Inspection Report Summary
Most inspections found no deficiencies, including the most recent report from May 9, 2025, which was triggered by a complaint but found no violations or injuries related to the allegation. Earlier reports were consistently clean, with only minor technical violations noted in April 2024 regarding posting size and emergency assembly point identification. A substantiated staffing deficiency was identified in April 2022, specifically in the memory care unit where residents were sometimes unsupervised and staff response was delayed, but no fines or enforcement actions were listed. Several complaint investigations, including allegations of unexplained bruising and inadequate health monitoring, were unsubstantiated. The facility appears to have improved over time, with no deficiencies cited in recent inspections.
Deficiencies per Year
4
3
2
1
0
High
Census Over Time
Census
Capacity
Inspection Report
Follow-Up
Census: 83
Capacity: 110
Deficiencies: 0
May 9, 2025
Visit Reason
An unannounced case management incident inspection was conducted to follow up on an incident report submitted regarding a resident's allegation of being dragged to the bathroom.
Findings
The investigation found no injuries or deficiencies related to the incident. The resident's statement was interpreted as being pushed too fast in a wheelchair, and no violations of Title 22 Division 6 of the California Code of Regulations were cited.
Complaint Details
The visit was triggered by a complaint alleging that Resident #1 was dragged to the bathroom. The complaint was not substantiated as no injuries or violations were found.
Report Facts
Capacity: 110
Census: 83
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria T. Domingo | Executive Director | Met with Licensing Program Analyst during inspection and involved in exit interview |
| Hanna Gough | Licensing Program Analyst | Conducted the unannounced case management incident inspection |
Inspection Report
Annual Inspection
Census: 80
Capacity: 110
Deficiencies: 0
Apr 17, 2025
Visit Reason
Licensing Program Analysts conducted an unannounced annual required evaluation of the facility to assess compliance with licensing requirements.
Findings
The facility was inspected for physical plant safety, medication storage, staff training, and resident care. No deficiencies were cited and the facility was found to be in compliance with Title 22 Division 6 of the California Code of Regulations.
Report Facts
Fire extinguisher service date: Oct 4, 2024
Administrator certificate expiration: Jun 16, 2025
Earthquake drill date: Apr 3, 2025
Fire drill date: Apr 6, 2025
Hot water temperature range (Fahrenheit): 108.9-119.9
Food supply minimum days: 2
Food supply minimum days: 7
Resident records reviewed: 8
Staff training records reviewed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria T. Domingo | Executive Director | Met with Licensing Program Analysts during inspection and participated in exit interview. |
| Roana Cruz | Resident Care Director, RN | Observed medication storage and reviewed centrally stored medications with Licensing Program Analyst. |
| Samer Haddadin | Licensing Program Analyst | Conducted inspection including physical plant, medication observation, and resident interviews. |
| RoseMarie Ruppert | Licensing Program Analyst | Observed medication storage, reviewed records, and confirmed administrator certification. |
Inspection Report
Annual Inspection
Census: 91
Capacity: 110
Deficiencies: 0
Apr 19, 2024
Visit Reason
The inspection was an unannounced Required 1 Year Annual Inspection conducted by Licensing Program Analysts and the Licensing Program Manager to evaluate compliance with regulatory standards.
Findings
The facility was found to be in compliance with no deficiencies cited under Title 22, Division 6, Chapter 6 of the California Code of Regulations. Two Technical Violations were issued related to posting size and emergency assembly point identification.
Report Facts
Hospice waiver residents: 8
Technical Violations issued: 2
Facility capacity: 110
Resident census: 91
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tisset Domingo | Executive Director | Met with during inspection and exit interview |
| Jessica Cho | Licensing Program Analyst | Conducted inspection and signed report |
| Lourdes Montoya | Licensing Program Manager | Conducted inspection and named in report |
| Edward Kim | Licensing Program Analyst | Conducted inspection |
| Faith La | Licensing Program Analyst | Conducted inspection |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 110
Deficiencies: 0
Sep 7, 2023
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 2023-08-02 alleging that staff did not monitor a resident's health changes.
Findings
The investigation found that the allegation was unfounded based on interviews with residents and staff and review of pertinent records. It was determined that the resident's attending physician was not affiliated with the facility and that the staff did monitor residents' health changes appropriately.
Complaint Details
The complaint alleged that staff did not monitor the resident's health changes. After investigation, including interviews and record review, the allegation was deemed unfounded, meaning it was false or without reasonable basis.
Report Facts
Complaint control number: 22-AS-20230802084533
Facility capacity: 110
Facility census: 85
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Cho | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Maria Domingo | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Sheila Santos | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 85
Capacity: 110
Deficiencies: 0
Sep 6, 2023
Visit Reason
This unannounced inspection was conducted to follow up on construction plans for renovating the kitchen floor submitted on 2023-06-27.
Findings
The kitchen floor renovation project was completed on 2023-08-11 without issues. The kitchen was observed to be clean, organized, and fully equipped with no health and safety concerns. No deficiencies were cited.
Report Facts
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria T. Domingo | Administrator | Met with Licensing Program Analyst during inspection and provided information about kitchen renovation |
| Sean Haddad | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Census: 88
Capacity: 110
Deficiencies: 0
Jul 3, 2023
Visit Reason
This unannounced inspection was conducted to follow up on construction plans for renovating the kitchen floor submitted to the Orange County Regional Office on 06/27/2023.
Findings
The inspection included a tour of the facility, review of construction plans, and discussion of the renovation project. No health and safety concerns were observed, and no deficiencies were cited.
Report Facts
Construction project duration: 14
Number of holding cabinets: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sean Haddad | Licensing Program Analyst | Conducted the inspection and authored the report |
| Maria Domingo | Administrator | Facility administrator met with the Licensing Program Analyst during the inspection |
| Armando J Lucero | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Census: 89
Capacity: 110
Deficiencies: 0
Dec 8, 2022
Visit Reason
The visit was an unannounced case management inspection conducted to review three incident reports received on 09/19/2022, 11/16/2022, and 12/03/2022.
Findings
Interviews were conducted with three residents and staff, and pertinent records were reviewed. No immediate health and safety concerns were identified, and no deficiencies were issued during this visit.
Report Facts
Incident reports reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Cho | Licensing Program Analyst | Conducted the unannounced case management visit |
| Tisset Domingo | Executive Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 110
Deficiencies: 1
Apr 5, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility is understaffed.
Findings
The investigation found substantiated evidence that the facility experienced staffing shortages, particularly in the Reminiscence Memory Care Unit, resulting in residents not being supervised or assisted timely. Observations included unsupervised residents during meals, delayed response to call lights, and staff shortages due to no-shows and breaks.
Complaint Details
The complaint alleging understaffing was substantiated based on interviews with twelve staff members, observations of unsupervised residents, and delayed responses to call lights. The Executive Director confirmed staffing challenges and agreed to corrective actions.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Personnel Requirements - General: Facility personnel were not sufficient in numbers and competent to meet resident needs, evidenced by unsupervised residents and delayed call light responses. | Type A |
Report Facts
Residents observed unsupervised: 16
Residents in Reminiscence Memory Care Unit with dementia diagnosis: 22
Care Managers on duty: 3
Call lights requiring assistance: 2
Plan of Correction due date: Apr 8, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosie Quiroz | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Roxanne Psenicnik | Executive Director | Facility Executive Director who acknowledged staffing issues and agreed to corrective actions |
| Lucy Yi | Business Office Coordinator | Met with Licensing Program Analyst during inspection and verified observations |
| Patti Darsow | Director of Sales | Joined inspection tour and verified call light response issues |
| Thais Andrade Souza | Interim Executive Director | Confirmed staffing challenges but denied unmet resident needs |
| Ruby Mendez | Assisted Living Coordinator | Confirmed staffing challenges during investigation |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 110
Deficiencies: 0
Apr 5, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that residents sustained unexplained bruising while in care.
Findings
The investigation found the complaint allegation to be unfounded, meaning the allegation was false, could not have happened, or was without a reasonable basis. The complaint was dismissed.
Complaint Details
The complaint allegation was that residents sustained unexplained bruising while in care. The allegation was found to be unfounded after investigation.
Report Facts
Capacity: 110
Census: 84
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosie Quiroz | Licensing Program Analyst | Conducted the complaint investigation visit |
| Roxanne Psenicnik | Executive Director | Met with investigator and participated in exit interview |
Inspection Report
Annual Inspection
Census: 87
Capacity: 110
Deficiencies: 0
Apr 4, 2022
Visit Reason
Licensing Program Analyst Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation).
Findings
The facility was toured and inspected with no deficiencies cited. All safety equipment and emergency supplies were found in proper condition, and the facility submitted a mitigation plan pending approval.
Report Facts
Fire drill date: Mar 28, 2022
Fire sprinkler test date: Feb 21, 2022
Food supply duration: 2
Food supply duration: 7
Delayed egress door alarm delay: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joseph Alejandre | Licensing Program Analyst | Conducted the inspection visit |
| Roanna Cruz | Resident Care Director | Met with Licensing Program Analyst during inspection |
| Roxanne Psenecnik | Executive Director | Met with Licensing Program Analyst during inspection and consulted on mitigation requirements |
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