Inspection Reports for The Gardens at Park Balboa

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The inspection was an unannounced Annual Continuation visit conducted by the Licensing Program Analyst to review compliance with licensing requirements.

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.

The inspection was a required one-year unannounced visit to evaluate the facility's compliance with licensing regulations.

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.

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An unannounced complaint investigation was conducted to investigate the allegation that staff did not provide proper mobility assistance to residents in care.

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.

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.

The visit was an unannounced complaint investigation regarding an allegation of a questionable death at the facility.

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.

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.

An unannounced complaint investigation visit was conducted to investigate an allegation that staff did not safeguard a resident's personal belongings.

The investigation found insufficient evidence to support the allegation that staff did not safeguard the resident's personal belongings; therefore, the complaint was unsubstantiated.

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.

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.

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.

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.

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.

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.

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.

The inspection was an unannounced complaint investigation visit triggered by an allegation of unlawful eviction received on 2024-10-18.

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.

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.

The inspection was an unannounced required annual visit to evaluate the facility's compliance with Title 22 Regulations and health and safety standards.

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.

An unannounced complaint investigation was conducted in response to an allegation that facility staff failed to provide timely access to a resident's records.

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.

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.

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.

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.

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.

An unannounced required Annual Inspection was conducted using the complete CARE Inspection Tool to review Infection Control, Operational Requirements, and Staffing domains.

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.

The inspection was an unannounced complaint investigation visit triggered by allegations that staff stole residents' personal belongings and medication.

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.

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.

Unannounced complaint investigation visit conducted due to an allegation that staff handled a resident in a rough manner resulting in injury.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

An unannounced complaint investigation visit was conducted following a complaint received on 2022-11-04 regarding non-functioning call buttons and water temperature issues.

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.

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.

The inspection was a required unannounced annual visit with an emphasis on infection control practices and procedures.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The inspection was an unannounced required annual visit with a specific emphasis on infection control practices and procedures.

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.

An unannounced complaint investigation visit was conducted to investigate allegations that staff were not properly trained to administer medications.

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.

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.

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.

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.

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.