Inspection Report Summary
Most inspections found no deficiencies, including the most recent annual inspection on June 3, 2025, which was clean with all files and the facility in good condition. Earlier reports showed some isolated issues such as unsecured cleaning supplies, incomplete care plans, and medication labeling problems in May 2023, as well as a substantiated complaint in December 2024 about a staff member working without a current criminal background clearance, which resulted in a $500 fine. Several complaint investigations were unsubstantiated, including allegations about medication administration, staff communication, and facility cleanliness. There was also a substantiated complaint in 2021 regarding failure to provide proper notice of rate increases and another about not issuing a refund after a resident’s passing. Overall, the facility’s record shows improvement over time, with recent inspections free of deficiencies and earlier issues addressed.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Jun 3, 2025
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be in good condition with no deficiencies cited. All resident and staff files were complete and up to date, and the physical plant, medication storage, and supplies were in compliance with regulations.
Report Facts
Food supply duration: 7
Food supply duration: 2
Administrator certificate expiration: Aug 16, 2026
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Ell | Facility Designated Administrator | Met during inspection and holds current administrator certificate |
| Ricki Cantu | House Manager | Met during inspection and explained purpose of visit |
| Jessica Galvan | Staff member present during inspection | |
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection visit |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 3
Capacity: 6
Deficiencies: 0
Mar 19, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2024-12-13 regarding medication administration, staff training, food supply adequacy, and facility cleanliness.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews and record reviews indicated that medications were administered as prescribed, staff received proper training, food supply was adequate, and the facility was kept clean. No deficiencies were observed or cited.
Complaint Details
The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred.
Report Facts
Facility capacity: 6
Census: 3
Shopping trip amounts: 360
Shopping trip amounts: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Ell | Facility Designated Administrator | Met during the investigation and involved in interviews regarding allegations |
| Arielle Pascua | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 3
Capacity: 6
Deficiencies: 0
Mar 19, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff did not communicate with residents’ authorized representatives about medication changes.
Findings
The investigation found that although a medication change occurred for a resident, the resident's authorized representative was notified through the doctor. There was no evidence that the facility failed to notify the responsible party. The allegations were found to be unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint alleged that staff did not communicate with residents’ authorized representatives about medication changes. The investigation concluded the allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 6
Census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Ell | Facility Designated Administrator | Met during the complaint investigation and interviewed regarding the allegations |
| Arielle Pascua | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 1
Dec 19, 2024
Visit Reason
The visit was conducted in response to a complaint investigation regarding an individual (S1) working at the facility without a current criminal background clearance.
Findings
The inspection found that S1 did not have a current criminal background clearance as required, posing immediate health, safety, and personal rights risks to persons in care. An immediate civil penalty of $500 was issued for this violation.
Complaint Details
The visit was triggered by a complaint. It was substantiated that S1 lacked a criminal background clearance and was working at the facility since 11/01/2024 without clearance. The clearance process was in progress as of 12/12/2024.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not ensure that S1 had a current criminal background clearance prior to working at the facility. | Type A |
Report Facts
Civil penalty amount: 500
Facility capacity: 6
Census: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Ell | Administrator | Met with Licensing Program Analyst during inspection |
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection and authored the report |
| Lisa Rios | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
May 16, 2024
Visit Reason
The visit was an unannounced annual inspection conducted by Licensing Program Analyst Arielle Pascua to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be in good condition and sanitary with no deficiencies cited. A technical violation was noted regarding the requirement for an annual physician's report. All resident and staff files reviewed were complete and up to date.
Report Facts
Fire extinguisher inspection validity: Sep 19, 2024
Administrator certificate expiration: Aug 16, 2024
Resident files reviewed: 4
Staff files reviewed: 3
Licensed capacity: 6
Current census: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Arielle Pascua | Licensing Program Analyst | Conducted the annual inspection visit |
| Sarena Arias | Facility Designated Representative | Met with Licensing Program Analyst during inspection |
| Nicole Ell | Administrator | Facility administrator named in report |
Inspection Report
Census: 3
Capacity: 6
Deficiencies: 0
Jul 27, 2023
Visit Reason
The visit was an unannounced case management follow-up to review information gathered from the annual visit conducted on 2023-05-04, specifically regarding the facility's transition to vendorization from Valley Mountain Regional Center and the requested update to the Plan of Operation.
Findings
No deficiencies were cited during this visit. The facility was reminded to submit the updated Plan of Operation by 2023-08-18 to avoid potential deficiencies.
Report Facts
Capacity: 6
Census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Arielle Pascua | Licensing Program Analyst | Conducted the case management visit and explained the purpose of the visit |
| Sarena Arias | Facility Designated Representative | Met with Licensing Program Analyst during the visit and was informed about the Plan of Operation update |
| Carolyn Lane | Staff Member | Greeted the Licensing Program Analyst and contacted the Facility Designated Representative |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 3
May 4, 2023
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate compliance with licensing regulations and assess the facility's condition and operations.
Findings
The facility was generally found to be in good condition and sanitary, with adequate supplies and furnishings. However, deficiencies were cited related to unsecured cleaning supplies, lack of a proper care plan for a resident with a Foley catheter, and medication without proper prescription labeling.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Cleaning supplies under the kitchen counter were not locked and accessible to residents, posing a safety risk. | Type A |
| Resident R1 did not have a proper care plan on file despite having a Foley catheter upon admission. | Type A |
| Over the counter pain medication for Resident R1 lacked a prescription label. | Type B |
Report Facts
Capacity: 6
Census: 3
Plan of Correction Due Date: May 5, 2023
Plan of Correction Due Date: May 25, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection and authored the report |
| Sarena Arias | Facility Designated Representative | Met with Licensing Program Analyst during inspection |
| Nicole Ell | Administrator | Facility Administrator named in the report |
| Stephenie Doub | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Apr 27, 2022
Visit Reason
Licensing Program Analyst Ruth Wallace conducted an unannounced 1 Year Required Annual Inspection Visit to evaluate the facility's compliance with regulations.
Findings
The inspection found no deficiencies. The physical plant, staff files, resident files, medication storage, and posted documents were all in compliance with regulatory requirements.
Report Facts
Fire Extinguisher Expiration Date: Sep 1, 2022
Hot Water Temperature: 113.5
Staff Files Reviewed: 4
Resident Files Reviewed: 4
Resident Medication Files Reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Ell | Administrator | Met with Licensing Program Analyst during inspection |
| Ruth Wallace | Licensing Program Analyst | Conducted the inspection |
| Stephen Richardson | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Dec 6, 2021
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 09/28/2021 regarding changes to a resident's Admissions Agreement without permission and failure to provide a copy of the Admissions Agreement to the resident's representative, as well as allegations of raising resident's rates without proper notice.
Findings
The investigation found the allegations regarding changes to the Admissions Agreement and failure to provide copies were unsubstantiated, with no changes made and copies provided. However, the allegation that the facility raised resident's rates without proper notice was substantiated, resulting in a cited deficiency for failure to provide the required 60 days' written notice of rate increases.
Complaint Details
The complaint investigation was triggered by allegations that the facility made unauthorized changes to a resident's Admissions Agreement and failed to provide a copy to the resident's representative, as well as raised resident's rates without proper notice. The first two allegations were unsubstantiated, while the rate increase allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide proper 60 days' written notice to residents or their representatives for rate increases, as required by HSC 1569.655. | Type B |
Report Facts
Capacity: 6
Census: 5
Deficiencies cited: 1
Plan of Correction Due Date: Dec 15, 2021
Notice sent date: Oct 4, 2021
Rate increase effective date: Dec 4, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Arlene D Garcia | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Nicole Eli | Administrator | Facility administrator involved in interviews and exit interview |
| Stephenie Doub | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Jun 23, 2021
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 2021-02-02 regarding the facility's failure to issue a refund.
Findings
The facility was found deficient for not properly issuing a refund to the responsible party of a deceased resident after the resident's personal property was removed. This posed a possible threat to the health, safety, and personal rights of residents in care.
Complaint Details
Complaint was substantiated. The allegation was that the facility failed to issue a refund. The investigation confirmed the deficiency related to refund issuance after a resident's passing.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to issue a refund of fees paid in advance covering the time after the resident’s personal property was removed, as required by CCR 87507(5)(c). | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: Jun 30, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Charlie Yang | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Stephenie Doub | Licensing Program Manager | Oversaw the complaint investigation and signed the report |
| Sharon Martin | Facility Designated Administrator | Facility administrator involved in the investigation and exit interview |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 6
May 21, 2021
Visit Reason
An unannounced annual / Infection Control inspection was conducted to evaluate compliance with licensing regulations and assess the facility's physical plant, resident and staff files, and safety measures.
Findings
The inspection found several deficiencies including missing fire clearance, absence of carbon monoxide detector, lack of fire drill documentation, missing oxygen in use signs, late payment of licensing fees, and incomplete resident records. These deficiencies pose potential or immediate health and safety risks to residents.
Severity Breakdown
Type A: 3
Type B: 3
Deficiencies (6)
| Description | Severity |
|---|---|
| Facility did not have a fire clearance approved by the fire department. | Type A |
| Licensee did not have a Carbon Monoxide detector on site, posing immediate health and safety risk. | Type A |
| Facility did not have record of fire drills log on site, posing potential safety risk. | Type B |
| Oxygen in use signs were not posted in resident rooms with oxygen. | Type A |
| Licensee failed to pay annual licensing fees timely, posing potential health, safety or personal rights risk. | Type B |
| Resident records were not complete, signed, and dated as required, posing potential health and safety risk. | Type B |
Report Facts
Capacity: 6
Census: 3
Deficiencies cited: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Arlene D Garcia | Licensing Program Analyst | Conducted the inspection and signed the report |
| Albert Johnson | Licensing Program Analyst | Conducted the inspection |
| Sharon Martin | Administrator | Facility administrator present during inspection and exit interview |
| Stephenie Doub | Licensing Program Manager | Supervisor overseeing the inspection |
| Remy Raqueno | Participated in exit interview related to fire clearance deficiency |
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