Inspection Report Summary
Most inspections found no deficiencies, including the January 17, 2024 annual inspection, which was fully compliant with regulations. Earlier reports showed only minor issues, such as a storage closet needing to be cleared during the original licensing process. The most recent inspection on January 7, 2025 cited several deficiencies related mainly to medication storage, staff background clearances, CPR training, and incident reporting, but none were severe or resulted in fines or enforcement actions. These findings suggest some areas for improvement in staff training and medication management, while other aspects like infection control and facility cleanliness remained satisfactory. Several complaint investigations were not applicable, as no complaints were reported.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
50% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
83% occupied
Based on a January 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 7
Jan 7, 2025
Visit Reason
Annual required visit and inspection of the facility to evaluate compliance with licensing regulations and ensure resident safety and care standards.
Findings
The facility was generally found to be in compliance with functional kitchen appliances, clean and safe common areas, and proper infection control plans. However, deficiencies were cited related to medication storage, staff criminal record clearances, CPR training, and incident reporting.
Severity Breakdown
Type A: 6
Type B: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| R2 injection was found in the refrigerator which was unlocked and accessible. | Type A |
| Surplus medication for resident R5 who refused to take medication; no incident report was received. | Type A |
| Two out of two staff fingerprint clearances were not done. | Type A |
| Two out of two staff LIC 508 clearances were not done. | Type A |
| Two out of two staff had no CPR training. | Type A |
| One out of one R3 injection was accessible in the refrigerator. | Type A |
| One out of one incident report was not submitted for resident R5 refusal of medication. | Type B |
Report Facts
Civil penalty amount: 1000
Number of bedrooms: 3
Number of bathrooms: 2
Hot water temperature: 118.8
Plan of Correction due date: Jan 14, 2025
Plan of Correction due date: Jan 8, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anna Hakobyan | Administrator | Met during inspection and advised of visit reason |
| Leslie Ngo-Castaneda | Licensing Program Analyst | Conducted inspection and signed report |
| Nichelle Gillyard | Licensing Program Manager | Supervisor of licensing evaluation |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 0
Jan 17, 2024
Visit Reason
The inspection was an annual required visit and inspection of the facility conducted by the Licensing Program Analyst Leslie Ngo-Castaneda.
Findings
The facility was found to be in compliance with California regulations, with no deficiencies noted. The physical plant, kitchen, bedrooms, bathrooms, common areas, infection control, surrounding grounds, laundry service, staff files, medication storage, and resident records were all reviewed and found to be satisfactory.
Report Facts
Temperature: 73
Hot water temperature: 109.8
Hot water temperature: 106.9
Residents: 3
Capacity: 6
Fire clearance: 6
Hospice waiver: 6
Food storage: 2
Food storage: 7
Bedrooms: 3
Bathrooms: 2
Residents' record review: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ngo-Castaneda | Licensing Program Analyst | Conducted the annual inspection and authored the report |
| Anna Hakobyan | Licensee | Facility licensee who assisted during the inspection |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 1
Jan 7, 2022
Visit Reason
A scheduled prelicensing visit was conducted to review all eleven inspection domains as part of the initial licensing process for the facility.
Findings
The inspection identified issues to be corrected, including the need to provide a photo of the closet in Bedroom #3 being cleared out of storage items. Component III was conducted during the visit.
Deficiencies (1)
| Description |
|---|
| Closet in Bedroom #3 needs to be cleared out of storage items and a photo provided. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anna Hakobyan | Administrator | Greeted Licensing Program Analyst and was present during the prelicensing visit. |
| Alexander Pitz | Licensing Program Analyst | Conducted the scheduled prelicensing visit and inspection. |
| Eva Miller | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Nov 23, 2021
Visit Reason
The visit was an office type original licensing inspection conducted via telephone to complete Component II (COMP II) of the licensing process for a Residential Care Facility for the Elderly (RCFE).
Findings
The Applicant and Administrator successfully completed COMP II by telephone, confirming understanding of Title 22 regulations, facility operation, staff qualifications, program policies, and other licensing requirements. No clients were in care at the time of the visit.
Report Facts
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anna Hakobyan | Applicant/Administrator | Participated in COMP II and was met during the inspection |
| Julia Kim | Licensing Program Manager | Named in report header |
| Thai Doan | Licensing Program Analyst | Named in report header and signed report |
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