Inspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally consistent compliance over time. The most recent report from August 7, 2025, found a serious deficiency where staff failed to evacuate a resident during a mandatory fire evacuation, resulting in the resident being rescued by the fire department; this posed an immediate risk to persons in care. Earlier deficiencies primarily involved infection control, medication management, and environmental safety issues such as improper storage of cleaning solutions and lapses in dementia care, with some corrected in follow-up visits. A $500 civil penalty was issued in March 2024 related to neglect causing a pressure injury and delayed medical care. While the facility showed improvement in some areas, recent findings indicate some serious concerns remain.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
6.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
55% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
0% occupied
Based on a August 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Capacity: 112
Deficiencies: 1
Date: Aug 7, 2025
Visit Reason
This was an unannounced complaint investigation visit triggered by an allegation that staff did not evacuate a resident during a mandatory evacuation due to a fire near the facility.
Complaint Details
The complaint alleged that staff did not evacuate a resident during a mandatory evacuation. The allegation was substantiated based on interviews and records showing a resident was left behind and evacuated by the fire department. The investigation included interviews with staff, residents, responsible parties, fire department personnel, and review of fire department status reports.
Findings
The investigation found that at least one resident was left in their room and had to be evacuated by the fire department, confirming the allegation as substantiated. Staff began evacuation procedures but were instructed by the fire department to not re-enter the building. Some residents were evacuated by family members or unidentified individuals. The facility was destroyed by the Eaton fire, and the investigation was conducted largely via telephone and interviews.
Deficiencies (1)
Failure to evacuate resident during mandatory evacuation, resulting in a resident being evacuated by the fire department which posed an immediate risk to persons in care.
Report Facts
Capacity: 112
Census: 0
Plan of Correction Due Date: Aug 8, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Maria Teresita Quizon | Administrator | Facility administrator contacted during investigation |
Inspection Report
Annual Inspection
Census: 112
Capacity: 112
Deficiencies: 0
Date: Jun 25, 2025
Visit Reason
The inspection was a required one-year unannounced annual visit to evaluate the facility's compliance with licensing requirements.
Findings
The report outlines the licensing deficiencies and the types of deficiencies (Type A and Type B) that may be cited. It also explains the process for plans of correction, civil penalties, and appeal rights. No specific deficiencies or findings are detailed in the provided pages.
Inspection Report
Complaint Investigation
Census: 96
Capacity: 112
Deficiencies: 0
Date: Nov 25, 2024
Visit Reason
The visit was an unannounced case management follow-up on an incident report submitted on 2024-11-19 regarding an altercation between two residents resulting in injury.
Complaint Details
The complaint involved an incident where Resident #2 threw a picture frame and hit Resident #1, causing bleeding and requiring paramedic intervention. The complaint was investigated through interviews and document review, confirming the aggressive behavior history of Resident #2 and the facility's response.
Findings
The investigation found that Resident #2 exhibited aggressive behavior towards Resident #1, causing injury that required hospital transport. The facility updated care plans and implemented increased monitoring measures. No deficiencies were noted during the visit.
Report Facts
Incident report date: Nov 19, 2024
Incident date: Nov 18, 2024
Time visit began: 1118
Time visit completed: 1330
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary Flores | Licensing Program Analyst | Conducted the unannounced case management visit and investigation |
| Maria Teresita Quizon | Administrator | Facility administrator met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 112
Deficiencies: 0
Date: Aug 26, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that facility staff did not provide information on a resident's injury and that staff were retaining residents who require a higher level of care.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to provide information on a resident's injury and retaining residents requiring a higher level of care. Interviews, document reviews, and resident interviews were conducted. The investigation concluded there was insufficient evidence to prove violations.
Findings
The investigation found that staff responded to a resident's fall and contacted 911 as per protocol, with family notified on the same day; however, staff were unable to provide detailed information to the resident's representative. Regarding retention of residents needing higher care, the facility had three residents with dementia in assisted living awaiting openings in the dementia unit, with precautions in place to ensure their safety. Both allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 112
Census: 92
Residents with dementia: 3
Resident files reviewed: 6
Residents interviewed: 5
Physician reports reviewed: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tony Vasallo | Licensing Program Manager | Oversaw the complaint investigation |
| Leticia Martinez | Wellness Coordinator | Met with Licensing Program Analyst during investigation |
| Maria Teresita Quizon | Administrator | Provided resident files and information during investigation |
Inspection Report
Plan of Correction
Census: 94
Capacity: 112
Deficiencies: 1
Date: Jul 22, 2024
Visit Reason
The visit was an unannounced plan of correction (POC) inspection to follow up on a previously noted deficiency regarding storage of cleaning solutions in a resident's room.
Findings
The deficiency related to storage of cleaning solutions on a resident's nightstand was cleared during this visit after the cleaning solutions were removed and staff training and care plans were reviewed.
Deficiencies (1)
Storage Space: Cleaning solution was found on resident's nightstand in room #222 despite previous citation.
Report Facts
Capacity: 112
Census: 94
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection |
| Mary Flores | Licensing Program Analyst | Conducted the plan of correction visit and cited deficiency |
Inspection Report
Plan of Correction
Census: 96
Capacity: 112
Deficiencies: 4
Date: Jul 9, 2024
Visit Reason
The visit was an unannounced plan of correction (POC) inspection conducted to follow up on deficiencies noted during an annual visit on 2024-06-06.
Findings
The inspection found that all previously noted deficiencies related to infection control, maintenance and operation, and oxygen administration were corrected by the date of the follow-up visit on 2024-07-09.
Deficiencies (4)
Staff exited quarantine room without using hand sanitizer or proper infection prevention measures.
Water temperature in resident rooms was not within required range.
Staff provided care to a resident with a contagious disease without wearing PPE supplies.
Oxygen tank was without a stand in resident room.
Report Facts
Capacity: 112
Census: 96
Water temperature: 122.8
Water temperature: 121
Water temperature: 97.5
Water temperature: 107.5
Water temperature: 117
Water temperature: 107.7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection and exit interview |
| Mary Flores | Licensing Program Analyst | Conducted the unannounced plan of correction visit |
Inspection Report
Follow-Up
Census: 96
Capacity: 112
Deficiencies: 1
Date: Jul 9, 2024
Visit Reason
The visit was an unannounced plan of correction (POC) follow-up to verify correction of deficiencies noted during an annual visit on 2024-06-06.
Findings
The facility was found to still have cleaning solutions stored in a resident's room (#222) where a resident with dementia resides, posing an immediate health and safety risk. The deficiency related to improper storage of hazardous materials was not corrected by the due date.
Deficiencies (1)
Cleaning solutions were observed in room #222 where a resident with dementia resides, violating storage space regulations.
Report Facts
Capacity: 112
Census: 96
Plan of Correction Due Date: Jun 7, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection and exit interview |
| Mary G Flores | Licensing Program Analyst | Conducted the unannounced plan of correction visit and annual visit |
| Tony Vasallo | Supervisor | Supervisor named in the report |
Inspection Report
Annual Inspection
Census: 94
Capacity: 112
Deficiencies: 0
Date: Jun 13, 2024
Visit Reason
An unannounced continuation annual visit was conducted as part of the annual case management inspection to evaluate compliance with regulatory requirements.
Findings
The Licensing Program Analyst reviewed multiple domains including infection control, staffing, personnel records, disaster preparedness, and residents with special health needs. No deficiencies were cited during this visit.
Report Facts
Staff files reviewed: 6
Staff interviewed: 4
Residents interviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection; administrator certificate observed |
| Mary Flores | Licensing Program Analyst | Conducted the unannounced continuation annual visit |
Inspection Report
Annual Inspection
Census: 94
Capacity: 112
Deficiencies: 5
Date: Jun 6, 2024
Visit Reason
An unannounced annual visit was conducted using the CARE inspection tool to evaluate compliance with licensing regulations and facility standards.
Findings
The facility was generally in good repair with adequate environmental cleaning and safety measures; however, several deficiencies were noted including improper hand hygiene by staff exiting a quarantine room, water temperature issues in resident bathrooms, unsafe storage of cleaning solutions in a resident's room, lack of PPE use when caring for contagious residents, and an unsecured oxygen tank in a resident's room.
Deficiencies (5)
Staff exiting quarantine room #229 did not perform hand hygiene, posing an immediate health and safety risk.
Water temperature in 3 out of 7 resident bathrooms was outside the required range (105-120°F), posing an immediate health and safety risk.
Cleaning solution was stored in room #222 where a resident with dementia resides, posing an immediate health and safety risk.
Staff providing care to a resident with a contagious disease were not wearing appropriate PPE, posing a potential health and safety risk.
An oxygen tank in room #118 was observed without a stand, posing a potential health and safety risk.
Report Facts
Residents under hospice: 11
Resident rooms observed: 7
Residents' medication files reviewed: 7
Water temperature readings: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection and involved in exit interview |
| Mary G Flores | Licensing Evaluator | Conducted the inspection and authored the report |
| Tony Vasallo | Supervisor | Supervisor overseeing the inspection process |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 112
Deficiencies: 0
Date: Mar 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted regarding an allegation that facility staff was restricting a resident from seeing a visitor.
Complaint Details
The complaint alleged that facility staff was restricting a resident from seeing a visitor who was a past employee. The investigation included interviews with residents and staff, review of visitor logs and policies. The allegation was found unsubstantiated.
Findings
The investigation found that residents are aware of the visiting policy and visitations have not been restricted. Former employees are allowed to visit residents if requested by the resident. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Visitors counted: 430
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
| Maria Teresita Quizon | Administrator | Named in relation to the allegation and exit interview |
| Tony Vasallo | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 112
Deficiencies: 0
Date: Mar 14, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations including questionable death, staff not preventing the spread of a communicable disease, and staff not following proper hand washing.
Complaint Details
The complaint involved allegations of questionable death related to a Covid-19 and Norovirus outbreak in March 2023, and staff failing to prevent disease spread and follow hand washing protocols. The allegations were unsubstantiated based on interviews, record reviews, and observations.
Findings
The investigation found no sufficient evidence to substantiate the allegations. Death reports indicated residents died of natural causes, and staff and residents denied improper sanitation or hand washing practices. The facility maintained proper infection control measures and timely reporting of outbreaks.
Report Facts
Capacity: 112
Census: 91
Staff interviewed: 4
Residents interviewed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during investigation |
| Tena Herrera | Licensing Program Analyst | Conducted the complaint investigation visit |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 112
Deficiencies: 0
Date: Mar 14, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff do not treat residents with dignity and respect.
Complaint Details
The allegation was that staff member S1 was rude and belittled residents. The Administrator and all interviewed staff denied the allegation. Six out of ten residents denied the allegation, while four residents did not remember S1. No disciplinary actions were found in staff files. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation found that the allegation was unsubstantiated as interviews with staff, residents, and review of staff files did not provide sufficient evidence to prove the alleged violation occurred.
Report Facts
Capacity: 112
Census: 91
Residents interviewed: 10
Staff interviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst and denied the allegation |
| Jewel Baptiste | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lisa Hicks | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 112
Deficiencies: 3
Date: Mar 14, 2024
Visit Reason
An unannounced complaint investigation visit was conducted regarding allegations that a resident developed a pressure injury due to staff neglect, facility staff did not seek timely medical attention for the resident, and staff did not notice a change in resident conditions.
Complaint Details
The complaint was substantiated regarding neglect leading to a pressure injury and failure to seek timely medical attention. The allegation about failure to provide laundry services was unsubstantiated.
Findings
The investigation substantiated that the resident developed an unstageable wound on the left heel due to staff neglect and failure to obtain timely medical care for at least two weeks. Staff were aware of the wound but lacked training in wound care and prevention. An immediate civil penalty of $500 was issued. Another allegation regarding failure to provide basic laundry services was unsubstantiated.
Deficiencies (3)
Licensee did not ensure measurements were taken to prevent Resident #1 from developing an unstageable wound on the left heel which poses an immediate risk to health, safety, or personal rights.
Licensee did not ensure Resident #1 was provided medical care and was not retained at the facility upon developing an unstageable wound on the left heel.
Licensee did not ensure Resident #1 was provided medical care in a timely manner after developing a wound on the left heel.
Report Facts
Civil Penalty: 500
Deficiency count: 3
Wound size: 3
Wound size: 2.3
Wound size: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit and interviews. |
| Tony Vasallo | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Maria Teresita Quizon | Administrator | Facility administrator met with Licensing Program Analyst during the investigation. |
| Peter Zertuche | Investigation Bureau Department Investigator | Conducted interviews with facility staff and wound care physician. |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 112
Deficiencies: 0
Date: Mar 5, 2024
Visit Reason
An unannounced complaint investigation visit was conducted regarding allegations that residents' diapering needs were not being met, staff mismanaged residents' money, and the facility was not kept free of hazards.
Complaint Details
The complaint investigation was unannounced and focused on three allegations: unmet diapering needs, mismanagement of residents' money, and failure to maintain a hazard-free facility. Interviews with staff and residents, review of documentation, and facility observations did not support the allegations. The police investigation related to similar claims found no criminal activity. The allegations were deemed unsubstantiated due to lack of evidence.
Findings
The investigation found no corroborating evidence for the allegations. Staff and residents denied the claims, documentation and observations supported proper care and safety, and the police investigation found no criminal activity. Therefore, the allegations were determined to be unsubstantiated.
Report Facts
Facility capacity: 112
Census: 89
Number of allegations: 3
Number of staff interviewed: 8
Number of residents interviewed: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Bennette Pena | Licensing Program Analyst | Conducted the complaint investigation |
| Maria Teresita Quizon | Executive Director | Facility administrator met during investigation |
| David Sicairos | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 112
Deficiencies: 0
Date: Oct 10, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation of lack of care and supervision resulting in multiple falls and an injury.
Complaint Details
The complaint alleged that a resident (R1) suffered multiple falls between June and July 2020 due to lack of supervision and communication among staff. The investigation included interviews with staff and residents, review of resident files, incident reports, hospice records, and observation of staff to resident ratios. The allegation was found unsubstantiated due to lack of sufficient evidence.
Findings
The investigation found insufficient evidence to substantiate the allegation. Staff interviews, resident interviews, and review of records indicated that the facility had procedures in place for communication and monitoring residents, and no falls resulted in hospitalization. The allegation was determined to be unsubstantiated.
Report Facts
Capacity: 112
Census: 91
Staff to resident ratio: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during the investigation and received the report |
| Bennette Pena | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 112
Deficiencies: 2
Date: Sep 1, 2023
Visit Reason
The visit was an unannounced case management follow-up on an incident report submitted on 2023-08-28 regarding a resident not found during a morning check on 2023-08-27.
Complaint Details
The visit was triggered by a complaint incident report about a resident with dementia who was not found during a morning check and was found in another resident's room. The facility did not contact the police as required. The complaint was substantiated with noted deficiencies.
Findings
The facility failed to provide appropriate dementia care to a resident with dementia, posing an immediate risk to health and safety. Additionally, the facility did not obtain an annual physician's report appraisal as required, posing a potential risk.
Deficiencies (2)
Licensee did not ensure resident with dementia was provided dementia care, posing an immediate risk to health, safety, or personal rights.
Licensee failed to obtain an annual physician's report appraisal for residents with dementia, posing a potential risk to health, safety, or personal rights.
Report Facts
Capacity: 112
Census: 93
Plan of Correction Due Date: Sep 2, 2023
Plan of Correction Due Date: Sep 15, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met during visit and provided information about resident care procedures |
| Mary G Flores | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report |
| Tony Vasallo | Supervisor | Named as supervisor in the report |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 112
Deficiencies: 0
Date: Aug 22, 2023
Visit Reason
An unannounced complaint investigation visit was conducted regarding an allegation that staff allowed dental services to a resident without the resident's consent.
Complaint Details
The allegation that staff allowed dental services to a resident without the resident's consent was investigated and found to be unfounded.
Findings
The investigation found that the resident in question does not reside or resided at the facility, and based on the information gathered, the allegation was deemed unfounded.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
| Maria Teresita Quizon | Administrator | Facility administrator involved in exit interview |
| Dana Denham | Health Services Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 92
Capacity: 112
Deficiencies: 2
Date: Jun 17, 2023
Visit Reason
An unannounced case management annual continuation visit was conducted to conclude review of Personnel Records, Resident Records, and Residents with Special Health Needs.
Findings
Deficiencies were noted related to incomplete staff training on postural support and restricted health conditions, and a missing TB clearance for resident #5. Plans of correction were required to address these issues by 06/30/2023.
Deficiencies (2)
Staff #3 and #4 did not receive required training on postural support and restricted health conditions.
Resident #5 was missing a TB clearance on file.
Report Facts
Staff files reviewed: 5
Resident files reviewed: 5
Staff interviewed: 4
Residents interviewed: 4
Plan of Correction due date: Jun 30, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the inspection and authored the report |
| Margaret Jay | Business Office Manager | Met with Licensing Program Analyst during the visit |
| Maria Teresita Quizon | Administrator | Facility administrator with certificate observed during inspection |
| Tony Vasallo | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Annual Inspection
Census: 92
Capacity: 112
Deficiencies: 1
Date: Jun 15, 2023
Visit Reason
An unannounced annual visit was conducted using the CARE tool to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean and in good repair with sufficient food supplies and proper safety measures in place. No deficiencies were noted, but a technical violation was recorded per Title 22 Regulations.
Deficiencies (1)
Technical Violation noted per Title 22 Regulations
Report Facts
Residents under hospice: 5
Water temperature range: 104.3-114.6
Fire drill date: May 25, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during inspection and involved in facility tour |
| Dana Denham | Health Service Director | Participated in exit interview |
| Mary Flores | Licensing Program Analyst | Conducted the unannounced annual visit and inspection |
Inspection Report
Complaint Investigation
Census: 89
Capacity: 112
Deficiencies: 0
Date: Aug 17, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-04-28 alleging lack of care and supervision resulting in multiple falls and an injury.
Complaint Details
The complaint alleged that Resident #1 suffered multiple falls between June and July 2020 due to lack of supervision and communication among staff. The allegation was found unsubstantiated based on interviews, documentation, and lack of preponderance of evidence.
Findings
The investigation included interviews with staff and residents, review of resident files, and facility records. Staff and residents denied the allegations, and the facility documented and reported falls and sought timely medical attention. There was insufficient evidence to substantiate the allegation, resulting in an unsubstantiated finding.
Report Facts
Capacity: 112
Census: 89
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Sicairos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Stefanie Coronel | Licensing Program Manager | Named in report as Licensing Program Manager |
| Dana Denham | Health Services Director | Met with Licensing Program Analyst during investigation |
| Maria Teresita Quizon | Administrator | Facility Administrator named in report |
Inspection Report
Plan of Correction
Census: 89
Capacity: 112
Deficiencies: 1
Date: Jul 12, 2022
Visit Reason
Unannounced Plan of Correction visit to follow up on deficiencies identified during the annual visit on 2022-06-29.
Findings
The deficiency related to the dementia care kitchen's cabinet being unlocked was corrected; the cabinet was found locked during this visit, indicating the deficiency was cleared.
Deficiencies (1)
Dementia care kitchen's cabinet with cleaning supplies unlocked on 2022-06-29.
Report Facts
Capacity: 112
Census: 89
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during the Plan of Correction visit and exit interview |
| Mary Flores | Licensing Program Analyst | Conducted the unannounced Plan of Correction visit and annual visit |
Inspection Report
Annual Inspection
Census: 90
Capacity: 112
Deficiencies: 2
Date: Jun 29, 2022
Visit Reason
An unannounced annual visit was conducted focusing on infection control, food supplies, and medication compliance.
Findings
The facility was generally compliant with required conditions including fire safety and food supplies, but deficiencies were noted such as unlocked cleaning supplies accessible to memory care residents, missing prescribed medications for some residents, and lack of infection control hand washing signs in certain areas.
Deficiencies (2)
Memory care unit kitchen's sink was unlocked, making cleaning supplies accessible to residents with dementia, posing an immediate health and safety risk.
Residents #3, #8, and #9 were missing medication prescribed by the physician.
Report Facts
Capacity: 112
Census: 90
Water temperature: 106.5
Water temperature: 110.4
Food supply duration: 2
Food supply duration: 7
Plan of Correction Due Date: Jun 30, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met during inspection and named in report |
| Raul Sandoval | Maintenance Director | Conducted facility tour with Licensing Program Analyst |
| Mary G Flores | Licensing Evaluator | Conducted inspection and authored report |
| Stefanie Coronel | Supervisor | Supervisor overseeing the inspection |
| Margaret Jay | Business Office Manager | Participated in exit interview |
Inspection Report
Complaint Investigation
Capacity: 112
Deficiencies: 2
Date: Mar 9, 2022
Visit Reason
The visit was a case management follow-up to provide deficiencies related to a complaint investigation conducted on 2021-11-09 regarding a HIPAA confidentiality breach during a resident transfer.
Complaint Details
The complaint investigation revealed a HIPAA violation where facility staff provided paramedics with the emergency packet for resident #2 instead of resident #1 during a hospital transfer, resulting in confidentiality breach and risk to resident welfare.
Findings
The facility failed to safeguard resident confidentiality by providing the emergency packet of resident #2 instead of resident #1 during a hospital transfer, violating HIPAA law and endangering the resident's welfare.
Deficiencies (2)
Failure to ensure staff were trained in safeguarding confidentiality of resident #1 during hospital transfer, posing immediate health, safety, and personal risk.
Failure to ensure resident #1's welfare was not endangered under care and supervision during hospital transfer, posing immediate health, safety, and personal risk.
Report Facts
Capacity: 112
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during the visit and exit interview |
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation and case management visit |
| Stefanie Coronel | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Census: 90
Capacity: 112
Deficiencies: 0
Date: Jan 14, 2022
Visit Reason
The visit was a case management visit regarding COVID-19 guidance for reporting requirements following the facility's report of COVID positive cases.
Findings
No deficiencies were given during this visit. A technical violation was provided related to timely reporting of COVID-19 breakout cases, and COVID guidance PINs were to be emailed to the administrator.
Report Facts
COVID positive cases report date: Dec 31, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analyst during the visit and was involved in the COVID reporting discussion |
| Mary Flores | Licensing Program Analyst | Conducted the case management visit and provided technical violation and guidance |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 112
Deficiencies: 0
Date: Nov 9, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that facility staff did not provide a resident's medical records to the resident's medical provider and that staff were not communicating with the resident's medical provider.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to provide correct medical records and lack of communication with the resident's medical provider. The investigation included interviews with staff and review of fax logs and hospital contacts. Despite some errors, there was insufficient evidence to prove violations occurred.
Findings
The investigation found that the facility mistakenly sent incorrect medical records to the hospital due to a receptionist error, but the facility provided training and corrected the issue. Communication with the resident's medical provider was confirmed through a medical technician, but there was no preponderance of evidence to substantiate the allegations. Therefore, the allegations were unsubstantiated.
Report Facts
Facility capacity: 112
Census: 90
Complaint control number: 28-AS-20210802133554
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met during investigation and provided information regarding allegations |
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Annual Inspection
Census: 82
Capacity: 112
Deficiencies: 6
Date: Jun 11, 2021
Visit Reason
An unannounced annual visit focusing on infection control, food supplies, and medication was conducted to evaluate compliance with regulatory requirements.
Findings
The inspection found multiple deficiencies including improper storage of cleaning solutions and scissors accessible to residents, lack of a 30-day supply of medication for some residents, medications not stored in original containers, PRN medications without proper labeling, malfunctioning auditory devices in the dementia unit, and staff not properly wearing face coverings according to CDC guidelines.
Deficiencies (6)
Cleaning solutions and scissors were observed in resident's room #112, posing a safety risk.
Two out of eight residents did not have a 30-day supply of medication present.
Three out of eight residents' medications were not in the original container.
One resident's PRN medication did not have a pharmacy label.
Auditory devices in the dementia unit were not functioning properly.
Staff and vendor were observed wearing face coverings under their chin, not properly covering mouth and nose.
Report Facts
Residents reviewed for medication: 8
Capacity: 112
Census: 82
Days of food supplies: 2
Days of food supplies: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maria Teresita Quizon | Administrator | Met with Licensing Program Analysts during inspection and named in plans of correction. |
| Mary G Flores | Licensing Evaluator | Conducted the inspection and signed the report. |
| Rebecca Orendain | Supervisor | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 112
Deficiencies: 0
Date: May 12, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that a resident's items and money were stolen while in care.
Complaint Details
The complaint alleged that a resident's items and money were stolen while in care. The investigation found no substantiation for the allegation based on interviews and record reviews.
Findings
The investigation included interviews with residents and staff, and a review of records. The evidence showed that most residents did not report missing items, staff were unaware of any thefts, and no incident or police reports were found. The allegation was found to be unsubstantiated.
Report Facts
Residents interviewed: 9
Staff interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation |
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation |
| Maria Quizon | Administrator | Met with during the investigation and exit interview |
| Rebecca Orendain | Licensing Program Manager | Named in report as Licensing Program Manager |
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