Deficiencies (last 8 years)
Deficiencies (over 8 years)
3.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
18% better than California average
California average: 4 deficiencies/yearDeficiencies per year
16
12
8
4
0
Occupancy
Latest occupancy rate
64% occupied
Based on a March 2026 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Complaint Investigation
Census: 521
Capacity: 817
Deficiencies: 0
Date: Mar 5, 2026
Visit Reason
An unannounced case management visit was conducted regarding an incident report about the death of a resident (R1) on March 3, 2026.
Complaint Details
The visit was triggered by an incident report of a resident's death. The department received the report on March 4, 2026, stating the resident was found unresponsive on March 3, 2026. The case is under review.
Findings
No deficiencies were cited during the visit. The case is under review and a follow-up visit will be conducted if warranted.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie B Zbasnik-Hulog | Administrator | Met with Licensing Program Analyst during the visit and discussed the purpose of the visit. |
| Manuel Monter | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 518
Capacity: 817
Deficiencies: 0
Date: Dec 23, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations that a resident was not assessed for injuries after a fall and that facility staff left the resident on the floor after calling 911.
Complaint Details
The complaint alleged that a resident was not assessed for injuries after a fall and that staff left the resident on the floor after calling 911. The investigation included interviews with the Director of Health Services, Memory Care Manager, licensed vocational nurse, caregivers, and review of incident and physician reports. The complaint was determined to be unfounded.
Findings
The investigation found the allegations to be unfounded after interviews with staff and review of records, confirming that facility policy requires nurses to visually assess residents on the floor without moving them until paramedics arrive, and that the resident was properly evaluated and documented.
Report Facts
Vital signs: Resident R1's vital signs were 120/57 blood pressure, 98.2 temperature, 80 pulse, 18 respiratory rate, and 98% oxygen.
Census: 518
Total Capacity: 817
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie B Zbasnik-Hulog | Administrator / Director of Health Services | Met during investigation and exit interview; provided information on facility policy. |
| Steve Chang | Licensing Program Analyst | Conducted the investigation visit and interviews. |
| Chihhsien Chang | Licensing Evaluator | Conducted the complaint investigation and signed the report. |
Inspection Report
Annual Inspection
Capacity: 817
Deficiencies: 0
Date: Jul 25, 2025
Visit Reason
The inspection was an unannounced Required 1 Year visit to evaluate compliance with licensing requirements at the facility.
Findings
The facility was found to be in compliance with no deficiencies cited. The inspection included tours of the facility, review of food supplies, medication storage, resident rooms, and safety equipment. A 90-day Eviction Notice for a resident was reviewed and found compliant with regulations.
Report Facts
Eviction Notice date: Jul 16, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie Zbasnik-Hulog | Administrator | Met during inspection and discussed eviction notice |
| Mark Nelson | Assistant Executive Director | Met during inspection |
| Simranjit Rai | Licensing Program Analyst | Conducted the inspection |
| Romeo Manzano | Licensing Program Manager | Named in report header and signature |
Inspection Report
Annual Inspection
Capacity: 817
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Rosalie Zbasnik-Hulog | Administrator | Met during inspection and discussed eviction notice |
| Mark Nelson | Assistant Executive Director | Met during inspection |
| Simranjit Rai | Licensing Program Analyst | Conducted the inspection |
| Romeo Manzano | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Sep 6, 2024
Visit Reason
The inspection was conducted to investigate a complaint regarding medication administration errors for Resident 1, specifically about the timing and documentation of lisinopril administration.
Complaint Details
The complaint investigation found that Resident 1 received lisinopril twice on 7/17/24 due to a scheduling error. The resident refused the second dose, but this refusal was not documented as required by facility policy.
Findings
The facility failed to ensure proper medication administration timing and documentation for Resident 1. The evening dose of lisinopril was mistakenly scheduled to start on 7/17/24 instead of 7/18/24, resulting in the resident receiving two doses on the same day and a refusal that was not documented.
Deficiencies (1)
F 0684: The facility scheduled a change in medication administration time to start on 7/17/24 when it should have started on 7/18/24. A medication was documented as administered when it should have been documented as refused.
Report Facts
Medication dose: 5
Medication tablets: 3
Date of medication order: Jul 8, 2024
Date of medication administration error: Jul 17, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN A | Registered Nurse | Carried out the medication order and acknowledged the scheduling mistake |
| Director of Nursing | Director of Nursing | Reviewed records and confirmed the scheduling and documentation errors |
Inspection Report
Annual Inspection
Census: 518
Capacity: 817
Deficiencies: 1
Date: Jul 23, 2024
Visit Reason
Licensing Program Analyst conducted an unannounced Required 1 Year visit to evaluate compliance with regulations and facility conditions.
Findings
The inspection found that the facility was generally compliant with regulations including food storage, safety equipment, and disaster drills. However, deficiencies were cited due to 6 out of 11 resident files lacking signed Appraisal/Needs and Services Plans and Individual Service Plans by residents or responsible parties.
Deficiencies (1)
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, posing a potential health, safety or personal rights risk.
Report Facts
Resident files missing signed plans: 6
Resident files reviewed: 11
Resident bedrooms toured: 10
Staff records reviewed: 10
Food supply days - perishable: 2
Food supply days - nonperishable: 7
Water temperature range: 108.7-119.7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie Zbasnik-Hulog | Administrator | Met with Licensing Program Analyst during inspection and discussed findings |
| Simranjit Rai | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Annual Inspection
Census: 518
Capacity: 817
Deficiencies: 1
Date: 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.
Deficiencies (1)
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.
Report Facts
Resident files missing signatures: 6
Resident files reviewed: 11
Staff records reviewed: 10
Resident bedrooms toured: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie Zbasnik-Hulog | Administrator | Met with Licensing Program Analyst during inspection and discussed findings |
| Simranjit Rai | Licensing Program Analyst | Conducted the inspection and authored the report |
| Romeo Manzano | Licensing Program Manager | Supervisor of the Licensing Program Analyst and named in the report |
Inspection Report
Routine
Deficiencies: 13
Date: Jul 19, 2024
Visit Reason
Routine inspection of the Health Care Center at the Forum at Rancho San Antonio to assess compliance with healthcare regulations and standards.
Findings
The facility had multiple deficiencies including failure to maintain resident dignity, incomplete advance directive documentation, inaccurate resident assessments, medication administration errors, improper oxygen therapy, unsafe bed rail use, inadequate infection control practices, expired medications storage, and food safety violations.
Deficiencies (13)
F0550: The facility failed to ensure dignity and privacy for Resident 332 by leaving the Foley catheter drain bag uncovered.
F0578: The facility failed to document advance directive status and complete POLST forms accurately for 5 of 11 residents.
F0582: The facility failed to give timely notice of Medicare Part A stay ending to Resident 26, limiting appeal opportunity.
F0641: The facility failed to accurately assess Resident 19's use of a wanderguard alarm in the Minimum Data Set.
F0656: The facility failed to implement the elopement risk care plan for Resident 19, resulting in inadequate monitoring of wandering behaviors.
F0658: The facility failed to follow physician's order by administering pantoprazole after breakfast instead of before for Resident 340.
F0695: The facility failed to follow physician's oxygen order for Resident 24 by setting oxygen rate at 4 LPM instead of 5 LPM.
F0700: The facility failed to determine appropriateness of bed rails for Residents 17 and 81 prior to installation, lacking assessments and orders.
F0732: The facility failed to post nurse staffing hours in a prominent, accessible location during the survey.
F0758: The facility failed to ensure Resident 339 was free from unnecessary psychotropic medication by not monitoring target behaviors or following pharmacy recommendations.
F0761: The facility failed to ensure proper storage of medications by keeping expired over-the-counter medications and suppositories in the medication room.
F0812: The facility failed to ensure food safety by stacking wet bowls and storing undated and expired food items in the kitchen freezer.
F0880: The facility failed to implement infection control practices including Foley catheter tubing on floor, oxygen tubing on floor and unchanged, failure to perform hand hygiene after glove removal, and staff wearing gloves in hallways.
Report Facts
Residents affected: 1
Residents affected: 5
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 2
Residents affected: 1
Expired OTC medications: 3
Expired suppositories: 12
Expired food items: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LVN C | Licensed Vocational Nurse | Confirmed uncovered Foley catheter drain bag and infection control issues |
| DON | Director of Nursing | Confirmed multiple deficiencies including dignity, medication errors, oxygen therapy, bed rail use, and infection control |
| PHMT | Phlebotomist | Observed wearing gloves in hallway |
| RN B | Registered Nurse | Confirmed oxygen rate error for Resident 24 |
| LVN A | Licensed Vocational Nurse | Observed medication administration error for Resident 340 and oxygen rate observation |
| CDM | Certified Dietary Manager | Confirmed food safety violations including expired and undated food |
| IP | Infection Preventionist | Confirmed infection control failures and recommended corrective actions |
| SW | Social Worker | Confirmed lack of advance directive documentation and discussion |
Inspection Report
Complaint Investigation
Census: 473
Capacity: 817
Deficiencies: 0
Date: Jan 23, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility abandoned a resident.
Complaint Details
The complaint alleged that the facility abandoned a resident by refusing to accept the resident back upon hospital discharge. The investigation concluded the allegation was unfounded.
Findings
The investigation found the allegation 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.
Report Facts
Capacity: 817
Census: 473
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Simranjit Rai | Licensing Program Analyst | Conducted the complaint investigation visit |
| Romeo Manzano | Supervisor | Named as supervisor on the report |
Inspection Report
Complaint Investigation
Census: 473
Capacity: 817
Deficiencies: 0
Date: Jan 23, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the facility abandoned a resident.
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.
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.
Report Facts
Capacity: 817
Census: 473
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Simranjit Rai | Licensing Program Analyst | Conducted the complaint investigation visit |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Jun 9, 2023
Visit Reason
The inspection was conducted as a routine annual survey to assess compliance with professional standards of quality and regulatory requirements in the nursing facility.
Findings
The facility was found deficient in multiple areas including failure to develop care plans for residents with pacemakers, improper use of psychotropic medications without stop dates, medication storage and labeling issues, food safety violations, infection control lapses, and improper handling of medications and supplies. These deficiencies had the potential to cause minimal harm or potential for actual harm to residents.
Deficiencies (5)
F 0658: The facility failed to document pacemaker-paced rate information and did not develop a care plan to manage pacemaker care for Resident 6.
F 0758: The facility failed to ensure psychotropic medication Lorazepam was ordered with a stop date for Resident 17, risking inadequate medication use.
F 0761: Medications and biologicals were stored and labeled improperly, including unlabeled, expired, and mixed supplies in treatment and medication carts.
F 0812: Food items in the kitchen were stored improperly with opened, undated, unlabeled, and outdated items in dry storage, refrigerator, and freezer.
F 0880: Infection prevention and control practices were inadequate, including failure to perform hand hygiene, improper disposal of masks, and contaminated medication storage areas.
Report Facts
Medication order dosage: 0.5
Medication infusion rate: 100
Medication infusion duration: 37
Medication dosage: 4
Residents affected: 22
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Vocational Nurse (LVN) A | Interviewed regarding pacemaker care and medication labeling issues | |
| Director of Nursing (DON) | Interviewed regarding psychotropic medication orders and medication labeling policies | |
| Licensed Vocational Nurse C (LVN C) | Interviewed regarding medication storage and labeling deficiencies | |
| Registered Nurse D (RN D) | Observed and interviewed regarding infection control lapses | |
| Registered Nurse B (RN B) | Observed and interviewed regarding IV therapy and glove use | |
| Director of Dining Services (DDS) | Interviewed regarding food storage and safety violations |
Inspection Report
Capacity: 791
Deficiencies: 0
Date: 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 clients observed on site. The unit has an approved fire clearance for 26 non-ambulatory clients, and all inspected areas were clean, well maintained, and equipped with necessary safety features. No deficiencies were cited.
Report Facts
Approved occupancy increase: 26
Total capacity before approval: 791
Total capacity after approval: 817
Fire extinguisher last inspection date: 202201
Hot water temperature (Fahrenheit): 113.5
Internal temperature range (Fahrenheit): 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Administrator | Met with Licensing Program Analyst during inspection |
| Dana Graefe | Director of Resident Services/RCFE Administrator | Met with Licensing Program Analyst during inspection |
| Ryker Heberle | Licensing Program Analyst | Conducted the case management visit and inspection |
| Sarah Yip | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Capacity: 791
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Administrator | Met during inspection and reviewed report |
| Dana Graefe | Director of Resident Services/RCFE Administrator | Met during inspection |
| Ryker Heberle | Licensing Program Analyst | Conducted the inspection |
| Sarah Yip | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 54
Capacity: 791
Deficiencies: 0
Date: Jul 25, 2022
Visit Reason
Licensing Program Analyst Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control.
Findings
The inspection found all fire exit routes clear, staff wearing face masks and N95 fit tested, proper COVID-19 screening and hygiene protocols in place, and adequate PPE supplies. No deficiencies were cited per California Code of Regulations, Title 22.
Report Facts
Capacity: 791
Census: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rosalie Hulog | Assisted Living Director | Met with Licensing Program Analyst during inspection |
| Dana Graefe | Resident Service Director | Met with Licensing Program Analyst during inspection |
| Nancy Kao | Executive Director | Report reviewed with Executive Director |
| Christine Dolores | Licensing Program Analyst | Conducted the annual inspection |
Inspection Report
Annual Inspection
Census: 54
Capacity: 791
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Rosalie Hulog | Assisted Living Director | Met with Licensing Program Analyst during inspection. |
| Dana Graefe | Resident Service Director | Met with Licensing Program Analyst during inspection. |
| Nancy Kao | Executive Director | Report reviewed with Executive Director. |
| Christine Dolores | Licensing Program Analyst | Conducted the annual inspection. |
| Sarah Yip | Licensing Program Manager | Named in report header. |
Inspection Report
Routine
Census: 58
Capacity: 791
Deficiencies: 0
Date: Jul 22, 2021
Visit Reason
Licensing Program Analyst Joanne Roadilla conducted an unannounced Infection Control site visit as part of the required 1-year inspection.
Findings
The facility was observed to have proper infection control measures including symptom screening, PPE use, and social distancing. No deficiencies were issued per Title 22 of the California Code of Regulations.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joanne Roadilla | Licensing Program Analyst | Conducted the unannounced Infection Control site visit. |
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during the inspection. |
| Rosalie Hulog | Assisted Living Manager | Accompanied Licensing Program Analyst during the facility tour. |
Inspection Report
Routine
Census: 58
Capacity: 791
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during infection control site visit. |
| Rosalie Hulog | Assisted Living Manager | Accompanied Licensing Program Analyst during facility tour. |
| Joanne Roadilla | Licensing Program Analyst | Conducted the unannounced infection control site visit. |
| Romeo Manzano | Licensing Program Manager | Named in report header. |
Inspection Report
Census: 449
Capacity: 789
Deficiencies: 0
Date: Mar 26, 2021
Visit Reason
The inspection was a tele-inspection visit conducted via Zoom as part of case management during the COVID-19 shelter in place order. The facility was also applying for an increase in capacity from 406 to 408 ambulatory residents.
Findings
The virtual inspection of villa #64 found the home ready for occupancy with adequate lighting, safety features such as grab bars and alarm systems, working smoke and carbon monoxide detectors, and a serviced fire extinguisher. The facility grounds were clear of hazards.
Report Facts
Capacity increase: 2
Hot water temperature: 107.2
Fire extinguisher last serviced: Sep 11, 2020
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during tele-inspection and signed report |
| Steven Parker | Director of Plant Operations | Met with Licensing Program Analyst during tele-inspection |
| Joanne Roadilla | Licensing Program Analyst | Conducted tele-inspection visit |
| Romeo Manzano | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Census: 449
Capacity: 789
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met during inspection and exit interview |
| Steven Parker | Director of Plant Operations | Met during inspection |
| Joanne Roadilla | Licensing Program Analyst | Conducted tele-inspection visit |
| Romeo Manzano | Licensing Program Manager | Named in report header |
Inspection Report
Census: 428
Capacity: 748
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met with Licensing Program Analyst during tele-inspection and named in report |
| Steven Parker | Director of Plant Operations | Met with Licensing Program Analyst during tele-inspection |
| Joanne Roadilla | Licensing Program Analyst | Conducted the tele-inspection visit |
| Romeo Manzano | Licensing Program Manager | Named in report |
Inspection Report
Census: 424
Capacity: 748
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met during tele-inspection and recipient of report |
| Steven Parker | Director of Plant Operations | Met during tele-inspection |
| Joanne Roadilla | Licensing Program Analyst | Conducted tele-inspection visit |
| Romeo Manzano | Licensing Program Manager | Named in report header |
Inspection Report
Census: 415
Capacity: 748
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Met during tele-inspection and exit interview |
| Steven Parker | Director of Plant Operations | Met during tele-inspection |
| Joanne Roadilla | Licensing Program Analyst | Conducted tele-inspection visit |
| Romeo Manzano | Licensing Program Manager | Named in report header |
Inspection Report
Census: 429
Capacity: 748
Deficiencies: 2
Date: 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)
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
| Name | Title | Context |
|---|---|---|
| Rosalie Hulog | Assisted Living Manager | Met with Licensing Program Analyst and Health Facilities Evaluator Nurse during the tele-visit. |
| Christine Jean | Wellness Manager, RN | Met with Licensing Program Analyst and Health Facilities Evaluator Nurse during the tele-visit. |
Inspection Report
Census: 430
Capacity: 743
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Spoke with Licensing Program Analyst during tele-inspection and received report copy |
| Joanne Roadilla | Licensing Program Analyst | Conducted tele-inspection visit |
| Romeo Manzano | Licensing Program Manager | Named in report header and footer |
Inspection Report
Census: 58
Capacity: 743
Deficiencies: 0
Date: 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
| Name | Title | Context |
|---|---|---|
| Nancy Kao | Executive Director | Spoke with Licensing Program Analyst during the visit |
| Rosalie Hulog | Assisted Living Manager | Met with Licensing Program Analyst and discussed report |
| Joanne Roadilla | Licensing Program Analyst | Conducted the unannounced Case Management tele-visit |
Inspection Report
Deficiencies: 3
Date: May 3, 2019
Visit Reason
The inspection was conducted to evaluate compliance with professional standards of quality in medication administration, food safety, and infection prevention at the nursing facility.
Findings
The facility failed to ensure proper medication administration education and monitoring for a resident using eye drops, resulting in potential infection risk. Additionally, food safety violations were observed including unlabeled and expired food items and improper glove use by kitchen staff.
Deficiencies (3)
F 0658: The facility failed to ensure residents administered eye drops correctly, as Resident 19 touched the dropper tip to her eye without receiving instruction or monitoring.
F 0812: The facility failed to store, prepare, and serve food under sanitary conditions, including unlabeled and expired food items and failure of kitchen staff to change gloves between tasks.
F 0880: The facility failed to implement an infection prevention program by not educating or monitoring Resident 19's use of eye drops, risking eye infection.
Report Facts
Date of survey completion: May 3, 2019
Expiration date on food items: Mar 17, 2017
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Vocational Nurse A (LVN A) | Observed administering medication and interviewed regarding eye drop administration | |
| Dietary Manager | Interviewed and confirmed food safety observations | |
| Dietary Aid B (DA B) | Observed changing trash bin liners and not changing gloves | |
| Dietary Aid C (DA C) | Observed chopping broccoli and not changing gloves | |
| Director of Nursing (DON) | Interviewed regarding infection control policy for eye dropper use |
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