Inspection Reports for Peninsula Del Rey
165 Pierce St, Daly City, CA 94015, United States, CA, 94015
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with the facility consistently meeting safety, infection control, and medication storage requirements. Several complaint investigations were unsubstantiated, including allegations about staff behavior, resident care, and medication handling. The only deficiency noted was in April 2022, when the facility failed to timely report staff COVID infections to the licensing division, which posed a potential health risk. The most recent report from April 15, 2025, was clean with no deficiencies observed. This record shows improvement over time, with no recent issues and a history of mostly unsubstantiated complaints.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
0.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
95% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
71% occupied
Based on a April 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 106
Capacity: 150
Deficiencies: 0
Apr 15, 2025
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements for the assisted living and independent living facility.
Findings
The facility was found to be clean, well-maintained, and compliant with safety and health regulations. No fire safety hazards or deficiencies were observed, and resident and staff records were complete and up to date. Medications and hazardous materials were securely stored.
Report Facts
Resident records reviewed: 5
Staff records reviewed: 5
Fire extinguisher check date: 2024
Water temperature range: 117
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Katherine Tazawa | Administrator | Met with Licensing Program Analyst during inspection |
| Komal Charitra | Licensing Program Analyst | Conducted the inspection visit |
| April Cowan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 106
Capacity: 150
Deficiencies: 0
Aug 15, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that facility staff refused to assist a resident with a CPAP machine and were unable to effectively communicate with the resident due to a language barrier.
Findings
The investigation found that although there were several attempts to assist the resident with the CPAP machine, the resident did not want to use it. The allegation of staff refusing assistance was unsubstantiated due to lack of evidence. The allegation of communication barriers was found to be unfounded as the resident communicated in English and no interpreter was requested.
Complaint Details
The complaint involved allegations that staff refused to assist a resident with a CPAP machine and were unable to communicate effectively due to a language barrier. The investigation included interviews with staff, the resident, and a police officer. The allegations were determined to be unsubstantiated and unfounded respectively.
Report Facts
Capacity: 150
Census: 106
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Donato | Licensing Program Analyst | Conducted the complaint investigation visit |
| Katherine Tazawa | Executive Director | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 150
Deficiencies: 0
Aug 15, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations regarding staff behavior, adequacy of food service, and residents' dignity in personal relationships with staff and others.
Findings
The investigation found that although some allegations may have occurred, there was insufficient evidence to substantiate the claims. Staff followed food safety protocols when disposing of returned food and provided replacement meals. Residents interviewed expressed satisfaction with staff and the facility environment.
Complaint Details
The complaint involved allegations of staff displaying inappropriate behavior in front of residents, failure to ensure adequate food service, and failure to accord residents dignity in personal relationships. The investigation concluded the allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 150
Census: 102
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Donato | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Katherine Tazawa | Executive Director | Met with Licensing Program Analyst during the investigation |
Inspection Report
Annual Inspection
Census: 95
Capacity: 150
Deficiencies: 0
Apr 12, 2024
Visit Reason
An unannounced required 1 year annual inspection visit was conducted to evaluate the facility's compliance with licensing regulations.
Findings
The Licensing Program Analyst toured the facility and observed compliance with safety, infection control, and physical plant requirements. No citations were issued during this inspection.
Report Facts
Bedridden residents: 20
Non-ambulatory residents: 140
Hospice approved capacity: 20
Hospice residents: 5
Facility temperature: 70
Hot water temperature: 111.6
Staff files reviewed: 3
Resident files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Katherine Tazawa | Executive Director | Met with Licensing Program Analyst during inspection and discussed administrator certificate status |
| Jaime Vado | Licensing Program Analyst | Conducted the inspection visit |
Inspection Report
Post Licensing
Census: 95
Capacity: 150
Deficiencies: 0
Apr 12, 2024
Visit Reason
An unannounced post licensing inspection was conducted to evaluate compliance with licensing requirements and ensure the safety and well-being of residents.
Findings
The facility was toured and inspected with no safety hazards observed. Infection control measures, medication storage, fire safety equipment, and resident rooms met regulatory requirements. No citations were issued.
Report Facts
Bedridden residents: 20
Non-ambulatory residents: 140
Hospice approved beds: 20
Hospice residents bedridden: 5
Facility temperature: 70
Hot water temperature: 111.6
Staff files reviewed: 3
Resident files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Katherine Tazawa | Executive Director | Met with Licensing Program Analyst during inspection |
| Jaime Vado | Licensing Program Analyst | Conducted the unannounced post licensing inspection |
Inspection Report
Complaint Investigation
Capacity: 150
Deficiencies: 0
Oct 20, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2023-02-27 regarding staff financial abuse, non-adherence to the Admission's Agreement, and unmet resident toileting needs.
Findings
After reviewing documents and conducting interviews, the Licensing Program Analyst was unable to substantiate the allegations due to lack of sufficient evidence. No citations were issued.
Complaint Details
The complaint investigation was unsubstantiated as there was not a preponderance of evidence to prove the alleged violations occurred.
Report Facts
Capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the complaint investigation |
| Cara Smith | Licensing Program Manager | Named in report as Licensing Program Manager |
| Katherine Tazawa | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 105
Capacity: 150
Deficiencies: 0
Sep 22, 2023
Visit Reason
The visit was an unannounced Required - 1 Year inspection to evaluate the facility's compliance with licensing regulations.
Findings
No deficiencies were observed or cited during the inspection. The facility was found to be in compliance with regulations including safety, medication storage, infection control, and environmental conditions.
Report Facts
Capacity: 150
Census: 105
Bedridden residents: 0
Hospice care residents: 5
Temperature inside facility: 70
Hot water temperature: 111.6
Perishables observed: 2
Non-perishables observed: 7
Staff files reviewed: 3
Resident files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Victoria Brown | Licensing Program Analyst | Conducted the inspection and signed the report |
| Joseph Bautista Nallas | Business Manager | Met with Licensing Program Analyst during inspection |
| Mariana Pelayo | Regional Nurse | Met with Licensing Program Analyst during inspection |
| Edgardo Baclaan | Environmental Services Director | Met with Licensing Program Analyst during inspection |
| Katherine Tazawa | Administrator | Facility Administrator; certificate observed expired but renewal submitted |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 150
Deficiencies: 0
Aug 31, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that facility staff did not answer a resident's call button in a timely manner.
Findings
The investigation found that the allegation was unsubstantiated. Interviews with the administrator, assisted living director, business office manager, front desk receptionist, and med-tech indicated that the resident's call was responded to according to facility protocol, and the resident confirmed no assistance was needed.
Complaint Details
The complaint alleged that facility staff did not answer a resident's call button in a timely manner on 08/20/2023. The allegation was deemed unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 150
Census: 105
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Katherine Tazawa | Administrator | Interviewed regarding the complaint and investigation findings |
| Maria Alcantra | Assisted Living Director | Interviewed regarding the complaint and investigation findings |
| Jed Nallas | Business Office Manager | Interviewed regarding the complaint and investigation findings |
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 150
Deficiencies: 0
Jun 16, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 04/13/2023 regarding staff withholding food from residents, staff not treating residents with dignity and respect, and staff retaliating against a resident for filing a complaint.
Findings
The investigation found no evidence to substantiate the allegations. Interviews with the administrator, staff, and residents indicated that food was not withheld from residents, staff treated residents with dignity and respect, and there was no retaliation against residents for filing complaints. The allegations were deemed unsubstantiated or unfounded.
Complaint Details
The complaint investigation addressed three allegations: 1) staff withholding food from residents, 2) staff not treating residents with dignity and respect, and 3) staff retaliating against a resident for filing a complaint. The findings concluded the first two allegations were unsubstantiated and the third was unfounded.
Report Facts
Capacity: 150
Census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Komal Charitra | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Cara Smith | Licensing Program Manager | Oversaw the complaint investigation |
| Katherine Tawaza | Administrator | Facility administrator interviewed during the investigation |
| Dillon Cagulada | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 150
Deficiencies: 0
May 15, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-09-01 alleging inadequate care and supervision, unqualified staff, unauthorized treatments, improper incident reporting, and medication mishandling.
Findings
Based on observations, interviews, and record reviews, the allegations were determined to be unsubstantiated due to insufficient evidence. Staffing levels and training records were reviewed, but it could not be confirmed if medication training was up to date. Medication administration procedures were observed but lacked sufficient evidence to confirm violations.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included inappropriate care and supervision, unqualified staff, unauthorized treatments, improper incident reporting, and medication mishandling. Partial record reviews and observations did not provide sufficient evidence to prove violations.
Report Facts
Capacity: 150
Census: 91
Staffing levels: 4
Staffing levels: 7
Staffing levels: 3
Staffing levels: 6
Staffing levels: 1
Staffing levels: 5
Staffing levels: 3
Staffing levels: 2
Clients reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Audrey Jeung | Evaluator / Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Cara Smith | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Katherine Tazawa | Met with during the inspection visit | |
| Dillon Cagulada | Administrator | Facility administrator named in the report |
Inspection Report
Census: 72
Capacity: 150
Deficiencies: 1
Apr 12, 2022
Visit Reason
The visit was a Case Management - Deficiencies inspection conducted due to reports of residents and staff with COVID infection and failure to timely report these infections to the Community Care Licensing Division (CCLD).
Findings
The facility failed to report COVID infections among staff in a timely manner, including 12 staff infections in January 2022 and a prior COVID positive staff case in July 2021. Clients were not tested despite public health recommendations. This failure posed a potential health and safety risk.
Deficiencies (1)
| Description |
|---|
| Licensee failed to furnish timely reports to CCLD regarding staff COVID infections, including failure to report within 24 hours or 7 days as required. |
Report Facts
Staff COVID infections: 12
Facility capacity: 150
Census: 72
Staff COVID infections: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Hogan | Administrator | Spoke with Licensing Program Analyst regarding COVID infections and staffing issues |
| Audrey Jeung | Licensing Program Analyst | Conducted the inspection and initiated call for COVID infection information |
| Julio Montes | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 150
Deficiencies: 0
Apr 30, 2021
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that an unqualified staff member checked residents' blood sugar levels, administered insulin, and gave medication to residents.
Findings
After interviews with facility staff, review of training and medication records, and evaluation by the Licensing Program Analyst, all allegations were found to be unsubstantiated due to lack of evidence and confirmation that only properly trained staff assisted residents with medication using approved techniques.
Complaint Details
The complaint involved allegations that an unqualified staff member checked residents' blood sugar levels, administered insulin, and gave medication. The investigation found no evidence to substantiate these allegations, and they were deemed unsubstantiated.
Report Facts
Facility capacity: 150
Resident census: 89
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mohamed Filouane | Licensing Program Analyst | Conducted the complaint investigation and follow-up visit |
| Scott Bissey | Facility Director | Interviewed during the investigation and exit interview |
| Dillon Cagulada | Administrator | Named as facility administrator |
| Julio Montes | Licensing Program Manager | Named as licensing program manager overseeing the investigation |
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