to residents. Deficiencies were cited under Title 22 California Code of Regulations.
Deficiencies (2)
Failure to submit the death report within 7 days as required by reporting regulations.
Failure to submit an incident report within 7 days as required by reporting regulations.
Report Facts
Deficiencies cited: 2
Plan of Correction Due Date: Dec 12, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during inspection. |
| Shenina Robinson-Mason | Assisted Living Director | Met with Licensing Program Analyst during inspection. |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 110
Deficiencies: 1
Date: Nov 28, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-11-22 regarding the facility staff not ensuring that resident files were up to date.
Complaint Details
The complaint was substantiated. It was alleged that facility staff did not ensure the resident file was up to date, specifically that the emergency binder contained blank pages and lacked accurate resident information for first responders.
Findings
The investigation found that 3 out of 4 residents reviewed did not have records in the emergency binder, confirming that the facility staff did not maintain complete and current resident records as required. The allegation was substantiated and a deficiency was cited.
Deficiencies (1)
Failure to maintain a separate, complete, and current record for each resident in the emergency binder, with 3 out of 4 residents missing records.
Report Facts
Residents missing records in emergency binder: 3
Facility capacity: 110
Facility census: 64
Plan of Correction due date: Dec 12, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during the investigation and discussed findings and plan of correction. |
| Shenina Robinson-Mason | Assisted Living Director | Met with Licensing Program Analyst during the investigation. |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 110
Deficiencies: 1
Date: Oct 23, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff consumed alcohol while on duty at Pacifica Senior Living Union City.
Complaint Details
The complaint was substantiated. The allegation was that staff consumed alcohol while on duty, resulting in inadequate care to residents. The investigation confirmed the incident occurred, and a deficiency was cited.
Findings
The allegation that staff consumed alcohol while on duty was substantiated based on evidence obtained during the investigation. A deficiency was cited for failure to provide care and supervision meeting residents' needs due to staff alcohol consumption. The facility terminated the involved staff and planned in-service training.
Deficiencies (1)
Staff consumed alcohol while in the facility, posing potential safety and personal rights risks to residents, violating Title 22 California Code of Regulations Section 87468.2(a)(4).
Report Facts
Capacity: 110
Census: 68
Deficiency Type: 1
Plan of Correction Due Date: Nov 6, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during investigation and discussed findings |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 110
Deficiencies: 2
Date: Oct 4, 2023
Visit Reason
The inspection visit was an unannounced case management visit conducted during a complaint investigation (#15-AS-20230925101546).
Complaint Details
The visit was conducted while investigating complaint #15-AS-20230925101546.
Findings
Two deficiencies were observed: chemicals for floor repairs were stored in the kitchen area, and a tray of bacon was stored uncovered in the walk-in refrigerator along with other loosely covered containers. These deficiencies posed immediate and potential health and safety risks to persons in care.
Deficiencies (2)
Chemicals for floor repairs were stored in the kitchen area, posing an immediate health and safety risk.
Readily perishable foods, including a tray of bacon, were stored without covered containers, posing a potential health and safety risk.
Report Facts
Capacity: 110
Census: 66
Plan of Correction Due Date: 10
Plan of Correction Due Date: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Executive Director | Met with Licensing Program Analyst during the inspection. |
| Grace Luk | Licensing Program Analyst | Conducted the inspection and documented findings. |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 110
Deficiencies: 0
Date: Jul 20, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate an allegation that staff did not safeguard a resident's personal belongings.
Complaint Details
The complaint alleged that staff did not safeguard a resident's personal belongings, specifically broken eyeglasses. The facility was found not responsible for the damage based on record review and interviews.
Findings
The investigation found that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, resulting in the allegation being unsubstantiated.
Report Facts
Refund amount: 2872.58
Invoice amount: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report signature |
| Robert Roby | Executive Director | Met with Licensing Program Analyst during investigation |
| Mandy Taylor | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 110
Deficiencies: 1
Date: Jul 19, 2023
Visit Reason
The visit was a case management inspection conducted in connection with complaint 15-AS-20220526161218 regarding an elopement incident.
Complaint Details
The visit was triggered by complaint 15-AS-20220526161218. The deficiency was substantiated as the facility failed to report the elopement incident to CCL.
Findings
During the investigation, it was found that a resident with dementia wandered out of the facility on May 23, 2022, and the incident was not reported to the Community Care Licensing (CCL), resulting in a cited deficiency.
Deficiencies (1)
Failure to report an elopement incident of a resident with dementia who wandered out of the facility on 5/23/2022 to the licensing agency as required by Title 22 California Code of Regulations Sec 87211.
Report Facts
Census: 58
Total Capacity: 110
Deficiency Type: 1
Plan of Correction Due Date: Jul 24, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted the case management visit and investigation |
| Yvonne Flores-Larios | Licensing Program Manager | Supervisor and Licensing Program Manager named in the report |
| Mandy Taylor | Administrator | Facility Administrator mentioned in the report |
| Marissa Baldomero | Person met with during the visit |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 110
Deficiencies: 2
Date: Jul 19, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2022-05-26 regarding staff not preventing a resident from wandering away and mismanaging resident's medication, as well as other allegations related to laundry needs and pests.
Complaint Details
The complaint investigation was substantiated based on evidence that Resident 1 (R1) wandered away from the facility on 2022-05-23 despite having dementia and documented wandering behavior, and that medication administration records showed incomplete administration of Donepezil in May 2022. Other allegations about laundry needs and pests were unsubstantiated.
Findings
The investigation substantiated that a resident with dementia wandered away from the facility unassisted and that staff mismanaged the resident's medication by not administering it as prescribed. Other allegations regarding unmet laundry needs and pests in resident rooms were found to be unsubstantiated based on interviews and observations.
Deficiencies (2)
Residents of residential care facilities for the elderly shall be free from neglect, including wandering away unassisted.
Failure to assist residents with self-administered medications as needed.
Report Facts
Capacity: 110
Census: 58
Medication administration days: 9
Medication scheduled days: 14
Distance wandered: 4.4
Walking time: 96
Plan of Correction due dates: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Yvonne Flores-Larios | Licensing Program Manager | Oversaw the complaint investigation |
| Marissa Baldomero | Memory Care Director | Interviewed during investigation and involved in exit interview |
| Robert Roby | Interviewed regarding pest control allegations |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 110
Deficiencies: 1
Date: May 4, 2023
Visit Reason
An unannounced Case Management visit was conducted to follow up on a substantiated complaint investigation regarding the facility's failure to seek timely medical attention for a resident, which resulted in amputation of the resident's right pinky toe.
Complaint Details
The complaint investigation was substantiated. The facility was cited for violating CCR Title 22, § 87465(a)(1) related to Incidental Medical and Dental Care. An immediate civil penalty of $500 was previously issued, and an additional civil penalty of $9,500 was assessed for serious bodily injury.
Findings
The investigation confirmed that the facility staff failed to obtain timely medical attention for the resident, causing serious bodily injury requiring hospitalization and surgery. A civil penalty of $9,500 was issued for this serious bodily injury violation.
Deficiencies (1)
Failure to seek timely medical attention for resident's right pinky toe resulting in amputation.
Report Facts
Civil penalty amount: 9500
Immediate civil penalty amount: 500
Facility capacity: 110
Census: 62
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted the unannounced Case Management visit and authored the report. |
| Yvonne Flores-Larios | Licensing Program Manager | Named in the report as Licensing Program Manager overseeing the investigation. |
| Robert Roby | Facility representative met during the visit and signed receipt of appeal rights. |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 110
Deficiencies: 1
Date: May 4, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 2023-02-24 alleging that a resident developed an open sore while in care.
Complaint Details
The complaint alleging that a resident developed an open sore while in care was substantiated based on the preponderance of evidence standard.
Findings
Investigation found that Resident 1 developed Stage 2 pressure injuries on the left posterior thigh and a Stage 1 pressure injury on the coccyx. The allegation was substantiated based on records review and interviews. A home health agency was contacted to provide wound treatment.
Deficiencies (1)
Failure to provide care, supervision, and services that meet individual needs, resulting in Resident 1 developing Stage 2 pressure injuries on left posterior thigh and Stage 1 pressure injury on coccyx.
Report Facts
Capacity: 110
Census: 62
Plan of Correction Due Date: May 5, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 110
Deficiencies: 0
Date: May 4, 2023
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations received on 2023-02-24 regarding resident care issues including soiled clothing, unmet personal needs, and food temperature concerns.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included residents being left in soiled clothing, unmet personal needs, and improper food temperature. Interviews with staff and residents did not support these claims.
Findings
Based on interviews with staff and residents, including the Memory Care Director, the allegations were found to be unsubstantiated due to lack of preponderance of evidence. Staff reported regular care practices such as timely changing of incontinent residents and ensuring clean clothing, and residents expressed satisfaction with care.
Report Facts
Capacity: 110
Census: 62
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Luisa Fontanilla | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Yvonne Flores-Larios | Licensing Program Manager | Named as Licensing Program Manager on report |
| Mandy Taylor | Administrator | Facility administrator named in report header |
| Robert Roby | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 110
Deficiencies: 1
Date: May 1, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that residents' requests for assistance were not responded to in a timely manner, the facility did not have enough staff to meet residents' needs, and residents' rooms were not maintained at a comfortable temperature.
Complaint Details
The complaint investigation was substantiated for delayed response to residents' requests for assistance. Other allegations regarding staffing sufficiency and room temperature were unsubstantiated.
Findings
The investigation substantiated that staff failed to respond to call pendants in a timely manner, with at least nine calls responded to after 30 minutes or more, posing a potential risk to resident health and safety. However, allegations regarding insufficient staffing and uncomfortable room temperatures were unsubstantiated based on staff schedules, resident interviews, and observations.
Deficiencies (1)
Facility staff failed to respond to pendants in a timely manner, with at least nine calls from residents responded to after 30 minutes or more, posing a potential risk to resident health and safety.
Report Facts
Capacity: 110
Census: 66
Number of delayed call responses: 9
Plan of Correction Due Date: May 15, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Robert Roby | Executive Director | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 110
Deficiencies: 2
Date: Feb 13, 2023
Visit Reason
The inspection was conducted unannounced on February 13, 2023, as a result of the Department receiving a priority 1 complaint regarding the facility.
Complaint Details
The visit was triggered by a priority 1 complaint (Complaint # 15-AS-20230209091605).
Findings
The inspection found that the hot water temperature was only 80 degrees Fahrenheit, which is below the required minimum, and that medications (Tylenol and Clobetasol cream) were unlocked in a resident's room despite the resident not being authorized to self-administer medications.
Deficiencies (2)
Hot water temperature controls were not maintained to regulate water temperature between 105 and 120 degrees Fahrenheit, measured at 80 degrees Fahrenheit.
Medications were unlocked in a resident's room despite being determined hazardous and the resident not authorized to self-administer.
Report Facts
Census: 67
Total Capacity: 110
Deficiencies cited: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Business Office Manager | Met with Licensing Program Analyst during inspection |
| Shanina Mason | Resident Services Director | Met with Licensing Program Analyst during inspection |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 110
Deficiencies: 2
Date: Feb 2, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to complaints received on 2021-08-26 regarding resident care issues including pressure injuries and medication administration.
Complaint Details
Complaint investigation was substantiated for allegations that resident sustained pressure injuries and medication was not administered as prescribed. Other allegations including weight loss, hygiene neglect, and inadequate feeding were unsubstantiated.
Findings
The investigation substantiated that a resident sustained one Stage 2 pressure injury and one Stage 1 pressure injury, and that staff failed to administer prescribed medication (Donepezil) from 5/20/2021 to 6/22/2021. Other allegations such as weight loss, hygiene neglect, and inadequate feeding were unsubstantiated.
Deficiencies (2)
Failure to comply with enumerated rights including neglect and failure to prevent pressure injuries.
Failure to comply with incidental medical and dental care regulations related to medication administration.
Report Facts
Resident census: 67
Total capacity: 110
Weight loss: 7.4
Weight gain: 6.4
Medication non-administration period (days): 33
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Robert Roby | Assistant Executive Director | Met with Licensing Program Analysts during investigation and involved in medication administration verification |
| Lizette Francisco | Licensing Program Analyst | Conducted investigation and reviewed records |
| Harpreet Humpal | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Census: 65
Capacity: 110
Deficiencies: 1
Date: Dec 8, 2022
Visit Reason
An unannounced case management visit was conducted to follow up on the criminal record exemption status of staff member S1.
Findings
The facility was found to have employed a non-cleared/excluded individual (S1) without criminal record clearance prior to employment, posing an immediate health and safety risk. S1 had been terminated on 08/29/22, and the deficiency was corrected during the visit with updated employment records.
Deficiencies (1)
Staff (S1) did not have criminal record clearance prior to employment, posing an immediate health and safety risk to residents.
Report Facts
Civil penalty amount: 500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mandy Taylor | Administrator | Facility administrator who stated that staff S1 was terminated on 08/29/22. |
| Daisy Panlilio | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager and Supervisor. |
Inspection Report
Census: 74
Capacity: 110
Deficiencies: 1
Date: May 26, 2022
Visit Reason
An unannounced case management visit was conducted regarding self-reporting an AWOL incident involving a resident in the memory care unit.
Findings
The licensee failed to comply with safety measures for persons with dementia, as a resident was able to elope from the facility posing an immediate safety risk. The memory care unit's exit doors were observed locked during the visit. A deficiency was cited per Title 22 California Code of Regulations.
Deficiencies (1)
Failure to meet safety measures to address behaviors such as wandering in a resident with dementia, resulting in the resident eloping and posing immediate safety risk.
Report Facts
Deficiency Type: 1
Capacity: 110
Census: 74
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bernadette Bender | Memory Care Director | Met during visit and provided information about the AWOL incident |
| Catherine Lin | Licensing Program Analyst | Conducted the inspection visit and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Census: 75
Capacity: 110
Deficiencies: 0
Date: Apr 28, 2022
Visit Reason
The visit was a case management and other type of inspection conducted to investigate concerns regarding Resident 2 not receiving assistance with brushing teeth.
Findings
The investigation found that Resident 2 is independent with activities of daily living and only requires cueing or reminders for some tasks such as brushing teeth. Staff provide the toothbrush but do not brush the resident's teeth. No deficiencies were noted during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bernadette Bender | Memory Care Director | Met with Licensing Program Analyst during the visit and discussed Resident 2's care. |
| Carol Fowler | Licensing Program Analyst | Conducted the case management visit and investigation. |
| L. Fontanilla | Licensing Program Analyst | Reviewed Resident 2's Physician’s Report and Appraisal Needs and Services Plan, and interviewed caregivers. |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 110
Deficiencies: 1
Date: Apr 28, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-02-01 regarding staff failing to keep a resident's room clean and free of incontinence odors, failure to assist resident with showers, failure to maintain resident's equipment clean and sanitary, and facility disrepair.
Complaint Details
The complaint investigation was substantiated for the allegation that staff failed to keep a resident's room clean and free of incontinence odors. The other allegations related to failure to assist with showers, failure to maintain resident's equipment clean and sanitary, and facility disrepair were unsubstantiated.
Findings
The investigation substantiated the allegation that staff failed to keep a resident's room clean and free of incontinence odors, citing urine smell and stains on the carpet posing a potential health risk. Other allegations regarding failure to assist with showers, maintain resident's equipment clean, and facility disrepair were found to be unsubstantiated based on interviews and record reviews.
Deficiencies (1)
Failure to ensure incontinent residents are kept clean and dry, evidenced by urine smell and stains on Resident 1's carpeted room.
Report Facts
Capacity: 110
Census: 75
Plan of Correction Due Date: May 5, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Carol Fowler | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
| Joyce Latimer | Administrator | Facility Administrator mentioned in relation to findings and exit interview |
| Bernadette Bender | Memory Care Director | Met with Licensing Program Analyst during inspection |
| Baljinder Singh | Resident Services Director | Interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 110
Deficiencies: 2
Date: Feb 17, 2022
Visit Reason
An unannounced case management visit was conducted to deliver findings related to a complaint investigation.
Complaint Details
The visit was complaint-related, and deficiencies were observed during the complaint investigation. The report does not explicitly state substantiation status.
Findings
Two deficiencies were identified: the facility did not have an updated medical assessment for resident R1, and the facility failed to submit a death report and report COVID-19 positive cases to the licensing agency as required.
Deficiencies (2)
Resident R1 did not have an updated medical assessment on file; the last assessment was dated 3/20/2019.
Facility did not submit a death report for a resident who expired and tested positive for COVID-19, and failed to report positive COVID-19 cases to the licensing agency.
Report Facts
Capacity: 110
Census: 74
Plan of Correction Due Dates: Due dates for Plan of Corrections were 03/04/2022 and 02/25/2022 for the two deficiencies.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Administrator | Met with Licensing Program Analysts during the visit. |
| Grace Luk | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Harpreet Humpal | Licensing Program Manager | Named in the report as Licensing Program Manager and Supervisor. |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 110
Deficiencies: 1
Date: Feb 17, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that the facility did not provide a copy of the care plan to the authorized representative.
Complaint Details
The complaint was substantiated based on the preponderance of evidence standard. The allegation was that the facility did not provide a copy of the care plan to the authorized representative, which was confirmed during the investigation.
Findings
The investigation found that although the care plan was reviewed and signed, the facility did not provide a copy of the care plan to the resident or the resident's responsible party upon request, which was substantiated as a violation of regulations.
Deficiencies (1)
Facility failed to provide a copy of the care plan to the resident's responsible party, violating the requirement to provide photocopied records within two business days.
Report Facts
Capacity: 110
Census: 74
Plan of Correction Due Date: Feb 25, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anoop Nair | Executive Director | Met with Licensing Program Analysts during the investigation |
| Grace Luk | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 110
Deficiencies: 2
Date: Aug 16, 2021
Visit Reason
The inspection was conducted as a case management visit in response to an incident report received on 2021-08-09 regarding a resident who left the facility unassisted.
Complaint Details
The visit was triggered by an incident report dated 2021-08-09 about a resident who left the facility unassisted (AWOL). The resident was found by police and taken to Kaiser Hospital. The physician's report dated 2021-04-01 stated the resident cannot leave unassisted. The complaint was substantiated by observed deficiencies.
Findings
The inspection found deficiencies related to the facility's failure to ensure the safety of residents with dementia, specifically a resident who left the facility unassisted, and issues with maintenance such as low audible delayed egress doors in the Memory Care Unit posing immediate health and safety risks.
Deficiencies (2)
Failure to ensure the continued safety of residents with dementia who wander away from the facility, resulting in a resident AWOL.
Facility not clean, safe, sanitary, and in good repair due to low audible delayed egress doors in Memory Care Unit posing immediate health and safety risk.
Report Facts
Deficiencies cited: 2
Capacity: 110
Census: 73
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rammy Kaur | Executive Director | Met with Licensing Program Analysts during inspection |
| Grace Luk | Licensing Program Analyst | Conducted inspection and signed report |
| Harpreet Humpal | Licensing Program Manager | Supervisor of inspection |
Inspection Report
Routine
Census: 78
Capacity: 110
Deficiencies: 0
Date: Jun 30, 2021
Visit Reason
An unannounced Infection Control Inspection was conducted as a required 1-year visit to assess infection control practices at the facility.
Findings
The facility was found to have adequate infection control measures including proper PPE use, sufficient food supply, universal screening, and posted hygiene protocols. No deficiencies were cited during the visit.
Report Facts
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ramandeep Kaur | Administrator | Met with Licensing Program Analyst and Staff Services Analyst during inspection |
Inspection Report
Census: 78
Capacity: 110
Deficiencies: 0
Date: Feb 5, 2021
Visit Reason
Licensing Program Analyst Luisa Fontanilla conducted case management in connection with an SOC 341 received by the agency. The purpose of the call was explained to the Executive Director.
Findings
The Licensing Program Analyst requested documents for Resident 1 including Physician's Report, Needs and Services Plan, and Incident Reports for January and February 2021. A copy of the report was provided to the Director via email.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joyce Latimer | Executive Director | Met with Licensing Program Analyst during case management visit |
| Luisa Fontanilla | Licensing Program Analyst | Conducted case management visit and requested documents |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 110
Deficiencies: 2
Date: Nov 23, 2020
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that staff did not respond to resident's call button in a timely manner, did not assist resident with toileting needs timely, and did not feed resident in a timely manner.
Complaint Details
The complaint investigation was substantiated for allegations that staff did not respond timely to call buttons and did not assist with toileting needs timely. The allegation that staff did not feed resident timely was unsubstantiated.
Findings
The investigation substantiated that staff did not respond to call buttons or assist with toileting needs in a timely manner, posing potential health and safety risks. The allegation regarding untimely feeding was found unsubstantiated due to insufficient evidence.
Deficiencies (2)
Facility failed to respond to resident's call button in a timely manner, posing a potential health and safety risk.
Facility did not assist resident with toileting needs in a timely manner, posing a potential health and safety risk.
Report Facts
Capacity: 110
Census: 78
Deficiencies cited: 2
Plan of Correction Due Date: Dec 7, 2020
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joyce Latimer | Executive Director | Met with during inspection and exit interview |
| Celia Phomphachanh | Licensing Program Analyst | Conducted the complaint investigation |
| Julio Montes | Licensing Program Manager | Oversaw complaint investigation |
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