Inspection Report
Complaint Investigation
Census: 82
Capacity: 107
Deficiencies: 0
Aug 25, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2025-07-11 regarding allegations of staff mismanaging resident's medication and not safeguarding resident's personal items.
Findings
The investigation found no sufficient evidence to substantiate the allegations. The review of medication records and interviews with staff and residents indicated that medication was managed properly and residents' personal items were safeguarded. The complaint was determined to be unsubstantiated.
Complaint Details
The complaint involved allegations that staff mismanaged a resident's medication and did not safeguard resident's personal items. After investigation including interviews and record reviews, the allegations were found to be unsubstantiated.
Report Facts
Capacity: 107
Census: 82
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met with Licensing Program Analyst during the complaint investigation |
| Arielle Pascua | Licensing Program Analyst | Conducted the complaint investigation |
| Lisa Rios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 80
Capacity: 107
Deficiencies: 1
Jun 16, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2025-01-28 regarding allegations that staff did not dispense medication as prescribed, did not safeguard resident's personal belongings, and were not following resident's care plan.
Findings
The investigation substantiated the allegation that staff did not administer medication to a resident as prescribed, citing evidence from staff interviews and record reviews. The allegations that staff did not safeguard resident's personal belongings and were not following the resident's care plan were found to be unsubstantiated based on interviews and evidence gathered.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not dispense medication to a resident as prescribed. The allegations regarding safeguarding resident's personal belongings and following the resident's care plan were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The licensee shall assist residents with self-administered medications as needed. This is not met as evidenced by: Based on record review and interview, the licensee did not ensure that R1 was provided medication as prescribed. | Type B |
Report Facts
Capacity: 107
Census: 80
Deficiency count: 1
Plan of Correction Due Date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met with Licensing Program Analyst during complaint investigation and involved in findings |
| Arielle Pascua | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lisa Rios | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 86
Capacity: 107
Deficiencies: 0
Nov 25, 2024
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
No deficiencies were observed or cited during this annual visit. The facility was found to have complete and up-to-date resident and staff files, adequate furnishings, proper food storage, locked chemical and medication storage, functional safety equipment, and required documentation.
Report Facts
Resident census: 86
Licensed capacity: 107
Resident distribution: 65
Resident distribution: 21
Fire extinguisher inspection date: Dec 11, 2023
Administrator certificate expiration: Apr 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met with Licensing Program Analyst during inspection and named in report |
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection visit |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager in report |
Inspection Report
Census: 78
Capacity: 107
Deficiencies: 0
May 24, 2024
Visit Reason
The visit was an unannounced case management visit to follow up on an eviction notice to be served to a current resident due to non-payment, ensuring compliance with Title 22 regulations.
Findings
No deficiencies were observed or cited during the visit. The eviction notice was reviewed and found to include all required components.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met with Licensing Program Analyst during the visit and involved in the eviction notice review. |
Inspection Report
Annual Inspection
Census: 83
Capacity: 107
Deficiencies: 0
Nov 15, 2023
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate the facility's compliance with licensing requirements and overall operation.
Findings
The inspection found the facility to be in compliance with no deficiencies observed or cited. All resident and staff files reviewed were current and up to date, and safety measures including fire extinguishers, smoke and carbon monoxide detectors were functional.
Report Facts
Residents in assisted living: 69
Residents in memory care: 14
Hospice waiver capacity: 10
Resident files reviewed: 8
Staff files reviewed: 5
Fire extinguisher inspection date: Dec 7, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met during inspection and received exit interview |
| Anna Jones | Business Office Director | Met during inspection and conducted facility tour |
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection visit |
| Lisa Rios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 80
Capacity: 107
Deficiencies: 0
Nov 19, 2022
Visit Reason
An unannounced annual infection control visit was conducted to evaluate compliance with infection control standards and overall facility conditions.
Findings
The facility was toured including resident areas, kitchen, medication storage, and safety equipment. No deficiencies were observed or cited during this annual visit. Safety measures, supplies, and equipment were found to be adequate and functional.
Report Facts
Residents in assisted living: 62
Residents in Memory Care: 18
Hot water temperature range: 105
Hot water temperature range: 120
Fire extinguisher inspection date: Dec 17, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Facility Designated Administrator | Met during the visit and named in the report |
| Cassandra Cooral | Resident Care Director | Interviewed and toured facility with Licensing Program Analyst |
| Arielle Pascua | Licensing Program Analyst | Conducted the inspection visit |
| Stephenie Doub | Licensing Program Manager | Named in the report |
Inspection Report
Annual Inspection
Census: 67
Capacity: 107
Deficiencies: 0
Nov 5, 2021
Visit Reason
An unannounced annual infection control inspection was conducted to evaluate compliance with regulatory standards and infection control practices at the facility.
Findings
The inspection found the facility to be in compliance with all applicable regulations, with no deficiencies cited. Observations included proper infection control measures, adequate food supplies, valid certifications, and complete staff and resident files.
Report Facts
Staff vaccinated: 62
Residents vaccinated: 66
Staff files reviewed: 10
Resident files reviewed: 10
Food supplies: 7
Food supplies: 2
Hot water temperature: 105
Last fire/disaster drill date: Sep 21, 2021
ANSUL system date: Jul 9, 2021
Kitchen extinguisher date: Dec 14, 2020
Fire extinguishers date: Oct 12, 2021
Administrator certificate valid until: Apr 30, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Rodriguez | Administrator | Met with Licensing Program Analyst during inspection and involved in observations |
| Arlene Garcia | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bill Cates | Maintenance Manager | On site during inspection |
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