Inspection Reports for The Forum at Rancho San Antonio

CA, 95014

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Inspection Report Annual Inspection Capacity: 817 Deficiencies: 0 Jul 25, 2025
Visit Reason
The inspection was an unannounced Required 1 Year visit to evaluate compliance with licensing requirements.
Findings
The facility was toured including resident rooms, kitchen, and secured areas; all safety equipment and disaster drills were up to date. No deficiencies were cited during this inspection. A 90-day eviction notice for one resident was reviewed and found compliant with regulations.
Report Facts
Resident rooms toured: 10 Staff records reviewed: 10 Resident records reviewed: 10 Hot water temperature range: 109.9-118.1 Facility capacity: 817
Employees Mentioned
NameTitleContext
Rosalie Zbasnik-HulogAdministratorMet during inspection and discussed eviction notice
Mark NelsonAssistant Executive DirectorMet during inspection
Simranjit RaiLicensing Program AnalystConducted the inspection
Romeo ManzanoLicensing Program ManagerNamed in report header
Inspection Report Annual Inspection Census: 518 Capacity: 817 Deficiencies: 1 Jul 23, 2024
Visit Reason
The inspection was an unannounced required 1-year visit to evaluate compliance with regulations at the facility.
Findings
The inspection found that the facility generally maintained safe conditions including clear exits, proper food storage, and functioning safety equipment. However, deficiencies were cited related to missing signatures on 6 out of 11 resident Appraisal/Needs and Services Plans and Individual Service Plans, posing potential health, safety, or personal rights risks.
Severity Breakdown
Type B: 1
Deficiencies (1)
DescriptionSeverity
6 out of 11 resident files did not contain Appraisal/Needs and Services Plan and Individual Service Plan signed by resident and/or responsible party.Type B
Report Facts
Resident files missing signatures: 6 Resident files reviewed: 11 Staff records reviewed: 10 Resident bedrooms toured: 10
Employees Mentioned
NameTitleContext
Rosalie Zbasnik-HulogAdministratorMet with Licensing Program Analyst during inspection and discussed findings
Simranjit RaiLicensing Program AnalystConducted the inspection and authored the report
Romeo ManzanoLicensing Program ManagerSupervisor of the Licensing Program Analyst and named in the report
Inspection Report Complaint Investigation Census: 473 Capacity: 817 Deficiencies: 0 Jan 23, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility abandoned a resident.
Findings
The investigation found the allegations to be unfounded after interviews and record reviews, determining that the resident was appropriately discharged to a skilled nursing facility and later readmitted to the assisted living unit under hospice services. No deficiencies were cited.
Complaint Details
The complaint alleged that the facility abandoned a resident by refusing to accept the resident back after hospital discharge. The investigation concluded the allegation was unfounded.
Report Facts
Capacity: 817 Census: 473
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during the investigation and exit interview
Simranjit RaiLicensing Program AnalystConducted the complaint investigation visit
Romeo ManzanoLicensing Program ManagerNamed as Licensing Program Manager on the report
Inspection Report Capacity: 791 Deficiencies: 0 Sep 22, 2022
Visit Reason
The visit was an unannounced case management inspection to evaluate the newly constructed memory care unit named Daffodil Ridge Memory Care Unit on the facility grounds.
Findings
The memory care unit was found to be ready for occupancy with no deficiencies cited. The unit has an approved fire clearance for 26 non-ambulatory clients, and the facility's approved occupancy increased from 791 to 817.
Report Facts
Approved occupancy increase: 26 Total approved occupancy: 817 Hot water temperature: 113.5 Internal temperature range: 70-73 Fire extinguisher last inspection: 2022
Employees Mentioned
NameTitleContext
Nancy KaoAdministratorMet during inspection and reviewed report
Dana GraefeDirector of Resident Services/RCFE AdministratorMet during inspection
Ryker HeberleLicensing Program AnalystConducted the inspection
Sarah YipLicensing Program ManagerNamed in report header
Inspection Report Annual Inspection Census: 54 Capacity: 791 Deficiencies: 0 Jul 25, 2022
Visit Reason
The inspection was an unannounced annual inspection focused on infection control conducted by the Licensing Program Analyst.
Findings
The facility was found to be in compliance with no deficiencies cited. Infection control procedures, PPE use, and COVID-19 screening protocols were observed and found adequate.
Employees Mentioned
NameTitleContext
Rosalie HulogAssisted Living DirectorMet with Licensing Program Analyst during inspection.
Dana GraefeResident Service DirectorMet with Licensing Program Analyst during inspection.
Nancy KaoExecutive DirectorReport reviewed with Executive Director.
Christine DoloresLicensing Program AnalystConducted the annual inspection.
Sarah YipLicensing Program ManagerNamed in report header.
Inspection Report Routine Census: 58 Capacity: 791 Deficiencies: 0 Jul 22, 2021
Visit Reason
An unannounced Infection Control site visit was conducted as a required 1-year routine inspection.
Findings
The facility was observed to have proper infection control measures including symptom screening, mask use, hand sanitizers, and social distancing. No deficiencies were issued related to Title 22 of the California Code of Regulations.
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during infection control site visit.
Rosalie HulogAssisted Living ManagerAccompanied Licensing Program Analyst during facility tour.
Joanne RoadillaLicensing Program AnalystConducted the unannounced infection control site visit.
Romeo ManzanoLicensing Program ManagerNamed in report header.
Inspection Report Census: 449 Capacity: 789 Deficiencies: 0 Mar 26, 2021
Visit Reason
The inspection was a tele-inspection visit conducted via Zoom as part of Case Management - Other, due to suspension of on-site visits from COVID-19 shelter in place orders.
Findings
The virtual inspection included a tour of villa #64, checking regulated temperatures, lighting, safety alarms, and fire safety equipment. The villa was found to be in good repair, free of hazards, and ready for occupancy.
Report Facts
Capacity increase application: 791 Hot water temperature: 107.2 Fire extinguisher last serviced: 2020
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet during inspection and exit interview
Steven ParkerDirector of Plant OperationsMet during inspection
Joanne RoadillaLicensing Program AnalystConducted tele-inspection visit
Romeo ManzanoLicensing Program ManagerNamed in report header
Inspection Report Census: 428 Capacity: 748 Deficiencies: 0 Jan 29, 2021
Visit Reason
The inspection visit was a Case Management - Other type conducted via tele-inspection due to COVID-19 restrictions, including a virtual tour of 7 villas to evaluate facility conditions and an application for increased capacity.
Findings
The inspection found that all 7 villas inspected had adequate safety features including fire extinguishers, smoke and carbon monoxide detectors, adequate lighting, grab bars, and alarm systems. Hot water temperatures and alarms were tested and observed working. The villas were deemed ready for occupancy.
Report Facts
Capacity increase application: 789 Hot water temperature: 115.1 Hot water temperature: 110.3 Hot water temperature: 114.9 Hot water temperature: 114.4 Hot water temperature: 117.6 Hot water temperature: 117.6 Hot water temperature: 116.6
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during tele-inspection and named in report
Steven ParkerDirector of Plant OperationsMet with Licensing Program Analyst during tele-inspection
Joanne RoadillaLicensing Program AnalystConducted the tele-inspection visit
Romeo ManzanoLicensing Program ManagerNamed in report
Inspection Report Census: 424 Capacity: 748 Deficiencies: 0 Jan 8, 2021
Visit Reason
The visit was a Case Management - Other type conducted as a tele-inspection due to COVID-19 shelter in place orders, including a virtual tour of two villas and evaluation of facility readiness for occupancy.
Findings
The inspection found that Villas #78 and #79, each accommodating non-ambulatory residents, were in good condition with working alarms, adequate lighting, safety features, and hot water temperatures within acceptable ranges. The villas were deemed ready for occupancy.
Report Facts
Hot water temperature: 115.5 Hot water temperature: 116 Capacity increase application: 775
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet during tele-inspection and recipient of report
Steven ParkerDirector of Plant OperationsMet during tele-inspection
Joanne RoadillaLicensing Program AnalystConducted tele-inspection visit
Romeo ManzanoLicensing Program ManagerNamed in report header
Inspection Report Census: 415 Capacity: 748 Deficiencies: 0 Dec 16, 2020
Visit Reason
The inspection was a Case Management - Other type visit conducted via tele-inspection due to COVID-19 restrictions, including a virtual tour of eight villas to assess readiness for occupancy and review of facility conditions.
Findings
The facility was found to have adequate safety features including fire extinguishers, smoke and carbon monoxide detectors, alarms, and proper lighting. Hot water temperatures in inspected villas were within acceptable ranges, and all inspected villas were deemed ready for occupancy.
Report Facts
Hot water temperature: 116.2 Hot water temperature: 119.1 Hot water temperature: 109.7 Hot water temperature: 111.3 Hot water temperature: 116 Hot water temperature: 113.3 Hot water temperature: 115.7 Hot water temperature: 116.9 Capacity increase applied for: 771
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorMet during tele-inspection and exit interview
Steven ParkerDirector of Plant OperationsMet during tele-inspection
Joanne RoadillaLicensing Program AnalystConducted tele-inspection visit
Romeo ManzanoLicensing Program ManagerNamed in report header
Inspection Report Census: 429 Capacity: 748 Deficiencies: 2 Nov 24, 2020
Visit Reason
The visit was a Case Management - Other type conducted via tele-visit to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility.
Findings
The evaluation identified infection control concerns including lack of signage on sofas and benches to promote social distancing and the recommendation to post signs in visible locations to promote protective measures such as hand washing, mask wearing, and social distancing.
Deficiencies (2)
Description
Two/three seater sofas and long benches did not have signage to keep people six feet apart; recommended blocking off sections to promote social distancing.
Lack of posted signs in highly visible locations promoting everyday protective measures and how to stop the spread of germs.
Employees Mentioned
NameTitleContext
Rosalie HulogAssisted Living ManagerMet with Licensing Program Analyst and Health Facilities Evaluator Nurse during the tele-visit.
Christine JeanWellness Manager, RNMet with Licensing Program Analyst and Health Facilities Evaluator Nurse during the tele-visit.
Inspection Report Census: 430 Capacity: 743 Deficiencies: 0 Nov 17, 2020
Visit Reason
The inspection was a tele-inspection visit conducted via FaceTime due to COVID-19 restrictions, focusing on case management and evaluation of facility capacity and safety features.
Findings
The virtual inspection of Villas #63, #68, #69, and #80 found all villas equipped with working smoke and carbon monoxide detectors, adequate hot water temperatures, fire extinguishers, and no tripping hazards. The villas were deemed ready for occupancy.
Report Facts
Hot water temperature: 115.8 Hot water temperature: 113 Hot water temperature: 111.7 Hot water temperature: 116.2 Capacity increase applied for: 1 Capacity increase applied for: 4 Fire extinguisher last serviced: Sep 11, 2020
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorSpoke with Licensing Program Analyst during tele-inspection and received report copy
Joanne RoadillaLicensing Program AnalystConducted tele-inspection visit
Romeo ManzanoLicensing Program ManagerNamed in report header and footer
Inspection Report Census: 58 Capacity: 743 Deficiencies: 0 Nov 10, 2020
Visit Reason
The visit was an unannounced Case Management tele-visit to gather additional information regarding the self-reported death of a resident that occurred on 2020-11-06.
Findings
No deficiencies were cited during the tele-visit. The report was discussed with and sent to the Assisted Living Manager for signature and return.
Report Facts
Capacity: 743 Census: 58
Employees Mentioned
NameTitleContext
Nancy KaoExecutive DirectorSpoke with Licensing Program Analyst during the visit
Rosalie HulogAssisted Living ManagerMet with Licensing Program Analyst and discussed report
Joanne RoadillaLicensing Program AnalystConducted the unannounced Case Management tele-visit

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