Inspection Report Summary
Most inspections found no deficiencies, with routine annual visits consistently showing compliance with licensing requirements and proper infection control practices. The most recent report from September 10, 2025, was perfect with no deficiencies cited. One complaint investigation in October 2022 found substantiated deficiencies related to improper mask use by staff during the COVID-19 pandemic, but no fines or enforcement actions were noted. Other complaint investigations, including one in April 2024 about phone access, were unsubstantiated. The facility appears to have improved infection control practices since the 2022 findings, as more recent inspections have been free of deficiencies.
Deficiencies per Year
4
3
2
1
0
Moderate
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 79
Capacity: 93
Deficiencies: 0
Sep 10, 2025
Visit Reason
The inspection was an unannounced required 1-Year annual visit conducted using the CARE Inspection Tool to evaluate compliance with licensing requirements.
Findings
The facility was found to be in compliance with all licensing requirements. The physical plant, infection control practices, emergency preparedness, and documentation were all satisfactory. No deficiencies were cited during this visit.
Report Facts
Fire extinguishers: 26
Residents interviewed: 7
Staff interviewed: 7
Water temperature range: 110.8-117.6
Facility temperature: 74
PPE supply: 30
Perishable food supply: 2
Non-perishable food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Hawk | Executive Director | Met with Licensing Program Analyst during inspection and received report copy |
| Edward Kim | Licensing Program Analyst | Conducted the inspection and authored the report |
| Lourdes Montoya | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 71
Capacity: 93
Deficiencies: 0
Sep 11, 2024
Visit Reason
The inspection was an unannounced required 1-Year annual visit conducted to evaluate the facility's compliance using the CARE Inspection Tool.
Findings
The facility was found to be sanitary, appropriately furnished, and in compliance with regulations. No deficiencies were cited during the visit. Infection control practices, emergency preparedness, and resident and staff records were all in order.
Report Facts
Resident rooms inspected: 9
Fire extinguishers: 26
Staff files audited: 10
Resident files audited: 9
Staff interviews conducted: 9
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Edward Kim | Licensing Program Analyst | Conducted the inspection and audit |
| Tyler Hawk | Executive Director | Facility administrator who joined the tour |
| Cristine Taylor | Business Officer Coordinator | Met with LPA and signed the report |
| Louie Placencia | Maintenance Coordinator | Accompanied LPA during the physical plant tour |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Apr 3, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff prevent a resident from making or receiving phone calls.
Findings
The investigation included interviews with residents, staff, and a witness, as well as a tour of the facility. The evidence did not substantiate the allegation, as residents reported being able to make calls and receive assistance, and the resident in question was observed making a phone call during the visit.
Complaint Details
The complaint alleged that staff prevent a resident from making or receiving phone calls. The allegation was deemed unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 93
Census: 75
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Hawks | Executive Director | Met with Licensing Program Analyst during the investigation |
| Ruth Martinez | Licensing Program Analyst | Conducted the complaint investigation visit |
| Armando J Lucero | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 69
Capacity: 93
Deficiencies: 0
Nov 18, 2022
Visit Reason
The visit was conducted to follow-up on an unusual incident report received on 11/15/2022 involving a resident who exited the Memory Care unit unassisted.
Findings
The resident was found to have exited the Memory Care unit through a delayed egress door and left the facility before staff were aware. A 1:1 caregiver was implemented for the resident during evening hours. No citation was issued at this time.
Report Facts
Residents in Memory Care unit: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Hawk | Administrator | Met with Licensing Program Analyst during the visit and involved in investigation of the incident |
| Michelle Reed | Licensing Program Analyst | Conducted the Case Management visit |
| Sheila Santos | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 2
Oct 18, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility does not follow COVID-19 protocol.
Findings
The investigation found that several staff members were not wearing masks properly, posing a potential risk to residents. The allegation was substantiated based on observations and interviews, and deficiencies were cited related to infection control practices.
Complaint Details
The complaint was substantiated. The investigation was triggered by an allegation that the facility did not follow COVID-19 protocols. The facility had several COVID-19 positive individuals in the Assisted Living section during July 2022. Observations and interviews confirmed improper mask usage by staff.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Incidental Medical and Dental Care - The licensee shall ensure that infection control practices are maintained in the facility as specified in Section 87470, Infection Control Requirements. This requirement is not being met as evidenced by: Based on interviews and observations, LPA observed three staff members who were not wearing masks properly. | Type B |
| The licensee did not ensure that the infection control practices were maintained and implemented at the facility. This poses a potential risk to the residents in care. | Type B |
Report Facts
Capacity: 93
Census: 65
Deficiencies cited: 2
Plan of Correction Due Date: Oct 21, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Hawk | Executive Director | Met with Licensing Program Analyst and stated that in-service training for all staff was completed on August 25, 2022 |
| Kathrina Chin | Licensing Program Analyst | Conducted the complaint investigation visit |
| Sheila Santos | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 68
Capacity: 93
Deficiencies: 0
Sep 30, 2022
Visit Reason
The visit was an unannounced required 1-year annual inspection to evaluate compliance with regulations, including infection control and facility conditions.
Findings
The facility met all regulatory requirements with no deficiencies cited. One advisory note was issued for best practices. The facility was found to have adequate supplies, safe environment, and proper infection control measures.
Report Facts
Hospice residents: 5
Hospice waiver capacity: 15
Temperature range: 106-113
Visit start time: 1030
Visit end time: 1315
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Reed | Licensing Program Analyst | Conducted the inspection visit |
| Cristine Taylor | Business Office Manager | Met with Licensing Program Analyst during inspection and exit interview |
| Tyler Hawk | Facility Administrator | Newly appointed administrator, not present during visit |
Inspection Report
Follow-Up
Census: 66
Capacity: 93
Deficiencies: 0
Jun 13, 2022
Visit Reason
This unannounced case management visit was conducted to follow up on a medication error reported to Community Care Licensing on 5/19/2022.
Findings
The medication error involved a resident whose medications were not activated in the E-mar system, resulting in missed medications for two days. No negative effects were noted, and staff continued to monitor the resident. No deficiencies were cited based on the information available.
Complaint Details
The visit was complaint-related, following up on a medication error. No deficiencies were cited, and no negative outcomes were observed.
Report Facts
Missed medication days: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Provided information about the medication error during the visit |
| Erica Colmenares | Resident Care Director | Met with Licensing Program Analyst during the visit |
| Kathrina Chin | Licensing Program Analyst | Conducted the case management visit |
| Sheila Santos | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Census: 74
Capacity: 93
Deficiencies: 0
Nov 15, 2021
Visit Reason
This unannounced case management visit was conducted to follow up on a gastrointestinal (GI) outbreak reported to Community Care Licensing on 2021-11-10.
Findings
The facility reported a GI virus outbreak starting on 2021-10-07, suspected to be Norovirus, with 7 staff and 11 residents showing symptoms. The memory care unit was quarantined and infection control measures were implemented. No deficiencies were cited at this time.
Report Facts
Staff with GI symptoms: 7
Residents with GI symptoms: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Reported details of the GI outbreak and infection control measures |
| Kathrina Chin | Licensing Program Analyst | Conducted the case management visit |
| Sheila Santos | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 75
Capacity: 93
Deficiencies: 0
Sep 29, 2021
Visit Reason
Licensing Program Analyst Kathrina Chin conducted an unannounced required annual inspection of the facility to evaluate compliance with regulations.
Findings
The facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. The environment was safe, clean, and well-maintained with operational safety equipment and adequate emergency supplies.
Report Facts
Staff members on floor: 15
Hot water temperature: 114.9
Food stock requirements: 2
Food stock requirements: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Met with Licensing Program Analyst during inspection and exit interview |
| Kathrina Chin | Licensing Program Analyst | Conducted the inspection and exit interview |
Inspection Report
Census: 74
Capacity: 93
Deficiencies: 0
Sep 10, 2021
Visit Reason
This unannounced case management visit was conducted to follow up on a death reported to Community Care Licensing on 08/31/2021 for a resident who died on 08/28/2021.
Findings
The Licensing Program Analyst reviewed documentation related to the resident's unwitnessed fall and subsequent death. No immediate or safety risks were observed in the facility, and no deficiencies were cited at this time.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Administrator | Met with Licensing Program Analyst during the visit and involved in the case management follow-up. |
| Ruth Martinez | Licensing Program Analyst | Conducted the unannounced case management visit and reviewed documentation related to the resident's death. |
| Sheila Santos | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Jun 18, 2021
Visit Reason
This unannounced case management visit was conducted to follow up on an incident reported to Community Care Licensing regarding a missed medication dose for a resident on 06/08/2021.
Findings
The facility acted appropriately and in a timely manner to address the incident, including notifying family and the resident's PCP, and providing additional staff training. No deficiencies or immediate safety risks were observed during the visit.
Complaint Details
The complaint involved a single occurrence where staff missed a dose of Carbidopa and Synthroid medication for resident 1 on 06/08/2021. The incident was self-reported, and the facility took corrective actions including removing the staff from duty and providing additional training.
Report Facts
Census: 70
Total Capacity: 93
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Viola Kaake | Reminiscence Coordinator | Met with Licensing Program Analyst during the visit |
| James August | Licensing Program Analyst | Conducted the case management visit |
| Maria Domingo | Administrator | Facility administrator named in the report |
Inspection Report
Census: 65
Capacity: 93
Deficiencies: 0
Mar 18, 2021
Visit Reason
The visit was a case management-incident follow-up conducted virtually due to COVID-19 precautions to discuss an SOC 341 incident/report involving resident #1 and resident #2 that occurred on March 16, 2021.
Findings
Resident #1 was found unconscious on the floor in the garage and was taken to UCI Medical Center where he remains hospitalized. No deficiencies were cited during this review as per Title 22 of the California Code of Regulations.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Spoke with Licensing Program Analyst regarding the incident involving residents and facility operations. |
| Kathrina Chin | Licensing Program Analyst | Conducted the virtual follow-up visit and discussed the incident with the Executive Director. |
Inspection Report
Census: 66
Capacity: 93
Deficiencies: 0
Feb 3, 2021
Visit Reason
The visit was a case management-incident follow-up conducted virtually due to COVID-19 precautions to discuss a self-reported incident where one resident stabbed another with a plastic form after a dispute over food.
Findings
The incident involved two residents with dementia in the Memory Care Unit, resulting in a skin tear. First aid was administered, medications were adjusted, and additional care was arranged. No deficiencies were cited during this review as per Title 22 of the California Code of Regulations.
Report Facts
Incident date: Jan 23, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Spoke with Licensing Program Analyst regarding the incident and follow-up |
| Kathrina Chin | Licensing Program Analyst | Conducted the virtual follow-up visit and discussed the incident |
| Sheila Santos | Licensing Program Manager | Named in the report header |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Nov 18, 2020
Visit Reason
The visit was a case management incident follow-up conducted via telephone due to COVID-19 and precautionary measures, specifically to discuss a self-reported incident involving resident #1 on 11/6/2020.
Findings
No deficiencies were cited during this review as per Title 22 of the California Code of Regulations. Resident #1 denied suicidal intent and was medically cleared to remain at the facility.
Complaint Details
The visit was triggered by a self-reported incident where resident #1 stated he would rather die than be with his wife. The resident denied wanting to kill himself and refused emergency room transfer. The incident was not substantiated with any deficiencies.
Report Facts
Capacity: 93
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Domingo | Executive Director | Spoke with Licensing Program Analyst regarding the incident and facility operations |
| Kathrina Chin | Licensing Program Analyst | Conducted the telephone follow-up visit and investigation |
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