Inspection Reports for
The Forum at Rancho San Antonio

CA, 95014

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Deficiencies (last 6 years)

Deficiencies (over 6 years) 0.7 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

83% better than California average
California average: 4 deficiencies/year

Deficiencies per year

4 3 2 1 0
2020
2021
2022
2024
2025
2026

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

0% 30% 60% 90% 120% Nov 2020 Dec 2020 Mar 2021 Jan 2024 Mar 2026

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
NameTitleContext
Rosalie B Zbasnik-HulogAdministratorMet with Licensing Program Analyst during the visit and discussed the purpose of the visit.
Manuel MonterLicensing Program AnalystConducted the unannounced case management visit.
Romeo ManzanoLicensing Program ManagerNamed 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
NameTitleContext
Rosalie B Zbasnik-HulogAdministrator / Director of Health ServicesMet during investigation and exit interview; provided information on facility policy.
Steve ChangLicensing Program AnalystConducted the investigation visit and interviews.
Chihhsien ChangLicensing EvaluatorConducted 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
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 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
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 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
NameTitleContext
Rosalie Zbasnik-HulogAdministratorMet with Licensing Program Analyst during inspection and discussed findings
Simranjit RaiLicensing Program AnalystConducted 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
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 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
NameTitleContext
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during investigation and exit interview
Simranjit RaiLicensing Program AnalystConducted the complaint investigation visit
Romeo ManzanoSupervisorNamed 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
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 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
NameTitleContext
Nancy KaoAdministratorMet with Licensing Program Analyst during inspection
Dana GraefeDirector of Resident Services/RCFE AdministratorMet with Licensing Program Analyst during inspection
Ryker HeberleLicensing Program AnalystConducted the case management visit and inspection
Sarah YipSupervisorSupervisor 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
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 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
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

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
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 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
NameTitleContext
Joanne RoadillaLicensing Program AnalystConducted the unannounced Infection Control site visit.
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during the inspection.
Rosalie HulogAssisted Living ManagerAccompanied 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
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 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
NameTitleContext
Nancy KaoExecutive DirectorMet with Licensing Program Analyst during tele-inspection and signed report
Steven ParkerDirector of Plant OperationsMet with Licensing Program Analyst during tele-inspection
Joanne RoadillaLicensing Program AnalystConducted tele-inspection visit
Romeo ManzanoSupervisorSupervisor 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
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 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
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 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
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 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
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 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
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 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
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 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
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

Report

September 6, 2024

Report

July 19, 2024

Report

June 9, 2023

Report

May 3, 2019

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