Inspection Report
Complaint Investigation
Capacity: 136
Deficiencies: 0
Oct 7, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of lack of supervision resulting in resident-on-resident abuse with serious injury.
Findings
The investigation found that although a resident (R1) sustained an injury after reportedly being pushed by another resident (R2), there was no corroborating evidence that lack of supervision caused the incident. Both residents have neurocognitive disorders, but R2 was not noted to have aggressive behavior. The allegation was determined to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint alleged lack of supervision leading to resident-on-resident abuse causing serious injury. The investigation included staff interviews and record reviews. The allegation was found unsubstantiated as there was no preponderance of evidence to prove the violation occurred.
Report Facts
Facility capacity: 136
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Grace Donato | Licensing Program Analyst | Conducted the complaint investigation and telephone interview with the facility |
| Kimberly Malaspina | Administrator | Spoke with Licensing Program Analyst during investigation |
| Brenda Chan | Licensing Program Manager | Named in report signature section |
Inspection Report
Census: 72
Capacity: 136
Deficiencies: 0
May 13, 2025
Visit Reason
The visit was an unannounced Case Management inspection conducted in response to the self-reported death of Resident #1 on May 5, 2025.
Findings
No deficiencies were observed or cited during this visit. The Licensing Program Analyst toured the facility, performed welfare checks, interviewed staff, and reviewed pertinent records.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Bawalan | Resident Care Director | Met with during the inspection and participated in the exit interview. |
Inspection Report
Annual Inspection
Census: 73
Capacity: 136
Deficiencies: 0
Apr 25, 2025
Visit Reason
An unannounced case management visit was conducted to complete the annual inspection originally scheduled for 04/07/2025.
Findings
The facility was found to be clean, safe, and in good repair with no pathway obstructions. All safety measures, including delayed egress and locked storage for hazardous materials and medications, were operational. Staff and resident records were complete and compliant. No deficiencies were cited during this inspection.
Report Facts
Water temperature readings: 111.7
Water temperature readings: 115
Water temperature readings: 115.4
Water temperature readings: 115.9
Water temperature readings: 116.8
Water temperature readings: 118.4
Internal temperature readings: 71
Internal temperature readings: 72
Internal temperature readings: 76
Facility capacity: 136
Current census: 73
Perishable food supply: 2
Non-perishable food supply: 7
Refrigerator temperature: 37
Freezer temperature: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kimberly Malaspina | Executive Director | Met during inspection and named in report |
| Anthony Bawalan | Resident Care Director | Named in exit interview confirming receipt of report |
| Rebecca Borunda | Licensing Program Analyst | Conducted the inspection visit |
| Jennifer Lott | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Plan of Correction
Census: 73
Capacity: 136
Deficiencies: 1
Apr 25, 2025
Visit Reason
The visit was an unannounced plan of correction (POC) inspection to document the clearance of a previously issued deficiency related to medication management and storage.
Findings
The Licensing Program Analyst verified that the licensee corrected the deficiency 87465(h)(2) regarding medication management and storage. A letter of Deficiency Cleared was provided to the Executive Director.
Deficiencies (1)
| Description |
|---|
| Deficiency regarding medication management and storage |
Report Facts
Correction due date: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kimberly Malaspina | Executive Director | Met with Licensing Program Analyst during the visit and named in relation to the deficiency correction |
| Rebecca Borunda | Licensing Program Analyst | Conducted the unannounced plan of correction visit and verified deficiency correction |
Inspection Report
Annual Inspection
Census: 73
Capacity: 136
Deficiencies: 1
Apr 7, 2025
Visit Reason
The inspection was an unannounced required 1-year annual visit to evaluate the facility's compliance with licensing requirements.
Findings
During the visit, a deficiency was cited for improper medication storage where multiple medication and supplement bottles were found unsecured in a resident's private bathroom. The Resident Care Director removed the medications to a locked medication room during the visit. The annual inspection was not completed due to time constraints and a return visit is needed.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Medication and supplement bottles were stored in an unlocked area of a resident's room, posing a potential safety risk. | Type B |
Report Facts
Plan of Correction Due Date: May 7, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Bawalan | Resident Care Director | Named in medication storage deficiency finding and exit interview |
| Rebecca A Borunda | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 136
Deficiencies: 1
Aug 12, 2024
Visit Reason
An unannounced complaint investigation was conducted regarding the allegation that the licensee did not issue a refund of pre-admission fees.
Findings
The investigation found that the licensee did not provide a refund of the $2,000 pre-admission deposit to Applicant 1, despite multiple attempts to complete refund paperwork and process the refund. The allegation was substantiated based on interviews and records review.
Complaint Details
The complaint was substantiated. Applicant 1 paid a $2,000 pre-admission deposit but decided not to move in and requested a refund. Despite multiple attempts by facility staff to obtain completed refund paperwork and process the refund, the refund had not been issued as of the investigation date.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not provide a refund of the $2,000 pre-admission fee to Applicant 1, posing a potential personal rights risk to residents. | Type B |
Report Facts
Pre-admission deposit amount: 2000
Census: 56
Total capacity: 136
Plan of Correction due date: Sep 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rebecca A Ruiz | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Melon Rivera | Executive Director | Participated in the exit interview and acknowledged receipt of the report. |
| Anthony Bawalan | Resident Care Director | Met with the Licensing Program Analyst during the investigation. |
Inspection Report
Original Licensing
Capacity: 136
Deficiencies: 0
Apr 4, 2024
Visit Reason
The visit was a pre-licensing inspection to ensure the facility's compliance with California Code of Regulations, Title 22, Division 6, prior to licensing.
Findings
The facility was found to be clean, safe, and in good repair with no deficiencies. All inspected areas including resident rooms, bathrooms, storage, and safety equipment were compliant and functioning properly.
Report Facts
Water temperature readings: 110.8
Water temperature readings: 111.6
Water temperature readings: 117.1
Water temperature readings: 119.5
Licensed capacity: 136
Bedridden capacity: 20
Non-perishable food supply: 7
Perishable food supply: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Launa Moore | Applicant | Met with Licensing Program Analyst during pre-licensing visit and participated in exit interview |
| Jason Malone | Applicant | Met with Licensing Program Analyst during pre-licensing visit |
| Rebecca A Ruiz | Licensing Program Analyst | Conducted the pre-licensing inspection |
| Jennifer Lott | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Original Licensing
Capacity: 136
Deficiencies: 0
Apr 3, 2024
Visit Reason
The visit was an initial licensing evaluation conducted via telephone interview to verify the applicant/administrator's understanding of community care facility licensing laws and readiness for licensing.
Findings
The applicant and administrator confirmed their understanding of licensing laws, facility operation, admission policies, staffing requirements, emergency preparedness, complaints reporting, and pre-licensing readiness. Identification was verified and required documentation was obtained.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Launa Moore | Administrator | Applicant/administrator participating in licensing evaluation |
| Herman Marquez | Met with during licensing evaluation | |
| Julia Kim | Licensing Program Manager | Named in report as Licensing Program Manager |
| Nicole Rouse | Licensing Program Analyst | Named in report as Licensing Program Analyst |
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