Inspection Reports for
Paramount House Senior Living

2061 Peabody Rd, Vacaville, CA 95687, USA, CA, 95687

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Deficiencies (last 5 years)

Deficiencies (over 5 years) 13.8 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

245% worse than California average
California average: 4 deficiencies/year

Deficiencies per year

16 12 8 4 0
2021
2022
2023
2024
2025

Occupancy

Latest occupancy rate 84% occupied

Based on a December 2025 inspection.

This facility has shown a decline in demand based on occupancy rates.

Occupancy rate over time

60% 70% 80% 90% 100% Feb 2021 Jul 2021 Oct 2022 Mar 2023 Apr 2024 Oct 2025 Dec 2025

Inspection Report

Annual Inspection
Census: 80 Capacity: 95 Deficiencies: 3 Date: Dec 18, 2025

Visit Reason
The inspection visit was an unannounced continuation of a required one-year annual inspection to evaluate compliance with licensing requirements at Paramount House Senior Living Facility.

Findings
The inspection found deficiencies related to staff training records, including lack of evidence for initial orientation, dementia training, and first aid training. Resident files were missing or had incomplete signed consents for emergency medical treatment and emergency contact information. Medicines were observed to be stored securely, and the facility conducts quarterly disaster drills.

Deficiencies (3)
Staff S1 lacked evidence of 40 hours of initial orientation and training including dementia and hospice care training.
Staff S2 lacked evidence of first aid training.
Residents R1 and R5 needed evidence of signed Consent For Emergency Medical Treatment; R2's consent was undated; R4's emergency contact page was undated.
Report Facts
Staff files reviewed: 6 Resident files reviewed: 6 Capacity: 95 Census: 80 Disaster drill date: Nov 20, 2025

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during inspection and reviewed report findings
Star StevensonLicensing Program AnalystConducted the inspection and authored the report
Bethany MoellersLicensing Program ManagerOversaw licensing program and signed report

Inspection Report

Annual Inspection
Census: 80 Capacity: 95 Deficiencies: 0 Date: Dec 16, 2025

Visit Reason
The inspection was a required unannounced 1-year annual inspection conducted to evaluate compliance with licensing requirements at the facility.

Findings
The facility was found to be clean, well-maintained, and compliant with safety and health regulations. No deficiencies were cited during the visit, and the facility demonstrated proper food storage, fire safety equipment maintenance, and resident care practices.

Report Facts
Licensed capacity: 95 Bedridden capacity: 5 Hospice waiver capacity: 10 Hospice exceptions granted: 2 Residents receiving hospice services: 12 Bedridden residents present: 2 Food delivery frequency: 2 Fire extinguisher last inspection: 202502 Smoke detector and sprinkler system certification date: Jun 10, 2025

Employees mentioned
NameTitleContext
Elizabeth AguiarResident Service DirectorMet with Licensing Program Analyst during inspection and involved in facility tour
Agustin SamaniegoExecutive Director/AdministratorReviewed initial annual inspection report and accepted findings
Star StevensonLicensing Program AnalystConducted the inspection
Bethany MoellersLicensing Program ManagerNamed as Licensing Program Manager on report

Inspection Report

Complaint Investigation
Census: 80 Capacity: 95 Deficiencies: 0 Date: Dec 16, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted to address an allegation that facility staff were not maintaining the facility in a clean condition.

Complaint Details
The complaint allegation was that facility staff were not maintaining the facility in a clean condition. The complaint was found to be unsubstantiated after investigation.
Findings
The investigation included observations, interviews with residents and staff, and record reviews. Conflicting information was found regarding housekeeping quality, with some residents reporting satisfaction and others noting issues. Evidence of dusty surfaces was observed but did not warrant citation. The complaint was determined to be unsubstantiated due to lack of preponderance of evidence.

Report Facts
Complaint Control Number: 21-AS-20251112101414 Employee Counseling Forms: 2

Employees mentioned
NameTitleContext
Star StevensonLicensing Program AnalystConducted the complaint investigation and delivered findings
Elizabeth AguiarResident Service DirectorMet with the evaluator and received the report
Bethany MoellersSupervisorSupervisor overseeing the investigation
Agustin SamaniegoAdministratorFacility administrator

Inspection Report

Complaint Investigation
Census: 80 Capacity: 95 Deficiencies: 1 Date: Dec 16, 2025

Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff were not meeting the incontinence care needs of residents, including improper use of multiple incontinence briefs and pads.

Complaint Details
The complaint was substantiated based on evidence including photographs and confidential interviews with residents confirming improper incontinence care practices. Repeat citation was issued.
Findings
The investigation substantiated the complaint, finding that staff were doubling up incontinence briefs and placing as many as six absorbent pads inside briefs, causing discomfort and redness to residents. Photographic evidence and resident interviews supported these findings.

Deficiencies (1)
Failure to ensure incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, as evidenced by improper incontinence care practices.
Report Facts
Residents non-compliant: 2 Total residents reviewed: 4 Plan of Correction due date: Dec 30, 2025

Employees mentioned
NameTitleContext
Star StevensonLicensing Program AnalystConducted the complaint investigation and delivered findings.
Elizabeth AguiarResident Service DirectorMet with Licensing Program Analyst during investigation and reviewed findings.
Bethany MoellersSupervisorSupervisor overseeing the investigation.

Inspection Report

Complaint Investigation
Census: 80 Capacity: 95 Deficiencies: 1 Date: Dec 16, 2025

Visit Reason
An unannounced complaint investigation was conducted due to allegations of financial abuse and violation of personal rights involving suspected theft of a resident's coins and snacks by a staff member.

Complaint Details
The complaint was substantiated regarding the facility's failure to report an unusual incident within the required timeframe. The theft allegations were unsubstantiated due to lack of evidence and the resident's medical history of Mild Cognitive Impairment.
Findings
The investigation found that although the resident suspected theft by a staff member, there was insufficient evidence to substantiate the theft allegations. However, it was substantiated that the facility failed to submit an Unusual Incident Report within seven days as required by regulations, resulting in a deficiency citation.

Deficiencies (1)
Failure to submit an Unusual Incident Report within seven days for an incident threatening the welfare, safety, or health of a resident as required by CCR 87211(a)(1)(D).
Report Facts
Capacity: 95 Census: 80 Deficiency count: 1 Plan of Correction Due Date: Dec 30, 2025

Employees mentioned
NameTitleContext
Elizabeth AguiarResident Service DirectorMet with during investigation and report review
Star StevensonLicensing Program AnalystConducted the complaint investigation
Agustin SamaniegoAdministratorFacility administrator named in report header

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 1 Date: Oct 31, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that unqualified staff provided medical care to residents and that facility staff administered medication without physician orders.

Complaint Details
The complaint was substantiated based on staff and resident interviews, record reviews, and observations. Medication Technicians administered insulin injections without proper qualifications, and documentation discrepancies were noted in MARs.
Findings
The investigation substantiated that Medication Technicians, who are not licensed nurses, administered insulin injections to residents, which is outside their approved scope of practice. Documentation errors were also found in the Medication Administration Records (MARs).

Deficiencies (1)
Facility failed to ensure that only qualified and trained personnel provided medical care and administered medications to residents, posing an immediate health, safety or personal rights risk.
Report Facts
Capacity: 95 Census: 82 Plan of Correction Due Date: Nov 3, 2025 Plan of Correction Completion Date: Nov 11, 2025

Employees mentioned
NameTitleContext
Agustin SamaniegoAdministratorMet with Licensing Program Analyst during investigation
Ali DenizLicensing EvaluatorConducted the complaint investigation
Victoria BertozziSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 0 Date: Oct 31, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2025-07-29 regarding unmet resident incontinence care needs, lack of supervision resulting in resident injury, and violations of personal rights.

Complaint Details
The complaint investigation was unsubstantiated. Allegations included unmet incontinence care needs, lack of supervision causing a resident fall and injury, and personal rights violations. Evidence did not support these claims.
Findings
After interviews, document reviews, and observations, there was insufficient evidence to substantiate the allegations. The resident's incontinence care needs were met according to staff and residents, the fall incident was not due to lack of supervision, and no personal rights violations were found. The complaint was determined to be unsubstantiated.

Report Facts
Capacity: 95 Census: 82 Staff interviewed: 5 Residents interviewed: 5

Employees mentioned
NameTitleContext
Agustin SamaniegoAdministratorMet with Licensing Program Analyst during investigation
Ali DenizLicensing EvaluatorConducted complaint investigation
Victoria BertozziSupervisorSupervisor overseeing the investigation

Inspection Report

Census: 82 Capacity: 95 Deficiencies: 0 Date: Oct 30, 2025

Visit Reason
The visit was an unannounced case management inspection to deliver amendments to a previously issued complaint report that was issued in error on 2025-10-21.

Findings
No deficiencies were issued during this unannounced visit. The Licensing Program Analyst met with the Executive Director who signed the amended reports.

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during the visit and signed the amended reports.

Inspection Report

Census: 82 Capacity: 95 Deficiencies: 0 Date: Oct 30, 2025

Visit Reason
The visit was an unannounced case management inspection to deliver amendments to a previously issued complaint report that was issued in error on 2025-10-21.

Findings
No deficiencies were issued during this unannounced visit where amendments to the complaint report were delivered and signed by the Executive Director.

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during the visit and signed amended complaint reports.
Star StevensonLicensing Program AnalystConducted the unannounced visit and delivered amendments to the complaint report.
Bethany MoellersLicensing Program ManagerNamed as Licensing Program Manager on the report.

Inspection Report

Census: 82 Capacity: 95 Deficiencies: 0 Date: Oct 21, 2025

Visit Reason
The case management visit was conducted to discuss an 8-second video received by Community Care Licensing on 2025-09-08, in which a staff member was purportedly dancing on top of a resident sink while working, shared on the social media site TikTok.

Findings
No residents were present during the video production, and the video was taken by an outside party not employed by the facility. The staff member involved was spoken to by phone and management, and no deficiencies were cited during this visit.

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during the visit and involved in discussion regarding the video incident.
Star StevensonLicensing Program AnalystConducted the unannounced case management visit and spoke with staff member S1 regarding the video.
Bethany MoellersLicensing Program ManagerNamed as Licensing Program Manager on the report.

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 1 Date: Oct 21, 2025

Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff do not answer resident call buttons in a timely manner, do not meet residents' care needs, do not treat residents with dignity and respect, and that there is insufficient staffing.

Complaint Details
The complaint was substantiated regarding delayed or absent response to resident call buttons. Other allegations about care needs, dignity, respect, and staffing levels were unsubstantiated. A repeat citation and civil penalty were issued for insufficient staffing under CCR 87411(a).
Findings
The investigation substantiated the allegation that staff do not answer call lights timely, with average response times exceeding facility goals and instances of care being delayed or not provided after call lights were turned off. Allegations regarding unmet care needs, lack of dignity and respect, and insufficient staffing were found to be unsubstantiated based on interviews, observations, and record reviews.

Deficiencies (1)
87411(a) Facility Personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs: This requirement was not met as evidenced by delayed or absent care after call lights were answered.
Report Facts
Capacity: 95 Census: 82 Call light response time: 20 Call light response time: 14 Call light response time: 12 Civil penalty amount: 250 Residents requiring two-person assistance: 15 Direct caregivers on lowest staffing shifts: 5 Direct caregivers on lowest staffing shifts: 7

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during investigation and reviewed report
Star StevensonLicensing Program AnalystConducted complaint investigation and authored report
Bethany MoellersSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Census: 82 Capacity: 95 Deficiencies: 0 Date: Oct 21, 2025

Visit Reason
The visit was a case management visit to discuss an 8-second video received by Community Care Licensing showing a staff member purportedly dancing on top of a resident sink while working, which was shared and since taken down from TikTok.

Findings
No residents were present during the video production, and the video was taken by an outside party not employed by the facility. The staff member involved was made aware that such conduct could lead to permanent exclusion from caregiving work. No deficiencies were cited during the visit.

Report Facts
Capacity: 95 Census: 82

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with Licensing Program Analyst during the visit and involved in discussion about the video incident
Star StevensonLicensing Program AnalystConducted the unannounced case management visit and spoke with staff member S1

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 1 Date: Jun 19, 2025

Visit Reason
This was an unannounced complaint investigation visit triggered by an allegation that staff was providing care beyond the scope of the license, specifically that a caregiver was performing skilled care tasks without proper training.

Complaint Details
The complaint was substantiated. The allegation involved staff providing care beyond the scope of the license, specifically a caregiver performing fecal impaction removal, suppository insertion, and medicated cream administration without proper training.
Findings
The allegation was substantiated based on document review, interviews, and observations. It was found that a caregiver provided suppository and ointment care without skilled professional training, posing a potential health and safety risk to residents.

Deficiencies (1)
Failure to ensure that administration of enemas, suppositories, or manual fecal impaction removal was performed by an appropriately skilled professional as required by CCR 87622(b)(1).
Report Facts
Capacity: 95 Census: 82 Plan of Correction Due Date: Jun 30, 2025

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive Director/AdministratorMet during investigation and named in findings
Ali DenizLicensing EvaluatorConducted the complaint investigation
Victoria BertozziSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 0 Date: May 15, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to complaints received on 2025-02-13 regarding personal rights issues, resident incontinent care needs, and safeguarding of resident's personal belongings at Paramount House Senior Living.

Complaint Details
The complaint investigation was substantiated for the allegation that the facility was not answering the phone line (call bells) in a timely manner, with evidence showing residents waited 15 minutes or more 57 times over a one-month period. The allegations regarding resident incontinent care needs and safeguarding of personal belongings were unsubstantiated after review of medical records, interviews, and facility protocols.
Findings
The investigation substantiated the allegation that the facility was not answering the phone line promptly, with documented delays in staff response to resident calls. However, allegations regarding resident incontinent care needs not being met and failure to safeguard personal belongings were unsubstantiated based on interviews, observations, and document reviews.

Report Facts
Resident wait times: 57 Resident wait times over 30 minutes: 7 Facility capacity: 95 Census: 79

Employees mentioned
NameTitleContext
Shannan HansenLicensing Program AnalystConducted the complaint investigation and delivered findings
Agustin SamaniegoAdministratorFacility administrator met during investigation and named in findings
Bethany MoellersSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 3 Date: May 15, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2025-02-10 regarding inadequate bathing services, delayed response to call buttons, and mal odors in resident rooms at Paramount House Senior Living.

Complaint Details
The complaint investigation was substantiated with findings that staff did not ensure adequate bathing services, timely response to call buttons, and proper management of mal odors related to catheter care. Repeat violations were noted with civil penalties of $250 each assessed for bathing and call response deficiencies. Other allegations were unsubstantiated due to lack of evidence.
Findings
The investigation substantiated that staff did not provide adequate bathing services as required, with documented evidence showing fewer baths than agreed. Staff also failed to respond timely to call button requests, with numerous instances of delays exceeding 15 minutes. Additionally, mal odors related to catheter care were observed in resident rooms. Other allegations regarding dental hygiene assistance, catheter care plan adherence, clean dry clothing, and communication abilities were found unsubstantiated.

Deficiencies (3)
Basic Services 87464(f)(4) - Failure to provide adequate bathing services as indicated in residents' admissions agreements.
87411(a) - Facility personnel insufficient in numbers and competence to provide timely response to residents' call button requests.
87625(b)(3) - Failure to ensure incontinent residents are kept clean and dry and facility remains free of odors from incontinence.
Report Facts
Civil penalty: 250 Civil penalty: 250 Number of baths documented: 9 Number of call delays over 15 minutes: 94 Number of call delays over 30 minutes: 14 Number of call delays over 60 minutes: 4 Facility capacity: 95 Facility census: 79

Employees mentioned
NameTitleContext
Agustin SamaniegoAdministratorMet with Licensing Program Analyst during complaint investigation and referenced in findings
Shannan HansenLicensing Program AnalystConducted the complaint investigation and authored the report
Bethany MoellersSupervisorSupervisor overseeing the complaint investigation

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 0 Date: May 15, 2025

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2025-02-13 regarding allegations including the facility not answering the phone line, resident incontinent care needs not met, and failure to safeguard resident's personal belongings.

Complaint Details
The complaint investigation was substantiated for the allegation that the facility was not answering phone calls and call bells promptly, with documented instances of residents waiting 15 minutes or more 57 times, including 7 times over 30 minutes. The other allegations about incontinent care and safeguarding personal belongings were unsubstantiated after review of interviews, observations, and documentation.
Findings
The allegation that the facility is not answering the phone line (including call bells) was substantiated based on interviews, observations, and record review. The allegations regarding resident incontinent care needs not met and failure to safeguard resident's personal belongings were unsubstantiated due to insufficient evidence.

Report Facts
Resident wait times: 57 Resident wait times over 30 minutes: 7 Census: 79 Total capacity: 95

Employees mentioned
NameTitleContext
Shannan HansenLicensing Program AnalystConducted the complaint investigation and delivered findings
Agustin SamaniegoAdministratorFacility administrator met during investigation and named in findings
Bethany MoellersLicensing Program ManagerNamed as Licensing Program Manager on report

Inspection Report

Annual Inspection
Census: 70 Capacity: 95 Deficiencies: 2 Date: Dec 30, 2024

Visit Reason
An unannounced annual required 1-year inspection visit was conducted to evaluate compliance with licensing regulations at the facility.

Findings
The facility was found to be clean, well-maintained, and compliant with safety and dietary regulations. Two technical violations were issued related to unsecured cleaning supply storage and incomplete staff training documentation. No deficiencies were cited during the visit.

Deficiencies (2)
Storage room and laundry room containing cleaning supplies were found open; laundry room was immediately secured after discussion.
Two staff members lacked required First Aid training and correct amount of training hours.
Report Facts
Licensed capacity: 95 Bedridden capacity: 5 Hospice waiver capacity: 10 Hospice exceptions granted: 7 Current census: 70 Hospice residents: 16 Fire extinguisher last charged date: May 15, 2024 Smoke detector and sprinkler certification date: Mar 18, 2024 Fire department inspection date: Nov 24, 2024 Water temperature range: 112.1-117.1 Document submission deadline: Jan 30, 2025

Employees mentioned
NameTitleContext
Agustin SamaniegoAdministratorMet with Licensing Program Analysts during inspection
Elizabeth AguiarResident Services DirectorMet with Licensing Program Analysts during inspection and received report
Robert FrankLicensing EvaluatorConducted inspection and signed report
Victoria BertozziSupervisorSupervisor overseeing inspection

Inspection Report

Annual Inspection
Census: 70 Capacity: 95 Deficiencies: 2 Date: Dec 30, 2024

Visit Reason
An unannounced Annual Required 1-year inspection visit was conducted to evaluate compliance with licensing regulations at the facility.

Findings
The facility was found to be clean, well-maintained, and compliant with safety and dietary regulations. Two technical violations were issued related to unsecured cleaning supplies and staff training deficiencies. No formal deficiencies were cited during the visit.

Deficiencies (2)
Storage room containing cleaning supplies was found open without staff supervision.
Two staff members lacked required First Aid training and sufficient training hours.
Report Facts
Licensed capacity: 95 Current census: 70 Hospice waiver capacity: 10 Hospice exceptions granted: 7 Residents receiving hospice services: 16 Fire extinguisher last charged date: May 15, 2024 Smoke detector and sprinkler system certification date: Mar 18, 2024 Vacaville Fire Department inspection date: Nov 24, 2024 Water temperature range: Measured between 112.1 and 117.1 degrees F

Employees mentioned
NameTitleContext
Agustin SamaniegoAdministratorMet during inspection and discussed concerns about unsecured storage room
Elizabeth AguiarResident Services DirectorPresent during inspection and received copy of report and technical violations

Inspection Report

Complaint Investigation
Census: 70 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff yelled at residents and did not ensure residents' incontinence needs were being met.

Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff yelling at residents and failure to meet incontinence needs. Investigators reviewed records, interviewed staff and residents, and found no evidence to substantiate the claims.
Findings
Based on interviews, document reviews, and observations, the allegations were found to be unsubstantiated. There was conflicting information regarding the allegations, and no preponderance of evidence was found to prove the violations occurred. No deficiencies were cited during the visit.

Report Facts
Capacity: 95 Census: 70 Response time: 13 Bathing and peri-care refusals: 4

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet with investigators and named in the investigation findings
Julie FlorioLicensing Program AnalystConducted the complaint investigation
Robert FrankLicensing Program AnalystAssisted in delivering complaint investigation findings

Inspection Report

Complaint Investigation
Census: 70 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff yelled at residents and did not ensure residents' incontinence needs were being met.

Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff yelling at residents and failure to meet incontinence needs. Evidence showed timely response to calls for assistance and documented refusals of care. Resident had a documented history of UTIs unrelated to staff actions.
Findings
Based on interviews, document reviews, and observations, the allegations were found to be unsubstantiated. There was conflicting information regarding the allegations, and no preponderance of evidence was found to prove the violations occurred.

Report Facts
Response time: 13 Bathing and peri-care refusals: 4

Employees mentioned
NameTitleContext
Agustin SamaniegoExecutive DirectorMet during investigation and named in relation to complaint findings
Julie FlorioLicensing Program AnalystConducted complaint investigation visits and authored report
Robert FrankLicensing Program AnalystParticipated in complaint investigation visit delivering findings

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 0 Date: Dec 6, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff did not notify a resident's responsible party of an incident and that staff were not providing adequate food services to residents.

Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to notify a resident's responsible party and inadequate food services. Interviews and documentation confirmed notification was made to the correct responsible party and food services were adequate.
Findings
The investigation found both allegations to be unsubstantiated based on interviews, observations, and document reviews. Staff were confirmed to have notified the responsible party as required, and food services were deemed adequate according to facility menus and resident care plans. No deficiencies were cited during the visit.

Report Facts
Capacity: 95 Census: 69

Employees mentioned
NameTitleContext
Julie FlorioLicensing Program AnalystConducted the complaint investigation and delivered findings
Agustin SamaniegoExecutive DirectorMet with during the inspection
Candice MosesAdministratorFacility administrator named in the report

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 2 Date: Dec 6, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff were not answering residents' call buttons in a timely manner and were not meeting residents’ bathing needs.

Complaint Details
The complaint was substantiated based on evidence including interviews, observations, and record reviews. Residents experienced extended wait times for call button responses, with one resident waiting 15 minutes or more 91 times over 4 months, including waits over 30 and 60 minutes. Bathing care was less than contracted, with one resident receiving approximately 1 bath per week instead of 2.
Findings
The investigation substantiated the allegations that staff failed to respond timely to residents' call buttons and did not meet bathing needs as agreed in residents' contracts. Documentation showed multiple instances of delayed staff response and fewer baths provided than contracted.

Deficiencies (2)
Failure to provide personal assistance and care, specifically bathing, as indicated in the pre-admission appraisal and admissions agreement.
Facility personnel were not sufficient in numbers and competence to provide necessary services, resulting in untimely response to residents' calls for assistance.
Report Facts
Wait times over 15 minutes: 91 Wait times over 30 minutes: 23 Wait times over 60 minutes: 5 Baths documented: 20 Baths per week: 1 Baths per week contracted: 2 Deficiencies cited: 2 Facility capacity: 95 Census: 69

Employees mentioned
NameTitleContext
Julie FlorioLicensing Program AnalystConducted the complaint investigation and authored the report
Agustin SamaniegoExecutive DirectorMet with the evaluator during the inspection
Bethany MoellersSupervisorSupervisor overseeing the licensing evaluation
Candice MosesAdministratorFacility administrator named in the report

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 0 Date: Dec 6, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-09-30 regarding failure to notify a resident's responsible party of an incident and inadequate food services to residents.

Complaint Details
The complaint involved two allegations: staff did not notify a resident’s responsible party of an incident, and staff were not providing adequate food services to residents. Both allegations were found unsubstantiated after investigation.
Findings
The investigation found both allegations to be unsubstantiated based on interviews, observations, and document reviews. Staff did notify the responsible party as required, and food services were deemed adequate according to menus and resident care plans. No deficiencies were cited during the visit.

Report Facts
Complaint Control Number: 21 Complaint Control Number Full: 21-AS-20240930151325

Employees mentioned
NameTitleContext
Julie FlorioLicensing Program AnalystConducted the complaint investigation and delivered findings
Agustin SamaniegoExecutive DirectorMet with during the investigation
Bethany MoellersLicensing Program ManagerNamed in report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 2 Date: Dec 6, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff were not answering residents' call buttons in a timely manner and were not meeting residents’ bathing needs.

Complaint Details
The complaint was substantiated based on interviews, observations, and record reviews. The reporting party alleged staff delays in responding to call buttons and failure to meet bathing needs, both of which were confirmed by evidence including resident interviews and documentation of wait times and bathing frequency.
Findings
The investigation substantiated the allegations that staff failed to respond timely to residents' call buttons, with documented delays of 15 minutes or more occurring 91 times over four months, and that residents did not receive the agreed-upon frequency of bathing, receiving approximately half the contracted number of baths.

Deficiencies (2)
Failure to provide personal assistance and care including bathing as indicated in the pre-admission appraisal and admissions agreements.
Facility personnel were not sufficient in numbers and competence to provide timely response to residents' calls for assistance, resulting in over 91 instances of delayed response within a 9-month period.
Report Facts
Instances of delayed staff response: 91 Instances of wait times over 30 minutes: 23 Instances of wait times over 60 minutes: 5 Number of baths documented: 20 Capacity: 95 Census: 69

Employees mentioned
NameTitleContext
Julie FlorioLicensing Program AnalystConducted the complaint investigation and authored the report
Bethany MoellersLicensing Program ManagerOversaw the complaint investigation process
Agustin SamaniegoExecutive DirectorFacility representative met during the inspection
Candice MosesAdministratorFacility administrator named in the report

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 2 Date: Apr 18, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints alleging the facility did not ensure a safe environment, was not kept clean, safe and sanitary, and that staff were not providing adequate care and supervision to residents.

Complaint Details
The complaint investigation was substantiated for allegations that the facility did not ensure a safe environment and was not kept clean, safe and sanitary. The allegation that staff were not providing adequate care and supervision was unsubstantiated.
Findings
The complaint that staff were not providing adequate care and supervision was found to be unsubstantiated due to lack of corroborating evidence. However, the allegations that the facility did not ensure a safe environment and was not kept clean, safe and sanitary were substantiated. Specifically, several unhoused individuals gained access to the facility posing an immediate safety risk, and a resident's bedside commode was not cleaned in a timely manner, posing health and safety risks.

Deficiencies (2)
Facility failed to provide safe, healthful, and comfortable accommodations, furnishings, and equipment as several unhoused individuals gained access to the facility posing an immediate health and safety risk.
Facility failed to maintain a clean, safe, and sanitary environment as a resident's bedside commode was not cleaned in a timely manner, posing a potential health and safety risk.
Report Facts
Capacity: 95 Census: 69 Plan of Correction Due Date: Apr 19, 2024 Plan of Correction Due Date: Apr 25, 2024

Employees mentioned
NameTitleContext
Candace MosesAdministratorMet with Licensing Program Analyst during investigation and referenced in findings
Dominic TobolaLicensing Program AnalystConducted the complaint investigation

Inspection Report

Complaint Investigation
Census: 69 Capacity: 95 Deficiencies: 2 Date: Apr 18, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints alleging the facility did not ensure a safe environment, was not kept clean, safe and sanitary, and that staff were not providing adequate care and supervision to residents.

Complaint Details
The complaint investigation was substantiated for allegations that the facility did not ensure a safe environment and was not kept clean, safe and sanitary. The allegation that staff were not providing adequate care and supervision was unsubstantiated.
Findings
The complaint that staff were not providing adequate care and supervision was found to be unsubstantiated due to lack of corroborating evidence. However, allegations that the facility did not ensure a safe environment and was not kept clean, safe and sanitary were substantiated. Specifically, several unhoused individuals gained access to the facility posing an immediate safety risk, and a resident's bedside commode was not properly disposed of in a timely manner, posing health and safety risks.

Deficiencies (2)
Facility did not ensure safe, healthful, and comfortable accommodations, furnishings, and equipment as several unhoused individuals gained access to the facility posing an immediate health and safety risk.
Facility failed to maintain a clean, safe, sanitary, and in good repair environment as staff failed to ensure a resident's bedside commode was cleaned in a timely manner, posing a potential health and safety risk.
Report Facts
Capacity: 95 Census: 69 Deficiency Type A due date: Apr 19, 2024 Deficiency Type B due date: Apr 25, 2024

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Kimberley MotaLicensing Program ManagerOversaw the complaint investigation
Candace MosesAdministratorFacility administrator interviewed during investigation and named in findings

Inspection Report

Complaint Investigation
Census: 64 Capacity: 95 Deficiencies: 0 Date: Mar 21, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of neglect and lack of supervision resulting in a resident being hospitalized.

Complaint Details
The complaint alleged neglect and lack of supervision that resulted in a resident being hospitalized. The investigation found contradicting information and insufficient evidence to substantiate the allegation. The resident was observed unassisted in their wheelchair for a substantial amount of time, but it could not be confirmed that neglect caused the hospitalization.
Findings
The allegation of neglect/lack of supervision resulting in resident hospitalization was unsubstantiated due to insufficient corroborating evidence. No deficiencies were cited during this investigation.

Report Facts
Complaint Control Number: 21

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Candace MosesAdministratorFacility administrator met during the investigation
Kimberley MotaSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 64 Capacity: 95 Deficiencies: 1 Date: Mar 21, 2024

Visit Reason
The visit was an unannounced case management inspection to address violations found during a complaint investigation regarding complaint number 21-AS-20231129102127.

Complaint Details
The visit was conducted to address violations found during complaint investigation number 21-AS-20231129102127. The deficiency was substantiated as the facility failed to provide adequate supervision and care to resident R1.
Findings
The Licensing Program Analyst found that on 11/22/2023, a resident (R1) was left unattended and soiled in their wheelchair for several hours, despite care plan requirements for two-person assist transfers and two-hour room checks. The facility failed to ensure adequate supervision and proper care for the resident.

Deficiencies (1)
Failure to provide basic services including care and supervision as required, evidenced by resident left unattended and soiled in wheelchair for several hours.
Report Facts
Capacity: 95 Census: 64 Plan of Correction Due Date: Apr 4, 2024

Employees mentioned
NameTitleContext
Candace MosesAdministratorFacility administrator present during inspection and named in findings
Dominic TobolaLicensing Program AnalystLicensing evaluator conducting the inspection
Kimberley MotaSupervisorSupervisor named in the report

Inspection Report

Complaint Investigation
Census: 64 Capacity: 95 Deficiencies: 0 Date: Mar 21, 2024

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of neglect/lack of care and supervision resulting in a resident being hospitalized.

Complaint Details
The complaint alleged neglect/lack of care and supervision that resulted in a resident being hospitalized. The investigation found contradicting information and insufficient evidence to substantiate the allegation. The complaint was determined to be unsubstantiated.
Findings
The allegation of neglect/lack of supervision resulting in resident hospitalization was unsubstantiated due to insufficient corroborating evidence. No deficiencies were cited, but a separate case management visit was initiated to issue a citation for general lack of supervision and failure to provide basic services to the resident.

Report Facts
Capacity: 95 Census: 64

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Kimberley MotaLicensing Program ManagerNamed as Licensing Program Manager on the report
Candace MosesAdministratorFacility Administrator met during the investigation

Inspection Report

Complaint Investigation
Census: 64 Capacity: 95 Deficiencies: 1 Date: Mar 21, 2024

Visit Reason
The case management visit was conducted to address separate violations found during a complaint investigation regarding complaint number 21-AS-20231129102127.

Complaint Details
The visit was complaint-related, addressing violations found during complaint investigation number 21-AS-20231129102127. The deficiency was substantiated as the facility failed to provide adequate supervision and proper room checks for resident R1.
Findings
The Licensing Program Analyst found that on 11/22/2023, a resident (R1) was left unattended and soiled in their wheelchair for several hours, despite care plan requirements for two-person assist transfers and two-hour room checks. The facility was unable to prove adequate supervision and proper room checks were conducted for R1.

Deficiencies (1)
Basic services shall at a minimum include care and supervision as described in Health and Safety Code section 1569.2(c). These requirements were not met as evidenced by: Based on review of records, R1 was found to be left unattended and soiled in their wheelchair for several hours.
Report Facts
Capacity: 95 Census: 64 Plan of Correction Due Date: Apr 4, 2024

Employees mentioned
NameTitleContext
Candace MosesAdministratorMet with Licensing Program Analyst during the visit
Dominic TobolaLicensing Program AnalystConducted the inspection and authored the report
Kimberley MotaLicensing Program ManagerSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Capacity: 95 Deficiencies: 0 Date: Dec 14, 2023

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation that staff would not allow a resident to return to the facility.

Complaint Details
The complaint alleged that staff would not allow resident R1 to return to the facility. The allegation was found to be unsubstantiated due to conflicting information and lack of corroborating evidence.
Findings
The investigation found that the resident had returned to the facility but was sent out for medical attention due to a C-diff diagnosis. The facility was not properly informed of the resident's condition, but the facility followed regulation protocols for approved exceptions. Due to conflicting information and lack of corroborating evidence, the allegation was unsubstantiated and no deficiencies were cited.

Report Facts
Facility capacity: 95

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation
Candace MosesAdministratorFacility administrator interviewed during investigation
Kimberley MotaSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Capacity: 95 Deficiencies: 0 Date: Dec 14, 2023

Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff would not allow a resident to return to the facility.

Complaint Details
The complaint alleged that staff would not allow resident R1 to return to the facility. The allegation was found to be unsubstantiated due to conflicting information and lack of corroborating evidence.
Findings
The investigation found that the resident had returned to the facility but was sent out for medical attention due to symptoms of C-diff. The facility was not properly informed of the resident's condition, which is a prohibited health condition. However, the facility followed regulation protocols for approved exception and the allegation was unsubstantiated due to lack of corroborating evidence.

Report Facts
Facility capacity: 95

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Candice MosesAdministratorFacility administrator interviewed during the investigation
Kimberley MotaLicensing Program ManagerNamed as Licensing Program Manager on the report

Inspection Report

Annual Inspection
Census: 68 Capacity: 95 Deficiencies: 3 Date: Oct 26, 2023

Visit Reason
An unannounced annual required 1-year inspection visit was conducted to evaluate compliance with licensing regulations and facility operations.

Findings
The facility was found to be clean, well-maintained, and compliant with safety and health regulations. Several technical violations were issued related to unsecured laundry room access, incomplete medication record entry, and staff training deficiencies. No deficiencies were cited during the visit.

Deficiencies (3)
Laundry room containing cleaning supplies was open with housekeeping staff nearby; no residents present. Laundry room was immediately secured after discussion.
One medication start date not properly input on the Centrally Stored Medication Record but indicated on the medication container.
Staff (S1 & S2) found in need of additional 40-hour onboard training.
Report Facts
Capacity: 95 Census: 68 Hospice capacity: 10 Hospice residents: 6 Water temperature range: 112.1-117.1 Fire extinguisher last charged date: Feb 17, 2023 Smoke detector and sprinkler system certification date: Aug 24, 2023 Administrator certification renewal training date: Jul 13, 2023 Document submission deadline: Nov 26, 2022

Employees mentioned
NameTitleContext
Candace MosesAdministratorMet with Licensing Program Analyst during inspection; named in discussion of facility operations and certification renewal
Dominic TobolaLicensing Program AnalystConducted the inspection visit and authored the report
Kimberley MotaSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Annual Inspection
Census: 68 Capacity: 95 Deficiencies: 3 Date: Oct 26, 2023

Visit Reason
An unannounced Annual Required – 1 year inspection visit was conducted to evaluate compliance with licensing regulations and facility standards.

Findings
The facility was found to be clean, well-maintained, and compliant with safety and health regulations. Several technical violations were issued related to an unsecured laundry room, incomplete medication record entry, and staff training deficiencies. No formal deficiencies were cited during the visit.

Deficiencies (3)
Laundry room containing cleaning supplies was found open and unsecured.
One medication start date not properly input on the Centrally Stored Medication Record.
Staff members (S1 & S2) found in need of additional 40-hour onboard training.
Report Facts
Licensed capacity: 95 Current census: 68 Water temperature range: 112.1-117.1 Fire extinguisher last charged date: Feb 17, 2023 Smoke detector and sprinkler system certification date: Aug 24, 2023 Administrator certification payment confirmation date: Jul 13, 2023

Employees mentioned
NameTitleContext
Candace MosesAdministratorMet with Licensing Program Analyst during inspection and named in report
Richard RemigioAdministratorNamed as facility administrator in report header

Inspection Report

Follow-Up
Census: 67 Capacity: 95 Deficiencies: 0 Date: Aug 18, 2023

Visit Reason
The visit was an unannounced follow-up on an incident report regarding a resident who was hospitalized due to burns. The purpose was to review corrective actions taken by the facility following the incident.

Findings
The facility updated the resident's level of care, issued a formal letter regarding house rules on smoking, and increased monitoring. No deficiencies were cited during this visit.

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the unannounced follow-up visit and discussed corrective actions with facility staff.
Richard RemigioAdministratorSpoke with Licensing Program Analyst regarding corrective actions following the incident.
Candace MosesAdministratorMet with Licensing Program Analyst during the visit.

Inspection Report

Follow-Up
Census: 67 Capacity: 95 Deficiencies: 0 Date: Aug 18, 2023

Visit Reason
The visit was an unannounced follow-up on an incident report regarding a resident who was hospitalized due to burns.

Findings
The facility took corrective actions including updating the resident's care level, issuing a formal notice regarding smoking policies, and increasing monitoring. No deficiencies were cited during this visit.

Report Facts
Capacity: 95 Census: 67

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the inspection and discussed corrective actions
Richard RemigioAdministratorFacility administrator involved in corrective action discussions
Candace MosesAdministratorMet with Licensing Program Analyst during inspection
Kimberley MotaLicensing Program ManagerNamed in report header

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 0 Date: May 16, 2023

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation of neglect/lack of supervision resulting in a resident fall with injury.

Complaint Details
The complaint alleged neglect/lack of supervision resulting in a resident fall with injury. The allegation was found unsubstantiated after investigation.
Findings
The investigation found that the allegation was unsubstantiated due to insufficient evidence to prove the alleged violation did or did not occur. The facility followed proper reporting requirements and the resident had a documented change of condition with a propensity to attempt to get out of bed without assistance.

Report Facts
Capacity: 95 Census: 79

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation
Richard RemigioAdministratorFacility administrator met with the evaluator and was involved in the investigation

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 0 Date: May 16, 2023

Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation of neglect/lack of supervision resulting in a resident fall with injury.

Complaint Details
The complaint alleged neglect/lack of supervision resulting in a resident fall with injury. The allegation was determined to be unsubstantiated as there was not a preponderance of evidence to prove the violation occurred.
Findings
The investigation found that Resident #1 had a documented change of condition and a propensity to attempt to get out of bed without assistance. The allegation of neglect/lack of supervision resulting in a resident fall with injury was unsubstantiated due to insufficient evidence.

Report Facts
Capacity: 95 Census: 79

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Richard RemigioAdministratorFacility administrator who met with the Licensing Program Analyst during the investigation
Hope DeBenedettiLicensing Program ManagerNamed in the report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 3 Date: Apr 10, 2023

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-02-22 regarding allegations of improper oxygen administration, neglect/lack of supervision, and physical plant issues at Paramount House Senior Living.

Complaint Details
The complaint investigation was substantiated. Allegations included improper oxygen administration, neglect/lack of supervision, and physical plant issues. The oxygen tank was found not turned on during transport, call bell response times were excessively delayed, and a rat trap was found in a resident's closet.
Findings
The investigation substantiated that oxygen equipment was not properly used as a resident's oxygen tank was not turned on during transportation. There were multiple instances of delayed response to call bells indicating neglect/lack of supervision. Additionally, a rat trap was found in a resident's closet, indicating physical plant maintenance issues.

Deficiencies (3)
Oxygen Administration - Facility staff lacked knowledge and ability in operating oxygen equipment, resulting in a resident's oxygen tank not being turned on during transportation.
Personnel Requirements - Facility personnel were insufficient in numbers and/or competence, evidenced by multiple instances of excessive wait times for resident call bell responses.
Maintenance and Operation - Facility was not clean, safe, sanitary, and in good repair as evidenced by presence of a rat trap in a resident's closet.
Report Facts
Capacity: 95 Census: 79 Deficiencies cited: 3 Plan of Correction Due Dates: 2023

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Niila PaulinMemory Care DirectorMet with the Licensing Program Analyst during the investigation and was present at exit interview
Richard RemigioAdministratorProvided information regarding staff training and response times during the investigation
Hope DeBenedettiSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Census: 79 Capacity: 95 Deficiencies: 3 Date: Apr 10, 2023

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including improper oxygen administration, neglect/lack of supervision, and physical plant concerns.

Complaint Details
The complaint investigation was substantiated. Allegations included oxygen not being used accordingly, neglect/lack of supervision, and physical plant issues. The investigation confirmed these issues through interviews, document reviews, and observations.
Findings
The investigation substantiated that staff failed to ensure oxygen tanks were turned on for residents during transport, there were multiple instances of delayed response to call bells indicating neglect, and a rat trap was found in a resident's closet indicating physical plant issues. Plans of correction were required for staff training, timely response, and pest control.

Deficiencies (3)
Oxygen Administration - staff did not ensure oxygen equipment was operated properly, resulting in a resident transported with oxygen tank not turned on.
Personnel Requirements - insufficient and/or incompetent staffing leading to delayed response times to resident call bells.
Maintenance and Operation - presence of a rat trap in resident's closet indicating unsanitary conditions and pest issues.
Report Facts
Capacity: 95 Census: 79 Deficiency count: 3 Plan of Correction Due Date: Apr 11, 2023 Plan of Correction Due Date: Apr 17, 2023

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Niila PaulinMemory Care DirectorFacility staff member who met with the Licensing Program Analyst and was involved in the investigation
Richard RemigioAdministratorFacility Administrator who provided information during the investigation
Hope DeBenedettiLicensing Program ManagerOversaw the licensing program and is named on the report

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 1 Date: Mar 14, 2023

Visit Reason
The inspection was an unannounced Case Management-Incident inspection conducted due to a resident eloping from the facility without staff knowledge.

Complaint Details
The visit was complaint-related due to an incident where Resident R1 eloped from the facility on February 8, 2023. The complaint was substantiated with deficiencies cited and civil penalties assessed.
Findings
The facility was found deficient in safety measures to address behaviors such as wandering, as Resident R1 eloped from the facility despite being assessed as unable to leave unassisted. Civil penalties were assessed and a plan of correction was required.

Deficiencies (1)
Safety measures to address behaviors such as wandering were not met, evidenced by Resident R1 eloping from the facility without staff knowledge despite medical assessment stating the resident cannot leave unassisted.
Report Facts
Capacity: 95 Census: 81 Plan of Correction Due Date: Mar 15, 2023

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the inspection and signed the report
Richard RemigioAdministratorFacility administrator involved in exit interview and appeal rights
Sony AndersonMed TechMet the Licensing Program Analyst at the facility entrance
Hope DeBenedettiSupervisorSupervisor overseeing the inspection

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 1 Date: Mar 14, 2023

Visit Reason
The inspection was an unannounced Case Management-Incident visit conducted to investigate an incident where Resident R1 eloped from the facility without staff knowledge on February 8, 2023.

Complaint Details
The visit was complaint-related due to an incident where Resident R1 eloped from the facility without staff knowledge. The complaint was substantiated by the findings.
Findings
The inspection found that the facility failed to implement adequate safety measures to prevent Resident R1, who is unable to leave unassisted, from eloping. Deficiencies were cited related to care of persons with dementia and safety measures addressing wandering behaviors.

Deficiencies (1)
87705 Care of Persons with Dementia - (b) (2) Safety measures to address behaviors such as wandering. Resident R1 eloped from facility without staff knowledge despite being unable to leave unassisted.
Report Facts
Census: 81 Total Capacity: 95 Deficiencies cited: 1

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the inspection and cited deficiencies
Richard RemigioAdministratorFacility administrator present during inspection and exit interview
Sony AndersonMed TechMet with Licensing Program Analyst during inspection
Hope DeBenedettiLicensing Program ManagerSupervisor overseeing the inspection

Inspection Report

Complaint Investigation
Census: 80 Capacity: 95 Deficiencies: 1 Date: Feb 14, 2023

Visit Reason
An unannounced complaint investigation was conducted following an allegation that staff do not distribute residents' medications as prescribed.

Complaint Details
Complaint was substantiated. The allegation was that staff did not distribute residents' medications as prescribed, which was confirmed during the investigation.
Findings
The investigation substantiated that agency staff failed to administer medications to residents on February 1 and February 3, 2023, presenting a health, safety, and personal rights risk. Civil penalties were assessed and a Plan of Correction was required.

Deficiencies (1)
87465(a)(5)-Incidental Medical and Dental Care: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by agency staff failing to distribute medication to residents on February 3, 2023.
Report Facts
Capacity: 95 Census: 80 Plan of Correction Due Date: Feb 15, 2023

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation
Richard RemigioAdministratorFacility administrator involved in the investigation and exit interview
Hope DeBenedettiSupervisorSupervisor named in the report

Inspection Report

Complaint Investigation
Census: 80 Capacity: 95 Deficiencies: 1 Date: Feb 14, 2023

Visit Reason
An unannounced complaint investigation was conducted due to allegations that staff do not distribute residents' medications as prescribed.

Complaint Details
Complaint was substantiated. The complaint alleged that staff did not distribute residents' medications as prescribed. The missed medications occurred when agency staff were on the floor.
Findings
The investigation substantiated that agency staff failed to distribute medications to residents on February 1 and February 3, 2023, presenting an immediate health, safety, and personal rights risk to residents. Civil penalties were assessed and a plan of correction was required.

Deficiencies (1)
Failure to assist residents with self-administered medications as needed, resulting in missed medication administration on February 1 and February 3, 2023.
Report Facts
Capacity: 95 Census: 80 Plan of Correction Due Date: Feb 15, 2023

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Richard RemigioAdministratorFacility administrator involved in the investigation and exit interview
Hope DeBenedettiLicensing Program ManagerOversaw the complaint investigation

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 0 Date: Jan 30, 2023

Visit Reason
The inspection was conducted as a Case Management-Incident inspection regarding an SOC 341 that was forwarded to the Santa Rosa Regional Office.

Complaint Details
The visit was complaint-related as a Case Management-Incident inspection regarding an SOC 341. No deficiencies were found, indicating no substantiated issues.
Findings
No deficiencies were observed or cited during this Case Management-Incident Inspection. The Licensing Program Analyst interviewed staff and residents and reviewed requested documents.

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the Case Management-Incident inspection.
Richard RemigioAdministratorFacility Administrator who met with the Licensing Program Analyst and was involved in the inspection.

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 0 Date: Jan 30, 2023

Visit Reason
The inspection was conducted as a Case Management-Incident visit regarding an SOC 341 that was forwarded to the Santa Rosa Regional Office.

Complaint Details
The visit was complaint-related as a Case Management-Incident inspection regarding an SOC 341. No deficiencies were found.
Findings
No deficiencies were observed or cited during this Case Management-Incident Inspection.

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analyst during the inspection and granted access to the facility.
Farhaan SarangiLicensing Program AnalystConducted the Case Management-Incident inspection.
Hope DeBenedettiLicensing Program ManagerNamed in the report header.

Inspection Report

Census: 85 Capacity: 95 Deficiencies: 0 Date: Jan 23, 2023

Visit Reason
The inspection was an unannounced Case Management - Incident visit conducted by the Licensing Program Analyst to assess the facility and review relevant documentation regarding Resident #1.

Findings
No deficiencies were observed or cited during this Case Management-Incident inspection. The Licensing Program Analyst interviewed staff and Resident #1 and reviewed the staff roster, resident roster, LIC 602, and care plan.

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the Case Management-Incident inspection.
Kathy PawlackActivities DirectorMet with the Licensing Program Analyst during the inspection.
Nyla PaulinMemory Care DirectorMet with the Licensing Program Analyst during the inspection.

Inspection Report

Census: 85 Capacity: 95 Deficiencies: 0 Date: Jan 23, 2023

Visit Reason
The inspection was an unannounced Case Management - Incident visit conducted to review the facility's compliance related to a specific incident.

Findings
No deficiencies were observed or cited during this Case Management-Incident inspection after interviews and record reviews.

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the Case Management-Incident inspection.
Kathy PawlackActivities DirectorMet with the Licensing Program Analyst during the inspection.
Nyla PaulinMemory Care DirectorMet with the Licensing Program Analyst during the inspection.

Inspection Report

Annual Inspection
Census: 83 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2022

Visit Reason
The inspection was an unannounced Required 1 Year inspection conducted to evaluate compliance with licensing regulations at Paramount House Senior Living.

Findings
The facility was found to be clean, well-maintained, and compliant with regulations including food safety, medication storage, bathroom safety features, and emergency preparedness. No deficiencies were observed or cited during the inspection.

Report Facts
Food supply duration: 2 Food supply duration: 7 Fire extinguisher last inspection date: 2022 Emergency drill last conducted: 2022

Employees mentioned
NameTitleContext
Richard RemigioAdministratorFacility Administrator who met with Licensing Program Analyst and was involved in the inspection
Farhaan SarangiLicensing Program AnalystConducted the inspection and authored the report

Inspection Report

Plan of Correction
Census: 83 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2022

Visit Reason
The inspection was an unannounced Plan of Correction (POC) visit conducted to review the facility's compliance with the previously submitted Plan of Correction and discuss staffing schedules and reporting requirements.

Findings
No deficiencies were observed or cited during the Plan of Correction inspection. Discussions included maintaining weekly staff schedules, use of outside staffing agencies, reporting requirements, and ensuring timely medication administration.

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the Plan of Correction inspection.
Richard RemigioAdministratorFacility Administrator who participated in the inspection and discussions.

Inspection Report

Annual Inspection
Census: 83 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2022

Visit Reason
The inspection was an unannounced Required 1 Year inspection conducted to evaluate compliance with licensing regulations at Paramount House Senior Living.

Findings
The facility was found to be clean, well-maintained, and compliant with regulations including food safety, resident room conditions, medication storage, and fire safety. No deficiencies were observed or cited during the inspection.

Report Facts
Fire extinguisher last inspection date: 2022 Last emergency drill date: Oct 6, 2022

Employees mentioned
NameTitleContext
Richard RemigioAdministratorFacility Administrator who met with Licensing Program Analyst and participated in the inspection
Farhaan SarangiLicensing Program AnalystConducted the inspection and authored the report
Hope DeBenedettiLicensing Program ManagerNamed as Licensing Program Manager on the report

Inspection Report

Plan of Correction
Census: 83 Capacity: 95 Deficiencies: 0 Date: Dec 19, 2022

Visit Reason
The inspection was conducted as an unannounced Plan of Correction (POC) visit to verify compliance with previously identified issues and to discuss ongoing corrective actions.

Findings
No deficiencies were observed or cited during the Plan of Correction inspection. Discussions included retaining weekly staff schedules, staffing coverage plans, reporting requirements, and ensuring timely medication administration.

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analyst during the Plan of Correction inspection and discussed corrective actions.
Farhaan SarangiLicensing Program AnalystConducted the unannounced Plan of Correction inspection.
Hope DeBenedettiLicensing Program ManagerNamed as Licensing Program Manager on the report.

Inspection Report

Complaint Investigation
Census: 84 Capacity: 95 Deficiencies: 1 Date: Dec 9, 2022

Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that facility staff did not inform a resident's authorized person of an incident.

Complaint Details
The complaint alleged that facility staff did not inform the resident's authorized person of an incident. The complaint was substantiated based on interviews and document review confirming delayed reporting and notification failures.
Findings
The investigation confirmed that the facility failed to report a facility-wide medication error incident to Community Care Licensing in a timely manner and did not notify the responsible parties of the residents about the incident. The incident occurred on September 5, 2022, but was not reported until September 7, 2022.

Deficiencies (1)
Failure to report occurrences such as major accidents threatening resident welfare to the licensing agency within 24 hours as required by CCR 87211(a)(2).
Report Facts
Capacity: 95 Census: 84 Deficiency count: 1 Plan of Correction Due Date: Dec 16, 2022

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Kathy PawlakActivities DirectorMet with the Licensing Program Analyst during the investigation and exit interview
Richard RemigioAdministratorFacility administrator named in the report header
Hope DeBenedettiSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Census: 84 Capacity: 95 Deficiencies: 1 Date: Dec 9, 2022

Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the facility failed to ensure sufficient staffing necessary to provide care and supervision to residents.

Complaint Details
The complaint was substantiated. The allegation was that the facility failed to ensure sufficient staffing necessary to provide care and supervision to residents. The investigation confirmed insufficient staffing and an incident where medication was not dispensed due to lack of staff.
Findings
The investigation substantiated the complaint, confirming through interviews, document reviews, and an incident report that there were instances of insufficient staffing, including a specific incident on September 5, 2022, where staff was not present to dispense medication from 1600 to 2200 hours, posing an immediate health, safety, and personal rights risk to residents.

Deficiencies (1)
87411(a) Personnel Requirements - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by insufficient staffing throughout the course of the investigation.
Report Facts
Capacity: 95 Census: 84 Deficiencies cited: 1 Plan of Correction Due Date: Dec 12, 2022 Incident time: 1600 Incident time: 2200

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Kathy PawlakActivities DirectorMet with the evaluator and participated in the exit interview
Richard RemigioAdministratorFacility administrator named in the report
Hope DeBenedettiSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Census: 84 Capacity: 95 Deficiencies: 1 Date: Dec 9, 2022

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-07-12 alleging insufficient staffing to provide care and supervision to residents.

Complaint Details
The complaint was substantiated. The allegation was that the facility failed to ensure sufficient staffing necessary to provide care and supervision to residents. The investigation confirmed this through interviews, document review, and an incident report.
Findings
The investigation confirmed insufficient staffing throughout the facility based on interviews, review of facility documents, and an incident report documenting lack of staff to dispense medication on 2022-09-05 from 1600 to 2200 hours, presenting an immediate health, safety, and personal rights risk to residents.

Deficiencies (1)
Facility personnel were not sufficient in numbers and competent to provide necessary services to meet resident needs, violating CCR 87411(a).
Report Facts
Capacity: 95 Census: 84 Incident time frame: 6 Plan of Correction due date: Due date for correction was December 12, 2022

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Kathy PawlakActivities DirectorMet with the Licensing Program Analyst during the investigation and was involved in the exit interview
Richard RemigioAdministratorFacility administrator named in the report
Hope DeBenedettiLicensing Program ManagerNamed in the report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 84 Capacity: 95 Deficiencies: 1 Date: Dec 9, 2022

Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that facility staff did not inform a resident's authorized person of an incident.

Complaint Details
The complaint alleged that facility staff did not inform the resident's authorized person of an incident. The complaint was substantiated based on interviews and document review confirming delayed reporting and notification failures.
Findings
The investigation confirmed that the facility failed to report a medication error incident to Community Care Licensing in a timely manner and did not notify the responsible parties of the residents about the incident. The incident occurred on September 5, 2022, but was reported to licensing on September 7, 2022.

Deficiencies (1)
Failure to report occurrences such as major accidents threatening resident welfare to the licensing agency within 24 hours as required by CCR 87211(a)(2).
Report Facts
Capacity: 95 Census: 84 Deficiency count: 1 Incident date: Sep 5, 2022 Incident report date: Sep 7, 2022 Plan of Correction due date: Dec 16, 2022

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Kathy PawlakActivities DirectorMet with the Licensing Program Analyst during the investigation
Richard RemigioAdministratorFacility administrator named in the report header
Hope DeBenedettiLicensing Program ManagerNamed as Licensing Program Manager overseeing the investigation

Inspection Report

Complaint Investigation
Census: 86 Capacity: 95 Deficiencies: 0 Date: Oct 5, 2022

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint alleging that staff did not meet residents' dietary needs.

Complaint Details
The complaint alleged that staff did not meet residents' dietary needs. The allegation was found unsubstantiated after interviews, observations, and record reviews.
Findings
The investigation found the complaint allegation unsubstantiated as there was insufficient evidence to prove or disprove that staff failed to meet residents' dietary needs. Observations of residents eating and kitchen operations showed no concerns, and facility records confirmed special diets were executed according to residents' needs.

Report Facts
Capacity: 95 Census: 86

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and delivered findings
Richard RemigioAdministratorFacility administrator who met with the evaluator during the investigation

Inspection Report

Complaint Investigation
Census: 86 Capacity: 95 Deficiencies: 0 Date: Oct 5, 2022

Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 07/07/2022 alleging that unqualified staff administered medications to residents.

Complaint Details
Complaint was unsubstantiated as the Licensing Program Analyst could neither prove nor disprove the allegation that unqualified staff administered medications to residents.
Findings
The complaint allegation that unqualified staff administered medications to residents was found to be unsubstantiated due to lack of sufficient evidence. The Medication Assessment Record for July 2022 was reviewed for 21 residents, noting the receptionist’s name was not documented on the MAR.

Report Facts
Residents reviewed in MAR: 21

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and delivered findings
Richard RemigioAdministratorFacility administrator who met with the Licensing Program Analyst during the investigation

Inspection Report

Complaint Investigation
Census: 86 Capacity: 95 Deficiencies: 0 Date: Oct 5, 2022

Visit Reason
The inspection visit was an unannounced complaint investigation triggered by a complaint received on 2022-07-06 alleging that staff did not meet residents' dietary needs.

Complaint Details
The complaint alleged that staff did not meet residents' dietary needs. The allegation was found unsubstantiated due to lack of preponderance of evidence to prove or disprove the claim.
Findings
The investigation found the allegation unsubstantiated after interviews, observations of residents eating, and review of facility records including food menus and special diets, with no evidence proving the staff failed to meet residents' dietary needs.

Report Facts
Facility capacity: 95 Census: 86

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Richard RemigioAdministratorFacility administrator who met with the Licensing Program Analyst during the investigation
Hope DeBenedettiLicensing Program ManagerNamed as Licensing Program Manager on the report

Inspection Report

Complaint Investigation
Census: 86 Capacity: 95 Deficiencies: 0 Date: Oct 5, 2022

Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that unqualified staff administered medications to residents at Paramount House Senior Living.

Complaint Details
The complaint alleged that unqualified staff administered medications to residents. The allegation was found unsubstantiated after investigation, with no preponderance of evidence to confirm or deny the claim.
Findings
The investigation found the allegation to be unsubstantiated, meaning there was insufficient evidence to prove or disprove that unqualified staff administered medications to residents. The Medication Assessment Record for July 2022 was reviewed, noting the receptionist's name was not documented on the MAR.

Report Facts
Capacity: 95 Census: 86 Residents reviewed in MAR: 21

Employees mentioned
NameTitleContext
Farhaan SarangiLicensing Program AnalystConducted the complaint investigation and authored the report
Richard RemigioAdministratorFacility administrator who met with the Licensing Program Analyst during the investigation
Hope DeBenedettiLicensing Program ManagerNamed as Licensing Program Manager on the report

Inspection Report

Capacity: 95 Deficiencies: 0 Date: Sep 2, 2022

Visit Reason
The visit was an unannounced case management inspection conducted in response to two incidents reported by the facility, including a complaint about the Director of Dining Services allegedly yelling at staff and residents, and a domestic dispute between two residents.

Findings
The investigation found no evidence of yelling directed at residents, and the noise in the kitchen likely required staff to raise their voices. The domestic dispute involved two residents who are responsible parties and do not require supervision. The facility reported the situation as required and no citations were issued.

Employees mentioned
NameTitleContext
Richard RemigioExecutive DirectorMet with Licensing Program Analyst during the visit and conducted investigation of incidents.
Christopher ArnholdLicensing Program AnalystConducted the case management visit and investigation.
Bethany MoellersSupervisorSupervisor overseeing the licensing evaluation.

Inspection Report

Capacity: 95 Deficiencies: 0 Date: Sep 2, 2022

Visit Reason
Unannounced case management visit conducted in response to two incidents reported by the facility, including a complaint about the Director of Dining Services yelling and a domestic dispute between two residents.

Findings
The investigation found no citations were issued. The Director of Dining Services was observed possibly raising their voice due to kitchen noise, but no direct yelling at residents was confirmed. The domestic dispute involved two residents who are responsible parties and was reported as required.

Employees mentioned
NameTitleContext
Richard RemigioExecutive DirectorMet with Licensing Program Analyst during visit and conducted investigation of incidents.
Christopher ArnholdLicensing Program AnalystConducted the case management visit and investigation.
Bethany MoellersLicensing Program ManagerNamed in report header.

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 1 Date: Aug 19, 2022

Visit Reason
The visit was an unannounced Case Management - Other visit conducted as part of a Complaint Investigation to review facility compliance and resident care.

Complaint Details
The visit was complaint-related, focusing on whether the facility updated resident care plans appropriately. The report does not explicitly state substantiation status.
Findings
The Licensing Program Analyst observed that a Resident's Needs and Services Plan was not appropriately updated to match the Physician's Report on file, indicating a failure to update care plans as needed. Additionally, a resident was observed having frequent and loud vocalizations, and discussions were held regarding the facility's response to their care needs.

Deficiencies (1)
Failure to ensure that a Resident's care plan was updated as needed to reflect changes indicated in the Physician's Report, posing potential health, safety, and personal risk to residents.
Report Facts
Capacity: 95 Census: 82 Plan of Correction Due Date: Sep 16, 2022

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analyst during the visit and discussed findings
Caitlynn FeliasLicensing Program AnalystConducted the inspection and authored the report
Kimberley MotaSupervisorSupervisor overseeing the inspection

Inspection Report

Complaint Investigation
Census: 82 Capacity: 95 Deficiencies: 1 Date: Aug 19, 2022

Visit Reason
The visit was an unannounced Case Management - Other visit conducted as part of a Complaint Investigation to review facility compliance and resident care.

Complaint Details
The visit was complaint-related. The deficiency involved failure to update a Resident's Needs and Services Plan to match the Physician's Report. Substantiation status is not explicitly stated.
Findings
The Licensing Program Analyst observed that a Resident's Needs and Services Plan was not appropriately updated to match the Physician's Report on file, posing a potential health, safety, and personal risk to residents. Additionally, a resident was observed having frequent and loud vocalizations, with discussions on care provided.

Deficiencies (1)
Resident's care plan was not updated as needed to reflect changes indicated by medical assessments, posing potential health, safety, and personal risk.
Report Facts
Capacity: 95 Census: 82 Plan of Correction Due Date: Sep 16, 2022

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analyst during inspection and discussed findings
Caitlynn FeliasLicensing Program AnalystConducted the inspection and documented findings
Kimberley MotaLicensing Program ManagerSupervisor overseeing the inspection

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 0 Date: Aug 11, 2022

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2022-06-03 regarding alleged personal rights violations at the facility.

Complaint Details
The complaint alleged personal rights violations involving suspected abuse of resident R1. The resident had mild cognitive impairment and was unable to recall the incident. Multiple interviews and documentation reviews were conducted, but no conclusive evidence was found to substantiate the allegation. The complaint was determined to be unsubstantiated.
Findings
The investigation found that the facility failed to report suspected abuse and did not conduct an investigation at the time of the incident. However, based on interviews, documentation, and police reports, the allegation of personal rights violation was unsubstantiated due to lack of sufficient evidence. No deficiencies were cited during this inspection.

Report Facts
Capacity: 95 Census: 81

Employees mentioned
NameTitleContext
Carla Fernandes-GoesLicensing EvaluatorConducted the complaint investigation
Richard RemigioExecutive DirectorFacility administrator met during the investigation and provided information

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 2 Date: Aug 11, 2022

Visit Reason
The visit was an unannounced case management inspection conducted to close a complaint investigation related to suspected abuse and staff training deficiencies at the facility.

Complaint Details
The complaint investigation was related to suspected abuse of resident R1 reported late by the facility and inadequate staff training. The complaint was substantiated by findings of delayed reporting and incomplete staff training documentation.
Findings
The investigation found that the facility failed to report suspected abuse in a timely manner and did not conduct an investigation as required. Additionally, staff members S1 and S2 lacked all required training hours and documentation as mandated by the Health & Safety Code.

Deficiencies (2)
Failure to submit a written report of suspected abuse and incident reports to the Department in a timely manner.
Staff training deficiencies: staff S1 and S2 did not have proof of required 40 hours of initial training and/or medication shadowing on file.
Report Facts
Training hours for staff S2: 30.25 Training hours for staff S1: 8.15 Plan of Correction Due Date: Aug 25, 2022

Employees mentioned
NameTitleContext
Richard RemigioExecutive DirectorNamed in relation to the suspected abuse incident and facility's failure to report
Jessica GarciaResident Care DirectorMentioned as responsible for staff training documentation
Carla Fernandes-GoesLicensing EvaluatorConducted the inspection and authored the report
Bethany MoellersSupervisorSupervisor overseeing the licensing evaluation

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 0 Date: Aug 11, 2022

Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2022-06-03 regarding alleged personal rights violations at the facility.

Complaint Details
The complaint allegation was related to personal rights violations. The allegation was unsubstantiated as there was not a preponderance of evidence to prove the violation did or did not occur.
Findings
The investigation found that the facility had a report of suspected abuse for a resident but failed to conduct an investigation or report it timely. However, based on interviews, documentation, and police reports, the allegation of personal rights violation was unsubstantiated due to lack of sufficient evidence. No deficiencies were cited during this inspection.

Report Facts
Complaint received date: Jun 3, 2022 Facility capacity: 95 Census: 81

Employees mentioned
NameTitleContext
Carla Fernandes-GoesLicensing Program AnalystConducted the complaint investigation and unannounced visit
Richard RemigioExecutive DirectorFacility administrator met during investigation and named in findings
Bethany MoellersLicensing Program ManagerNamed as Licensing Program Manager on report

Inspection Report

Complaint Investigation
Census: 81 Capacity: 95 Deficiencies: 2 Date: Aug 11, 2022

Visit Reason
The visit was conducted as a case management follow-up to close a complaint investigation regarding suspected abuse and staff training deficiencies at the facility.

Complaint Details
The complaint investigation was related to suspected abuse of resident R1 reported late by the facility and incomplete staff training records for staff S1 and S2. The complaint was substantiated with observed deficiencies.
Findings
The facility failed to report suspected abuse in a timely manner and did not conduct an investigation as required. Additionally, staff members S1 and S2 lacked required training hours and documentation as mandated by the Health & Safety Code.

Deficiencies (2)
Failure to submit a written report of suspected abuse timely, posing potential health, safety, and personal rights risks to residents.
Staff training deficiencies: two caregivers lacked proof of required 40 hours of initial training and medication shadowing.
Report Facts
Deficiencies cited: 2 Staff training hours: 30.25 Medication training hours: 8.15 Plan of Correction due date: Aug 25, 2022

Employees mentioned
NameTitleContext
Richard RemigioExecutive DirectorNamed in relation to the suspected abuse incident and facility's failure to report

Inspection Report

Plan of Correction
Census: 80 Capacity: 95 Deficiencies: 0 Date: Aug 3, 2022

Visit Reason
Unannounced Plan of Corrections (POC) visit to review corrections made for deficiencies cited during a prior visit on 2022-07-01.

Findings
The administrator provided the plan of corrections to Licensing Program Analysts, and the previously cited deficiency was cleared during this visit. No deficiencies were cited during this inspection.

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analysts during the Plan of Corrections visit.

Inspection Report

Plan of Correction
Census: 80 Capacity: 95 Deficiencies: 0 Date: Aug 3, 2022

Visit Reason
Unannounced Plan of Corrections (POC) visit to review corrections made for deficiencies cited during a prior visit on 2022-07-01.

Findings
The administrator provided the plan of corrections to Licensing Program Analysts, and the deficiency cited previously was cleared during this visit. No deficiencies were cited during this inspection.

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analysts during the Plan of Corrections visit.

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 1 Date: Jul 1, 2022

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that the facility was not providing medication as prescribed and not meeting residents' needs.

Complaint Details
The complaint investigation was substantiated regarding the facility not providing medication as prescribed. The allegation that the facility was not meeting residents' needs was unsubstantiated.
Findings
The allegation that the facility was not providing medication as prescribed was substantiated, as the facility failed to administer medication as ordered for three days before obtaining a new physician order. The allegation that the facility was not meeting residents' needs was unsubstantiated based on file review and interviews.

Deficiencies (1)
Licensee did not ensure that Resident's medication was provided as prescribed, posing an immediate health, safety, and personal risk to residents in care.
Report Facts
Capacity: 95 Census: 78 Plan of Correction Due Date: Jul 2, 2022 Plan of Correction Due Date: Jul 20, 2022

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with during inspection and involved in plan of correction development
Caitlynn FeliasLicensing Program AnalystConducted the complaint investigation
Kimberley MotaSupervisorSupervisor overseeing the investigation

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 1 Date: Jul 1, 2022

Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that the facility was not providing medication as prescribed.

Complaint Details
The complaint was substantiated. The allegation that the facility was not providing medication as prescribed was found valid based on the preponderance of evidence.
Findings
The investigation substantiated that the facility did not provide medication as prescribed for three days, failing to administer a medication two times per day as ordered. The facility contacted the physician for an updated order and began administering the medication as directed.

Deficiencies (1)
Licensee did not ensure that Resident's medication was provided as prescribed, posing an immediate health, safety, and personal risk to residents in care.
Report Facts
Capacity: 95 Census: 78 Plan of Correction Due Date: Jul 2, 2022 Plan of Correction Due Date: Jul 20, 2022

Employees mentioned
NameTitleContext
Caitlynn FeliasLicensing Program AnalystConducted the complaint investigation and delivered findings
Richard RemigioAdministratorFacility administrator involved in exit interview and plan of correction development
Kimberley MotaLicensing Program ManagerOversaw the complaint investigation process

Inspection Report

Annual Inspection
Census: 80 Capacity: 95 Deficiencies: 0 Date: Dec 17, 2021

Visit Reason
Licensing Program Analysts conducted an unannounced Annual Required inspection focused on the Infection Control procedures and practices of the facility.

Findings
The facility was found to be compliant with infection control practices including visitor screening, staff vaccination, PPE availability, and cleaning protocols. No deficiencies were cited during this inspection.

Report Facts
PPE supply duration: 30 Medication supply duration: 30

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analysts during the inspection and provided documentation.
Victoria WillisLicensing EvaluatorConducted the inspection and signed the report.
Caitlynn FeliasLicensing Program AnalystConducted the inspection.
Hope DeBenedettiSupervisorSupervisor overseeing the inspection.

Inspection Report

Annual Inspection
Census: 80 Capacity: 95 Deficiencies: 0 Date: Dec 17, 2021

Visit Reason
Licensing Program Analysts conducted an unannounced Annual Required inspection focused on Infection Control procedures and practices at the facility.

Findings
The facility demonstrated compliance with infection control practices including visitor screening, staff vaccination, and PPE availability. No deficiencies were cited during this inspection.

Report Facts
PPE supply duration: 30 Medication supply duration: 30

Employees mentioned
NameTitleContext
Richard RemigioAdministratorMet with Licensing Program Analysts during the inspection and provided documentation.
Victoria WillisLicensing Program AnalystConducted the inspection.
Caitlynn FeliasLicensing Program AnalystConducted the inspection.
Hope DeBenedettiLicensing Program ManagerNamed in the report as Licensing Program Manager.

Inspection Report

Complaint Investigation
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation received on 2021-06-28 that staff were not adequately trained, specifically medication technicians lacking proper training to distribute medication.

Complaint Details
The complaint was substantiated based on interviews and review of staff records. The allegation that staff were not adequately trained, specifically medication technicians lacking proper training, was found valid by a preponderance of the evidence standard.
Findings
The investigation found that the facility was unable to provide verification that all required training had been completed for 5 out of 5 staff reviewed, substantiating the allegation that staff were not adequately trained. This posed an immediate health, safety, or personal rights risk to persons in care.

Deficiencies (1)
Personnel Requirements (CCR 87411(d)(4)) not met: All personnel shall be given on the job training appropriate for the job assigned, including knowledge required to safely assist with prescribed medications. The Administrator did not provide verification of staff training for 5 out of 5 staff.
Report Facts
Staff training records reviewed: 5 Capacity: 95 Census: 83 Plan of Correction Due Date: Aug 9, 2021

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted the complaint investigation and authored the report.
Richard RemigioAdministratorFacility administrator met during the investigation and stated unawareness of staff training records.
Siobhan LehmanAdministratorNamed as facility administrator in report header.
Hope DeBenedettiSupervisorSupervisor overseeing the licensing evaluation.

Inspection Report

Follow-Up
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The visit was a case management follow-up on a self-reported incident involving neglect of a resident with incontinence care that occurred on 2021-07-01.

Complaint Details
The visit was complaint-related, triggered by a self-reported incident on 2021-07-01 involving neglect of a resident with incontinence care. The incident was substantiated.
Findings
The investigation confirmed that staff neglected to assist a resident with incontinence care, violating the resident's personal rights. Staff responsible were terminated, and a deficiency citing Personal Rights (LIC 809-D) was issued.

Deficiencies (1)
Staff neglected to assist a resident with incontinence care, violating personal rights as per LIC 809-D.
Report Facts
Capacity: 95 Census: 83 Plan of Correction Due Date: Aug 9, 2021

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted the case management visit and investigation
Richard RemigoAdministratorFacility administrator who investigated the incident

Inspection Report

Complaint Investigation
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The Licensing Program Analyst arrived unannounced to deliver findings on a complaint regarding facility practices.

Complaint Details
Complaint investigation visit; findings substantiated by observation of unlocked medication cart accessible to residents with dementia.
Findings
During the complaint investigation, it was observed that a medication cart was left unlocked with keys on top in the memory care unit, posing an immediate health and safety concern for residents with dementia.

Deficiencies (1)
Medication cart was unlocked and accessible to persons with dementia, violating CCR 87705(f)(2) which requires over-the-counter medication, nutritional supplements or vitamins to be stored inaccessible to residents with dementia.
Report Facts
Capacity: 95 Census: 83 Deficiencies cited: 1

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted complaint investigation and cited deficiencies
Siobhan LehmanAdministratorFacility administrator present during inspection and involved in addressing findings

Inspection Report

Follow-Up
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The visit was a case management follow-up on a self-reported incident involving neglect of a resident with incontinence care.

Complaint Details
The visit was triggered by a self-reported incident on 07/01/2021 involving neglect by staff (S1). The incident was substantiated, and the responsible staff member was terminated the same day.
Findings
The investigation confirmed that staff neglected to assist a resident with incontinence care, violating the resident's personal rights. A deficiency was cited under Personal Rights (LIC 809-D).

Deficiencies (1)
Staff neglected to assist resident (R1) with incontinence care, violating personal rights.
Report Facts
Capacity: 95 Census: 83 Plan of Correction Due Date: Aug 9, 2021

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted the case management visit and investigation
Hope DeBenedettiLicensing Program ManagerSupervisor overseeing the licensing evaluation
Richard RemigoAdministratorFacility administrator involved in the investigation

Inspection Report

Complaint Investigation
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The inspection visit occurred to deliver findings on a complaint and to investigate the complaint regarding facility practices.

Complaint Details
The visit was complaint-related. The complaint was substantiated by the observation of the unlocked medication cart posing an immediate health and safety concern.
Findings
During the complaint investigation, it was observed that a medication cart was left unlocked with keys on top in the memory care unit, posing an immediate health and safety concern for residents with dementia.

Deficiencies (1)
Medication cart was unlocked and accessible to persons with dementia in care, violating care requirements for persons with dementia.
Report Facts
Capacity: 95 Census: 83 Plan of Correction Due Date: 0

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted the complaint investigation and authored the report
Hope DeBenedettiLicensing Program ManagerSupervisor overseeing the inspection
Richard RemigioAdministratorFacility administrator present during the inspection

Inspection Report

Complaint Investigation
Census: 83 Capacity: 95 Deficiencies: 1 Date: Jul 30, 2021

Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation received on 2021-06-28 that staff are not adequately trained, specifically that medication technicians do not have proper training to distribute medication.

Complaint Details
The complaint was substantiated based on interviews and review of staff records. The allegation that staff are not adequately trained, specifically medication technicians lacking proper training, was found valid by preponderance of evidence.
Findings
The investigation found that the facility was unable to provide verification that all required training had been completed for 5 out of 5 staff reviewed, substantiating the allegation that staff are not adequately trained. This poses an immediate health, safety, or personal rights risk to persons in care.

Deficiencies (1)
Personnel Requirements (CCR 87411(d)(4)) not met: All personnel shall be given on the job training as appropriate for the job assigned, including knowledge required to safely assist with prescribed medications. The facility did not provide verification of staff training for 5 out of 5 staff.
Report Facts
Staff training records reviewed: 5 Capacity: 95 Census: 83 Plan of Correction due date: Aug 9, 2021

Employees mentioned
NameTitleContext
Katrina WaltersLicensing Program AnalystConducted the complaint investigation and authored the report
Hope DeBenedettiLicensing Program ManagerOversaw the complaint investigation
Richard RemigioAdministratorFacility administrator met during the investigation and stated unawareness of staff training records

Inspection Report

Complaint Investigation
Census: 76 Capacity: 95 Deficiencies: 1 Date: Jun 23, 2021

Visit Reason
The inspection was an unannounced complaint investigation triggered by a complaint received on 2021-02-19 alleging that staff did not provide assistance in meeting a resident's need for a medical appointment with a physician.

Complaint Details
The complaint was substantiated based on evidence that facility staff did not provide assistance for resident R1's medical appointment, resulting in a missed video appointment due to staff no-show.
Findings
The investigation found that the facility staff failed to assist resident R1 with a scheduled medical video appointment, resulting in a 'no show' by facility staff. The facility lacked documentation of the scheduled appointment and any rescheduling efforts. The allegation was substantiated.

Deficiencies (1)
87465(a)(1) INCIDENTAL MEDICAL & DENTAL CARE. The licensee failed to ensure arranging or assisting in arranging for medical and dental care appropriate to the condition and needs of resident.
Report Facts
Capacity: 95 Census: 76 Plan of Correction Due Date: Jun 28, 2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation
Richie RimigioActing AdministratorMet with Licensing Program Analyst during investigation
Siobhan LehmanAdministratorNamed as facility administrator

Inspection Report

Complaint Investigation
Census: 76 Capacity: 95 Deficiencies: 1 Date: Jun 23, 2021

Visit Reason
The inspection was an unannounced complaint investigation conducted due to a complaint alleging that staff did not provide assistance in meeting a resident's need for a medical appointment with a physician.

Complaint Details
The complaint alleged that staff did not provide assistance in meeting a resident's need for a medical appointment with a physician. The allegation was substantiated after investigation, including interviews with the resident's healthcare provider and facility staff, confirming a 'no show' by facility staff for the scheduled video appointment.
Findings
The investigation found that the facility did not have any record of the resident's scheduled medical appointment or documentation of rescheduling the missed appointment. The allegation that staff failed to assist the resident with the medical appointment was substantiated based on interviews and record reviews.

Deficiencies (1)
Failure to arrange or assist in arranging medical and dental care appropriate to the conditions and needs of residents, specifically failing to ensure a scheduled medical video appointment was conducted and documented.
Report Facts
Deficiencies cited: 1 Plan of Correction Due Date: Jun 28, 2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Richie RimigioActing AdministratorMet with Licensing Program Analyst during investigation
Siobhan LehmanAdministratorNamed as facility administrator in report header
Kimberley MotaLicensing Program ManagerNamed as Licensing Program Manager overseeing the investigation

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 0 Date: Jun 8, 2021

Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2021-01-21 regarding staff mismanaging resident's medication, not meeting resident's needs, and not following emergency protocols.

Complaint Details
The complaint included allegations of staff mismanaging resident's medication, not meeting resident's needs, and not following emergency protocols. The investigation found these allegations to be unsubstantiated due to conflicting information and lack of evidence.
Findings
The investigation found that the allegations were unsubstantiated based on medication counts matching records, observations of adequate care, and lack of corroborating evidence regarding emergency protocol violations despite conflicting information from interviews.

Report Facts
Capacity: 95 Census: 78

Employees mentioned
NameTitleContext
Siobhan LehmanAdministratorMet with Licensing Program Analyst during the complaint investigation
Dominic TobolaLicensing EvaluatorConducted the complaint investigation visit
Kimberley MotaSupervisorSupervisor overseeing the complaint investigation

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 0 Date: Jun 8, 2021

Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2021-01-21 regarding staff mismanaging resident's medication, not meeting resident's needs, and not following emergency protocols.

Complaint Details
The complaint included allegations that staff mismanaged resident medication, failed to meet resident needs, and did not follow emergency protocols during a January 2021 emergency incident. All allegations were found to be unsubstantiated due to conflicting information and lack of corroborating evidence.
Findings
The investigation found all allegations to be unsubstantiated after reviewing medication counts, interviewing staff, residents, and outside parties, and touring the facility. Conflicting information was received, and no corroborating evidence was found to prove the allegations.

Report Facts
Capacity: 95 Census: 78 Medication count sample: 3

Employees mentioned
NameTitleContext
Siobhan LehmanAdministratorMet with Licensing Program Analyst during investigation
Dominic TobolaLicensing Program AnalystConducted complaint investigation
Kimberley MotaLicensing Program ManagerNamed in report as Licensing Program Manager

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 2 Date: Jun 3, 2021

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-02-19 regarding staff not following physician's orders, failure to accord resident dignity, and failure to report changes in resident's condition timely.

Complaint Details
The complaint investigation was substantiated for allegations that staff did not follow physician's orders and resident was not accorded dignity. The allegation that staff did not ensure changes in resident's condition were reported to a physician in a timely manner was unsubstantiated.
Findings
The investigation substantiated that staff did not follow physician's medication orders for resident R1 and that resident R1 was not accorded dignity due to being left in soiled continence care products for several hours. The allegation that staff did not ensure timely reporting of changes in resident's condition to a physician was unsubstantiated.

Deficiencies (2)
Facility failed to ensure residents with continence care are properly managed; resident R1 was left in soiled continence care products for hours after requesting assistance.
Facility failed to ensure resident's medication orders were followed according to physician's directions; resident R1 was administered a laxative daily against a physician's discontinue order.
Report Facts
Capacity: 95 Census: 78 Plan of Correction Due Date: 2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Siobhan LehmanAdministratorFacility administrator met with the evaluator during the investigation

Inspection Report

Complaint Investigation
Census: 78 Capacity: 95 Deficiencies: 2 Date: Jun 3, 2021

Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2021-02-19 regarding staff not following physician's orders and resident dignity concerns.

Complaint Details
The complaint investigation was substantiated for allegations that staff did not follow physician's orders regarding medication administration and that a resident was not accorded dignity due to delayed changing of continence care products. The allegation that staff did not ensure timely reporting of changes in resident condition to a physician was unsubstantiated.
Findings
The investigation substantiated that staff did not follow physician's orders by administering a laxative medication against a discontinuation order and that a resident was left in soiled continence care products for several hours, violating dignity standards. Another allegation regarding timely reporting of changes in resident condition to a physician was unsubstantiated.

Deficiencies (2)
Facility failed to ensure residents with continence care are properly managed, leaving resident R1 in soiled continence care products for hours.
Facility failed to ensure resident's medication orders were followed according to physician's directions, administering laxative medication against a discontinue order.
Report Facts
Facility capacity: 95 Census: 78 Plan of Correction due date: Jun 4, 2021 Plan of Correction due date: Jun 15, 2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Siobhan LehmanAdministratorFacility administrator met during investigation and named in findings
Kimberley MotaLicensing Program ManagerNamed as Licensing Program Manager overseeing the investigation

Inspection Report

Complaint Investigation
Census: 75 Capacity: 95 Deficiencies: 1 Date: Feb 18, 2021

Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations of staff mismanaging residents' medications and other related complaints.

Complaint Details
The complaint investigation was substantiated for staff mismanaging medications, specifically a missing narcotic medication by staff S1. Other allegations regarding medication errors, inappropriate staff behavior, and resident care were found unsubstantiated.
Findings
The complaint investigation found that staff S1 was responsible for a missing narcotic medication for resident R1 during a medication audit. Two additional medication errors were noted for other staff, but the facility lacked documentation of corrective actions. Other allegations including residents being given another resident's medication, staff speaking inappropriately, staff hitting residents, and residents not being changed timely were found to be unsubstantiated due to conflicting information and lack of corroborating evidence.

Deficiencies (1)
Administrator failed to ensure proper management of medication administration, including a missing narcotic medication for resident R1 found during a medication audit.
Report Facts
Capacity: 95 Census: 75 Medication audit date: Jan 25, 2021 Plan of Correction Due Date: Mar 2, 2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation
Kathleen BritoResident Service DirectorMet with Licensing Program Analyst during investigation
Siobhan LehmanAdministratorNamed in medication management deficiency
Hope DeBenedettiLicensing Program ManagerOversaw complaint investigation
Kimberley MotaLicensing Program ManagerSigned plan of correction acknowledgment

Inspection Report

Complaint Investigation
Census: 75 Capacity: 95 Deficiencies: 2 Date: Feb 17, 2021

Visit Reason
The inspection was an unannounced complaint investigation conducted in response to multiple allegations received on 2020-04-29 regarding medication handling, incident report submission, staff qualifications, resident file management, and staff conduct.

Complaint Details
The complaint investigation was substantiated for allegations that staff had access to discontinued medication and that incident reports were not submitted timely. Other allegations including questionable death, staff handling destroyed medications, roughness with residents, and inappropriate comments were unsubstantiated.
Findings
The investigation substantiated that staff had access to discontinued medication stored unsecured and that incident reports were not submitted in a timely manner. Other allegations including questionable death, staff handling destroyed medications, rough treatment of residents, and inappropriate comments were found to be unsubstantiated.

Deficiencies (2)
Facility failed to follow the plan of operation regarding handling of medication requiring disposal; medications requiring destruction were improperly stored unsecured on a medication room shelf accessible to untrained staff.
Facility failed to submit 11 separate incident reports within the required 7 days of occurrence between March 2020 and June 2020; 5 reports were submitted over 10 days late.
Report Facts
Incident reports not submitted timely: 11 Incident reports submitted over 10 days late: 5 Facility capacity: 95 Facility census: 75

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation
Kathleen BeritoResident Service DirectorMet with Licensing Program Analyst during investigation
Siobhan LehmanAdministratorNamed in relation to deficiencies regarding medication handling and incident report submission

Inspection Report

Complaint Investigation
Census: 75 Capacity: 95 Deficiencies: 1 Date: Feb 16, 2021

Visit Reason
The inspection was an unannounced complaint investigation triggered by a complaint received on 2020-10-19 alleging that the facility was short staffed and not providing adequate services to residents.

Complaint Details
Complaint control number 21-AS-20201019132325. The complaint was substantiated regarding insufficient staffing but unsubstantiated regarding inadequate services to residents.
Findings
The investigation substantiated the allegation that the facility was short staffed on multiple dates between 2020-10-11 and 2020-10-24, posing an immediate health and safety risk. The allegation that the facility was not providing adequate services to residents was found to be unsubstantiated due to conflicting information.

Deficiencies (1)
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Administrator failed to ensure number of staffing was sufficient on multiple dates between 10/11/2020 - 10/24/2020.
Report Facts
Capacity: 95 Census: 75 Dates of insufficient staffing: Multiple dates between 10/11/2020 and 10/24/2020 Plan of Correction Due Date: 02/17/2021

Employees mentioned
NameTitleContext
Dominic TobolaLicensing Program AnalystConducted the complaint investigation and authored the report
Siobhan LehmanAdministratorFacility administrator met during investigation and named in findings

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