Inspection Report Summary
Most inspections found no deficiencies, with the most recent annual inspection on October 2, 2025, showing full compliance and no deficiencies cited. Earlier reports included some substantiated complaints involving resident abuse by staff in 2023 and issues with medication documentation and hospice resident capacity in late 2024. Several complaint investigations were unsubstantiated, including allegations about resident belongings, transportation, and staff treatment. Deficiencies related mainly to resident rights, medication management, and environmental safety, with isolated incidents of staff misconduct resulting in terminations. The facility’s record shows improvement over time, with recent inspections consistently clean and no enforcement actions or fines listed in the available reports.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
3.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
15% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
86% occupied
Based on a October 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 103
Capacity: 120
Deficiencies: 0
Oct 2, 2025
Visit Reason
The inspection was an unannounced Annual Continuation visit conducted by the Licensing Program Analyst to review compliance with licensing requirements.
Findings
The facility was found to be generally in compliance with regulations, including resident and personnel records, infection control, emergency disaster plans, and medication management. No deficiencies were cited, though the analyst advised ensuring direct care staff obtain first aid/CPR certification.
Report Facts
Resident records reviewed: 10
Personnel records reviewed: 11
Residents' medications reviewed: 5
Emergency disaster drills frequency: 1
Fire alarm system inspection date: May 1, 2025
Commercial kitchen inspection date: Aug 30, 2025
Fire doors test date: Sep 23, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Met with Licensing Program Analyst during inspection and advised regarding staff certification |
| Quoc Huynh | Licensing Program Analyst | Conducted the Annual Continuation visit and inspection |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 102
Capacity: 120
Deficiencies: 0
Sep 22, 2025
Visit Reason
The inspection was a required one-year unannounced visit to evaluate the facility's compliance with licensing regulations.
Findings
The facility was found to be in compliance with health and safety regulations, with no deficiencies cited. Resident rooms, common areas, and kitchen facilities were inspected and found to be clean, safe, and properly maintained.
Report Facts
Units in facility: 106
Water temperature range: 108.1-118.2
Fire extinguisher service date: 202509
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Met with Licensing Program Analyst during inspection |
| Quoc Huynh | Licensing Program Analyst | Conducted the inspection visit |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 120
Deficiencies: 0
Jul 1, 2025
Visit Reason
An unannounced complaint investigation was conducted to investigate the allegation that staff did not provide proper mobility assistance to residents in care.
Findings
The investigation included interviews with staff and residents and review of facility records. It was found that the allegation was unsubstantiated due to insufficient evidence, and staff involved in a related breakroom incident were counseled and required to take workplace harassment training.
Complaint Details
The complaint alleged that staff did not provide proper mobility assistance to residents. The allegation was found unsubstantiated after investigation, including interviews and record reviews.
Report Facts
Facility capacity: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Met with Licensing Program Analyst during investigation |
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation |
| Kristin Heffernan | Licensing Program Manager | Named in report signature and oversight |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 120
Deficiencies: 0
May 28, 2025
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation of a questionable death at the facility.
Findings
The investigation found that Resident #1 died by suicide after falling from the second-floor landing. There was no preponderance of evidence to prove the alleged violation occurred, and the allegation was unsubstantiated. No deficiencies were cited during the visit.
Complaint Details
The complaint involved a questionable death of Resident #1. The resident had a history of bipolar disorder and depression but was not on psychiatric medications at admission. The resident was found deceased after falling from the second floor, with the manner of death ruled as suicide by the police and coroner. Family reported threats by the resident to harm themselves, but staff were not informed and did not observe signs of depression. The allegation was unsubstantiated due to lack of evidence.
Report Facts
Facility capacity: 120
Resident census: 103
Date of resident admission: Jun 8, 2024
Date of death: Sep 29, 2024
Time of death: 1324
Date of physician report: May 22, 2024
Date medication started: Sep 17, 2024
Date of coroner examination: Sep 30, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Yee | Licensing Program Analyst | Conducted complaint investigation and subsequent visits |
| Dion Gallarza | Executive Director | Facility representative interviewed during investigation |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 120
Deficiencies: 0
Oct 30, 2024
Visit Reason
An unannounced complaint investigation visit was conducted to investigate an allegation that staff did not safeguard a resident's personal belongings.
Findings
The investigation found insufficient evidence to support the allegation that staff did not safeguard the resident's personal belongings; therefore, the complaint was unsubstantiated.
Complaint Details
The complaint alleged that staff did not safeguard Resident #1's black gel pillow, which was missing after being left in the dining room. Interviews with residents and the Executive Director revealed that Resident #2, who has mild cognitive impairment, admitted to seeing and possibly taking the pillow believing it was theirs. The pillow was not found in Resident #2's room. The Executive Director stated staff regularly remind residents to safeguard their belongings. The allegation was unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 120
Census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation visit |
| Dion D. Gallarza | Executive Director | Interviewed during the investigation and involved in the findings |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 120
Deficiencies: 0
Oct 30, 2024
Visit Reason
The visit was conducted as an unannounced complaint investigation following allegations received on 05/05/2023 regarding staff assistance with medical transportation, treatment of residents with dignity and respect, and overcharging of a resident.
Findings
After investigation including interviews and document reviews, all allegations were found to be unsubstantiated due to insufficient evidence. The facility staff assisted with transportation as required, treated residents with dignity and respect, and did not overcharge the resident.
Complaint Details
The complaint included three allegations: 1) Facility staff did not assist resident with medical transportation needs; 2) Facility staff did not treat resident with dignity and respect; 3) Facility overcharged resident. All allegations were found unsubstantiated based on interviews, document reviews, and evidence.
Report Facts
Capacity: 120
Census: 104
Late fee charge: 250
Lyft charge: 18.67
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Dion D Galarza | Executive Director | Facility administrator met during the investigation |
| Katia Arriaga | Business Manager | Interviewed during initial complaint visit |
| Javier Rosales | Chef | Interviewed during initial complaint visit |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 120
Deficiencies: 1
Oct 30, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-02-28 regarding allegations of staff assaulting a resident and failure to notify the resident's responsible party of an incident.
Findings
The allegation that staff assaulted a resident was substantiated based on evidence including eyewitness reports, injury to the resident, and subsequent staff termination. The allegation that the resident's responsible party was not notified of the incident was unsubstantiated due to insufficient evidence.
Complaint Details
The complaint involved two allegations: 1) Staff assaulted a resident in care, which was substantiated. 2) Resident's responsible party was not notified of an incident, which was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Residents in all residential care facilities for the elderly shall have personal rights to be free from punishment, humiliation, intimidation, abuse, or other punitive actions. This requirement was not met as Resident #1 was shoved by their caregiver causing injury. | Type A |
Report Facts
Capacity: 120
Census: 104
Civil penalty: 500
Plan of Correction Due Date: Oct 31, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Galarza | Executive Director | Met with during investigation and provided information regarding allegations |
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kristin Heffernan | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 120
Deficiencies: 0
Oct 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation of unlawful eviction received on 2024-10-18.
Findings
The investigation found insufficient evidence to support the allegation of unlawful eviction. The resident involved had not paid rent since June 2024 due to financial issues and had not complied with payment arrangements. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged unlawful eviction of Resident #1. The resident was involved in a financial fraud scheme and unable to pay rent. The facility attempted to assist the resident with payment arrangements and support, but the resident did not comply. The allegation was unsubstantiated.
Report Facts
Capacity: 120
Census: 104
Outstanding balance: 12624
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erica Mosley | Licensing Program Analyst | Conducted the complaint investigation |
| Dion D Gallarza | Executive Director | Interviewed during investigation and involved in payment arrangement discussions |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 102
Capacity: 120
Deficiencies: 3
Sep 21, 2024
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with Title 22 Regulations and health and safety standards.
Findings
The facility was generally found to be in compliance with health and safety regulations, including physical plant conditions, emergency preparedness, and record keeping. However, deficiencies were cited related to medication administration documentation, hospice resident capacity, and PRN medication record-keeping.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Medication for Resident #2 (ROSUVASTATIN 20 mg) had 4 extra pills with no documented refusal, posing an immediate health and safety risk. | Type A |
| Three out of four PRN medications for Resident #1 were administered but not documented, posing a potential health and safety risk. | Type B |
| Facility has an approved hospice waiver for four residents but currently has five residents on hospice, posing a potential health and safety risk. | Type B |
Report Facts
Census: 102
Total Capacity: 120
PRN medications reviewed: 4
Hospice residents approved: 4
Hospice residents present: 5
Plan of Correction Due Date: Oct 4, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Met during inspection and mentioned in report |
| Jonathan McFall | Marketing Director | Met during inspection and mentioned in report |
| Erica Mosley | Licensing Program Analyst | Conducted inspection and authored report |
| Kasandra Lopez | Licensing Program Manager | Supervisor for the inspection and cited in deficiency sections |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 120
Deficiencies: 1
Oct 16, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that facility staff failed to provide timely access to a resident's records.
Findings
The investigation substantiated the allegation that the facility did not provide timely access to Resident #1's records. The facility received the request on 10/6/2023 but failed to provide the records or contact the legal representatives within the required two business days.
Complaint Details
The complaint was substantiated. The allegation was that facility staff failed to provide timely access to Resident #1's records. The legal representatives had not been provided the requested documents or contacted within the required timeframe of two business days.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to provide timely access to Resident #1's files as required by California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87468.2(a)(19). | Type B |
Report Facts
Capacity: 120
Census: 97
Deficiency count: 1
Plan of Correction Due Date: Oct 23, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Yee | Licensing Program Analyst | Conducted the complaint investigation visit |
| Katia Arriaga | Business Manager | Interviewed during the investigation and participated in exit interview |
| Dion D Gallarza | Administrator | Administrator of the facility, interviewed via telephone |
| Adam Khalifa | CEO | Interviewed regarding the request for Resident #1's documents |
| Kristin Heffernan | Licensing Program Manager | Oversaw the licensing program and signed the report |
Inspection Report
Annual Inspection
Census: 98
Capacity: 120
Deficiencies: 0
Sep 28, 2023
Visit Reason
An unannounced subsequent required Annual Inspection was conducted to continue the annual inspection initiated on 2023-09-27, reviewing multiple domains including personnel records, resident rights, and disaster preparedness.
Findings
No deficiencies were observed during this visit. Immediate Civil Penalties were delivered related to a previously substantiated complaint from 2023-04-07. A return visit will be conducted to complete the review of the Physical Plant and Environmental Safety domain.
Complaint Details
Immediate Civil Penalties were assessed for the deficiency cited as a result of the substantiated findings for complaint #29-AS-20220601142537 on 2023-04-07.
Report Facts
Capacity: 120
Census: 98
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Facility Administrator present during inspection |
| Christine Yee | Licensing Program Analyst | Conducted the inspection |
| Kristin Heffernan | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 98
Capacity: 120
Deficiencies: 2
Sep 27, 2023
Visit Reason
An unannounced required Annual Inspection was conducted using the complete CARE Inspection Tool to review Infection Control, Operational Requirements, and Staffing domains.
Findings
Citations were issued for deficiencies related to emergency care information availability and staff first aid training. Some domains were not reviewed due to time constraints and will be reviewed on a return visit.
Deficiencies (2)
| Description |
|---|
| Facility did not maintain readily available names, addresses, and telephone numbers of each resident's physician and dentist. |
| Staff files lacked evidence of current first aid training except for one staff member, posing a potential health and safety risk. |
Report Facts
Staff files reviewed: 10
Resident bedrooms: 101
Rooms downstairs: 59
Rooms upstairs: 42
Non-ambulatory residents allowed: 40
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Facility Administrator present during inspection |
| Christine Yee | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kristin Heffernan | Licensing Program Manager | Supervisor overseeing the inspection |
| Grace Bulaclac | Only staff member with evidence of current first aid training in staff files |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 120
Deficiencies: 0
Apr 7, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff stole residents' personal belongings and medication.
Findings
The investigation found insufficient evidence to support the allegations that staff stole residents' personal belongings or medication. Interviews with residents, staff, and the administrator revealed no consistent or substantiated claims, and the staff member named was no longer employed at the facility for unrelated reasons.
Complaint Details
The complaint involved allegations that staff stole residents' personal belongings and medication. The allegations were unsubstantiated based on interviews and evidence collected during the investigation.
Report Facts
Capacity: 120
Census: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Named in relation to the investigation and provided information about staff and facility incidents |
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 120
Deficiencies: 1
Apr 7, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff handled a resident in a rough manner resulting in injury.
Findings
The investigation confirmed that staff #1 pushed resident #1 to the ground during an incident triggered by a dementia episode, resulting in a minor injury. The allegation was substantiated and staff #1 was suspended and ultimately terminated.
Complaint Details
The complaint alleged that staff handled a resident roughly resulting in injury. The allegation was substantiated based on interviews, police report, and investigation findings. Resident #1 was pushed to the ground by staff #1, causing a minor cut above the left eye. Staff #1 was suspended and terminated for violating company policies.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 1569.269 Enumerated rights; severability (a)(10) Residents of residential care facilities for the elderly shall have all of the following rights: To be free from ... verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by the resident being handled roughly by staff resulting in injury. | Type A |
Report Facts
Capacity: 120
Census: 100
Deficiency Type: 1
Plan of Correction Due Date: Apr 11, 2023
Plan of Correction Documentation Due Date: Apr 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Administrator who conducted investigation and confirmed staff suspension and termination |
| Elsie Campos | Licensing Program Analyst | Evaluator who conducted the complaint investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Manager overseeing the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 120
Deficiencies: 0
Mar 27, 2023
Visit Reason
The inspection visit was conducted in response to a complaint alleging that staff failed to prevent a resident from being bullied by another resident and failed to provide a safe and comfortable environment for residents.
Findings
The investigation found insufficient evidence to substantiate the allegations. Staff intervened appropriately during a verbal altercation between two residents, and interviews with staff and residents confirmed that the environment is safe and comfortable with no bullying or intimidation reported.
Complaint Details
The complaint alleged staff failed to prevent bullying and failed to provide a safe and comfortable environment. The investigation was unannounced and conducted by Licensing Program Analyst Angel Ascencio. The allegations were deemed unsubstantiated based on interviews and evidence gathered.
Report Facts
Capacity: 120
Census: 98
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Met with during investigation and provided information about the resident altercation and facility procedures |
| Angel Ascencio | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 120
Deficiencies: 0
Mar 27, 2023
Visit Reason
The inspection was conducted as an unannounced complaint investigation following allegations that staff did not ensure a safe and healthful environment by failing to accord dignity in their relationship with a resident and that staff yelled at a resident.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with the Executive Director, Marketing Director, staff, residents, and the complainant revealed that staff acted professionally and respectfully, and residents felt safe and supported. The allegations were deemed unsubstantiated.
Complaint Details
The complaint alleged that staff did not ensure a safe and healthful environment by failing to accord dignity to a resident and that staff yelled at a resident. The complaint was unsubstantiated based on interviews and evidence gathered during the investigation.
Report Facts
Capacity: 120
Census: 98
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Executive Director | Named in investigation findings and interviews related to complaint |
| Angel Ascencio | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 120
Deficiencies: 0
Jan 31, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations received on 2022-05-11 regarding staff not intervening in resident verbal altercations and financial abuse.
Findings
The investigation found insufficient evidence to substantiate the allegations that staff failed to intervene in resident verbal altercations and that financial abuse occurred. Residents and staff interviews indicated staff do intervene when needed and billing discrepancies were clarified with credits issued.
Complaint Details
The complaint included allegations that facility staff do not intervene in resident on resident verbal altercations and that Resident #2 was financially abused by being charged for tray service they did not need and being billed incorrectly for medication administration. Both allegations were found unsubstantiated based on interviews and record reviews.
Report Facts
Tray passing services charged: 10
Tray passing services provided: 15
Tray passing services credited: 5
Medication administration monthly charge: 411
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and interviews. |
| Dion D Gallarza | Executive Director | Met with Licensing Program Analyst during the investigation. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 120
Deficiencies: 0
Jan 27, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that due to lack of care and supervision, a resident was verbally abused by another resident.
Findings
Interviews with residents and staff revealed that the residents involved had a history of disagreements but there was no evidence of verbal abuse due to lack of care and supervision. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged verbal abuse between residents due to lack of care and supervision. Investigations including interviews with residents and staff found insufficient evidence to support the claim. The allegation was unsubstantiated.
Report Facts
Capacity: 120
Census: 94
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elsie Campos | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Dion D Gallarza | Executive Director | Met with Licensing Program Analyst during the investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 120
Deficiencies: 0
Nov 22, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2022-11-04 regarding staff disrespect, failure to assist with transportation arrangements, and improper placement of grab bars.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Interviews with staff and residents, facility tours, and document reviews confirmed that staff treated residents respectfully, transportation assistance was provided according to protocol, and grab bars were appropriately placed and installed per resident requests.
Complaint Details
The complaint investigation addressed three allegations: staff failed to treat a resident with dignity and respect, failure to assist with arranging transportation for medical care, and grab bars not placed appropriately. All allegations were deemed unsubstantiated based on interviews, observations, and documentation.
Report Facts
Capacity: 120
Census: 94
Number of rooms inspected: 13
Number of residents interviewed: 7
Number of additional grab bars installed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted the complaint investigation and issued findings |
| Dion D Gallarza | Executive Director | Facility administrator involved in interviews and facility tours during the investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation process |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 120
Deficiencies: 2
Nov 7, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2022-11-04 regarding non-functioning call buttons and water temperature issues.
Findings
The investigation substantiated that some call buttons were not working, including one involved in a resident fall, and that water temperatures in several rooms exceeded the regulatory maximum of 120 degrees Fahrenheit, posing immediate health and safety risks.
Complaint Details
The complaint alleged that call buttons were not working and water temperature was not within the required range. Both allegations were substantiated based on interviews, observations, and testing during the visit.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Call buttons were inoperable in some rooms and one resident's call button was not working at the time of a fall. | Type A |
| Water temperature exceeded 120 degrees Fahrenheit in four rooms, violating hot water temperature regulations. | Type A |
Report Facts
Rooms without call buttons: 3
Rooms with water temperature above 120°F: 4
Residents interviewed: 7
Rooms inspected: 14
Plan of Correction due dates: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Dion D Gallarza | Executive Director | Met with the Licensing Program Analyst and involved in the investigation. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Annual Inspection
Census: 86
Capacity: 120
Deficiencies: 0
Aug 26, 2022
Visit Reason
The inspection was a required unannounced annual visit with an emphasis on infection control practices and procedures.
Findings
The facility was found to be in compliance with Title 22 Regulations, with clean and safe common areas, adequate infection control measures, and no deficiencies cited at this time.
Report Facts
Water temperature: 120.8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted the inspection and met with the Executive Director |
| Dion D Gallarza | Executive Director | Met with the Licensing Program Analyst during the inspection |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 120
Deficiencies: 0
Jul 7, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that faucets used by residents for personal care such as shaving and grooming do not deliver hot water.
Findings
The investigation found that one of four hot water boilers was in disrepair causing no hot water delivery to half of the building, but the facility took immediate action by replacing the boiler, notifying residents, and providing alternative rooms with hot water. Water temperatures in ten inspected resident rooms measured between 110.2 and 118.7 degrees Fahrenheit. The allegation was unsubstantiated due to insufficient evidence.
Complaint Details
The complaint alleged that faucets used by residents for personal care did not deliver hot water for 10 days and that the facility was not maintaining hot water temperature between 105 and 120 degrees Fahrenheit as required by Title 22 Regulation section 87303(e)(2). The complaint was found unsubstantiated.
Report Facts
Resident rooms inspected: 10
Hot water temperature range: 110.2-118.7
Boilers in disrepair: 1
Total boilers: 4
Complaint received date: Jun 29, 2022
Boiler replacement date: Jun 29, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Salia Walker | Licensing Program Analyst | Conducted the complaint investigation and physical plant tour |
| Dion D Gallarza | Administrator | Facility administrator interviewed during the investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 120
Deficiencies: 0
Jul 7, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 12/17/2021 regarding the dining hall heater being in disrepair and transportation not being available to residents.
Findings
After interviews, record reviews, and observations, there was insufficient evidence to substantiate the allegations. The dining hall heater was repaired with temporary space heaters provided during repairs, and transportation was intermittently unavailable due to vehicle repairs but alternative transportation was provided to residents.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included the dining hall heater being in disrepair for three weeks and transportation not being available due to the facility bus being out of service for about a month and lack of a driver. Investigations found temporary space heaters were safely used and the heater was repaired, and alternative transportation options such as ride shares were provided while the bus was out of service.
Report Facts
Complaint Control Number: 29-AS-20211217112145
Facility Capacity: 120
Census: 82
Inspection Visit Time: Inspection began at 03:30 PM and completed at 04:00 PM on 07/07/2022
Duration of Dining Hall Heater Disrepair: 21
Duration of Bus Out of Service: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Salia Walker | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Dion D Gallarza | Administrator | Facility administrator interviewed regarding allegations and findings |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 120
Deficiencies: 0
Jun 1, 2022
Visit Reason
The visit was conducted as a Case Management-Incident follow-up on a self-reported suspected dependent adult/elder abuse incident reported by the facility on 2022-05-28.
Findings
During the visit, the Licensing Program Analyst conducted interviews, a physical plant tour, and document review. The resident involved appeared in good health with no immediate concerns, and no immediate health and safety issues were observed. Further investigation is required before issuing findings.
Complaint Details
The complaint involved an allegation that on 2022-05-27, Staff #2 physically abused Resident #1 by grabbing the resident's right arm and pushing them to the ground, causing bleeding to the resident's face. The facility reported the incident to the Local Ombudsman, Community Care Licensing, and the police, and attempted to contact the resident's responsible party.
Report Facts
Capacity: 120
Census: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Met with Licensing Program Analyst during the visit and involved in the investigation |
| Salia Walker | Licensing Program Analyst | Conducted the Case Management-Incident visit and investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 120
Deficiencies: 3
May 16, 2022
Visit Reason
The visit was an unannounced Case Management - Deficiencies inspection conducted in conjunction with complaint control #29-AS-20210125142107 to investigate issues related to the facility's response to a resident's calls for assistance and failure to submit a death report.
Findings
The investigation found that the facility failed to submit a required death report for Resident #1 and that staff did not respond in a timely manner to the resident's calls for assistance, posing potential and immediate health, safety, and personal rights risks to residents. Deficiencies were cited related to reporting requirements, personal rights, and personnel sufficiency.
Complaint Details
The visit was triggered by complaint control #29-AS-20210125142107. The complaint investigation revealed failure to submit a death report for Resident #1 and delayed staff response to the resident’s calls for assistance. The complaint was substantiated based on these findings.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to submit Resident #1's Death Report within seven days as required by reporting regulations. | Type B |
| Facility staff did not respond in a timely manner to Resident #1’s calls for assistance, posing immediate health, safety, and personal rights risks. | Type A |
| Facility personnel were not sufficient in numbers or competency to meet resident needs, as evidenced by delayed responses to Resident #1’s calls. | Type A |
Report Facts
Resident calls for assistance: 39
Resident calls for assistance: 22
Resident calls for assistance: 26
Resident calls for assistance: 20
Resident calls for assistance: 21
Resident calls for assistance: 17
Resident calls for assistance: 29
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Met with Licensing Program Analyst during the inspection and provided information about Resident #1's death. |
| Salia Walker | Licensing Program Analyst | Conducted the unannounced Case Management - Deficiencies visit and complaint investigation. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the inspection and deficiency citations. |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 120
Deficiencies: 1
May 16, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including staff not responding to residents' call buttons and failure to seek medical attention for a resident.
Findings
The allegation that staff did not respond to residents' call button was substantiated based on record reviews and interviews showing delayed or no response to calls. The allegation that staff did not seek medical attention for a resident was unsubstantiated as staff called 9-1-1 and the resident independently went to the hospital.
Complaint Details
The complaint investigation was initiated due to allegations that staff did not respond to residents' call buttons and failed to seek medical attention for a resident. The allegation regarding call button response was substantiated, while the allegation regarding seeking medical attention was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87468.1 Personal Rights of Residents in All Facilities (a)(2) - Residents were not accorded safe, healthful and comfortable accommodations as staff did not respond to two calls for assistance, posing immediate health, safety, and personal rights risks. | Type A |
Report Facts
Resident calls not responded to: 2
Capacity: 120
Census: 78
Dates with multiple pendant presses: 13
Unresponded alerts: 2
Pendant presses on 1/19/2021: 9
Pendant presses on 1/13/2021: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Met with Licensing Program Analyst during inspection and provided information about resident pendant use and staff response times. |
| Salia Walker | Licensing Program Analyst | Conducted the complaint investigation and inspection. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation report. |
| Aja Richardson | Licensing Program Analyst | Initiated the complaint investigation and conducted virtual interviews. |
| Katia Arriaga | Business Office Manager | Accompanied Licensing Program Analyst during physical plant tour. |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 120
Deficiencies: 0
Mar 22, 2022
Visit Reason
The visit was an unannounced complaint investigation initiated due to allegations that the facility overcharged a resident and did not provide an itemized statement for the resident's care.
Findings
The investigation found insufficient evidence to substantiate the allegations. The facility provided documentation and communication showing charges and notifications to the resident and responsible party, and the allegations were deemed unsubstantiated.
Complaint Details
The complaint investigation was initiated based on allegations that the facility overcharged Resident #1 and failed to provide an itemized statement for the resident's care. After record reviews, interviews, and follow-ups, the allegations were found unsubstantiated due to insufficient evidence to prove the alleged violations occurred.
Report Facts
Facility capacity: 120
Census: 74
Resident monthly rate: 2700
Deposit: 500
Balance due: 643.8
Laundry charge: 25
Outstanding balance: 5536.3
Assisted Living Service charge: 487
Late payment fee: 250
Additional laundry charge: 30
Pendant charge: 200
Increased Assisted Living Services charge: 760.1
Accumulated late charges: 1000
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Salia Walker | Licensing Program Analyst | Conducted the complaint investigation and unannounced visits |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Dion Gallarza | Administrator | Facility administrator interviewed during the investigation |
| John Purdue | Administrator | Facility administrator interviewed telephonically during initial investigation |
Inspection Report
Annual Inspection
Census: 72
Capacity: 120
Deficiencies: 2
Aug 23, 2021
Visit Reason
The inspection was an unannounced required annual visit with a specific emphasis on infection control practices and procedures.
Findings
The facility was generally clean and well-maintained with adequate infection control measures. However, immediate health and safety risks were identified due to unsecured cleaning supplies in the laundry room and hot water temperatures exceeding the regulatory maximum in the kitchen and resident bathrooms.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Laundry room was not properly secured, containing cleaning supplies and disinfectants accessible to residents, posing an immediate health and safety risk. | Type A |
| Hot water temperature in resident rooms and kitchen exceeded the maximum allowed temperature of 120 degrees Fahrenheit, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 120
Census: 72
Hot water temperature: 128.7
Hot water temperature: 130
Deficiency due date: Aug 30, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Director | Met with Licensing Program Analyst during inspection and involved in addressing deficiencies |
| Salia Walker | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 120
Deficiencies: 1
Apr 15, 2021
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that staff were not properly trained to administer medications.
Findings
The investigation found that 1 out of 4 staff who currently or previously carried out medication technician duties did not have current training documentation, substantiating the allegation of improper staff training in medication administration.
Complaint Details
The complaint was substantiated based on lack of medication training documentation for staff. The Licensing Program Analyst conducted interviews and record reviews confirming the deficiency.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Employees assisting residents with self-administration of medication did not meet the required training requirements as set by the health and safety code. | Type B |
Report Facts
Capacity: 120
Census: 69
Staff training deficiency count: 1
Plan of Correction due date: Apr 20, 2021
Training completion timeframe: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dion D Gallarza | Administrator | Met with Licensing Program Analyst during investigation and named in findings related to staff training |
| Aja Richardson | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 120
Deficiencies: 0
Apr 15, 2021
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following a complaint received on 2020-03-20 alleging that staff were not maintaining residents' hygiene.
Findings
The Licensing Program Analyst observed residents appearing well groomed and clean during the facility tour. Interviews with residents and staff indicated satisfaction with the shower schedule and grooming assistance. The allegation that staff were not maintaining residents' hygiene was unsubstantiated.
Complaint Details
The complaint alleged that staff were not maintaining residents' hygiene, with concerns that residents looked unkempt and dirty. After investigation including multiple visits and interviews, the allegation was found to be unsubstantiated.
Report Facts
Complaint Control Number: 31-AS-20200320160751
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Aja Richardson | Licensing Program Analyst | Conducted the complaint investigation and facility tour |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report signature and oversight |
| John Purdue | Administrator | Facility administrator during initial complaint visit |
| Dion Gallarza | Administrator | Facility administrator met during investigation visits |
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