Inspection Report
Annual Inspection
Census: 44
Capacity: 60
Deficiencies: 5
Sep 5, 2025
Visit Reason
An unannounced required 1-year inspection visit was conducted to evaluate compliance with licensing requirements for the Residential Care For Elderly (RCFE) facility serving cognitively impaired residents aged 60 and over.
Findings
The inspection found several deficiencies including failure to report administrator changes within 30 days, missing mattress pads on 10 beds, outdated medical assessment for one resident, missing medications for two residents, lack of 'No Smoking-Oxygen in Use' signs in rooms with oxygen tanks, and other minor violations. Plans of correction were agreed upon for all deficiencies.
Severity Breakdown
Type A: 1
Type B: 4
Deficiencies (5)
| Description | Severity |
|---|---|
| Executive Director Subishsani Kumar was hired on 4/15/25 and licensee failed to report changes to CCL within 30 days. | Type B |
| Rooms 101, 106, 107, 111, 114, 202, 210, 216, 217, 219 beds did not have mattress pads. | Type B |
| Resident R6's last medical assessment is dated 7/28/2023 and is outdated. | Type B |
| Rooms 110, 115, and 210 had oxygen tanks but no 'No Smoking-Oxygen in Use' signs posted. | Type B |
| Resident R1’s Levothyroxine Sodium 75 mcg and Resident R2’s Hyoscyamine sulf 0.125mg PRN medications were not filled and last administered on 8/25/25. | Type A |
Report Facts
Staff count: 37
Residents with hospice services: 16
Residents with home health services: 2
Modified diet residents: 18
Beds missing mattress pads: 10
Plan of Correction due date: Sep 19, 2025
Plan of Correction due date: Sep 6, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Subishsani Kumar | Executive Director | Named in deficiencies related to administrator reporting and medication issues |
| Lisa Hicks | Licensing Program Manager | Named as licensing program manager overseeing the inspection |
| Noemi Galarza | Licensing Program Analyst | Conducted the inspection and signed the report |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 60
Deficiencies: 0
Jul 17, 2025
Visit Reason
The visit was an unannounced complaint investigation to examine allegations that the licensee does not provide a safe environment for residents in care, specifically concerning resident-on-resident abuse and staff response.
Findings
The investigation found insufficient evidence to substantiate the allegation of an unsafe environment due to resident abuse. Staff and residents largely denied the allegations, and no reported injuries were found. The Executive Director confirmed measures taken to ensure safety, including relocating residents involved in altercations and noted that one resident moved out.
Complaint Details
The complaint alleged that a resident was abusing another resident and staff were not addressing the behavior, creating an unsafe environment. Six of nine staff denied the allegation, two corroborated concerns about altercations, and one was neutral. All staff stated they would intervene immediately in altercations. Five residents denied feeling unsafe or being abused. The allegation was deemed unsubstantiated due to lack of sufficient evidence.
Report Facts
Staff interviewed: 9
Residents interviewed: 5
Date complaint received: May 22, 2025
Date resident moved out: Jun 6, 2025
Date residents relocated: May 28, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daniel Konishi | Licensing Program Analyst | Conducted the complaint investigation visit |
| Subishsani Kumar | Executive Director | Facility representative met during the investigation and provided information |
| David Sicairos | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 41
Capacity: 60
Deficiencies: 0
Jun 19, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff left residents in wet diapers for extended periods and did not ensure residents' showering needs were met.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with residents, staff, and witnesses, as well as observations and review of electronic charting, indicated residents were clean and showered as required. The allegations were deemed unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included residents being left in wet diapers for extended periods and showering needs not being met. Interviews with eight residents, six staff, and four witnesses, along with observations and documentation review, did not corroborate the allegations.
Report Facts
Capacity: 60
Census: 41
Number of residents interviewed: 8
Number of staff interviewed: 6
Number of witnesses interviewed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Conducted the complaint investigation |
| Suby Kumar | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Mark Chisum | Environmental Services Director | Accompanied Licensing Program Analyst during facility tour |
Inspection Report
Complaint Investigation
Census: 41
Capacity: 60
Deficiencies: 0
Jun 19, 2025
Visit Reason
An unannounced complaint investigation was conducted regarding allegations that staff did not safeguard resident's personal belongings, did not provide clean clothing, did not maintain resident's room cleanliness, and did not respond promptly to communications from resident's representatives.
Findings
The investigation found insufficient evidence to substantiate the allegations. Staff and Executive Director denied the claims, observations and interviews confirmed that residents' belongings were safeguarded, clothing was clean, rooms were maintained in a clean condition, and communications with family members were handled promptly.
Complaint Details
The complaint investigation was unsubstantiated based on interviews with staff, residents, and the Executive Director, as well as observations made during the visit. Allegations included theft of personal belongings, failure to provide clean clothing, unclean resident rooms, and poor communication with family members. No evidence was found to prove these allegations.
Report Facts
Facility capacity: 60
Resident census: 41
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation visit |
| Robert Jakini | Administrator / Executive Director | Interviewed regarding allegations and findings |
| Subishsani Kumar | Met with during the investigation |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 60
Deficiencies: 0
Jun 5, 2025
Visit Reason
The inspection was an unannounced complaint investigation regarding an allegation that staff do not provide adequate supervision to residents.
Findings
The investigation included interviews with the Executive Director, staff, and residents, and a tour of the facility. Staff and residents stated that supervision is adequate, with staff always available and monitoring residents. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged inadequate supervision of residents by staff. The investigation found no sufficient evidence to substantiate the allegation, resulting in an unsubstantiated finding.
Report Facts
Capacity: 60
Census: 40
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cynthia D Chan | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Named in report signature section |
| Subashsani Kumar | Executive Director | Interviewed during investigation |
Inspection Report
Annual Inspection
Census: 37
Capacity: 60
Deficiencies: 0
Jul 11, 2024
Visit Reason
The inspection was a required annual unannounced visit to evaluate compliance with licensing regulations for the memory care community facility.
Findings
The inspection found the facility to be in compliance with no deficiencies cited. Safety measures, environmental conditions, food service, planned activities, resident rights, disaster preparedness, special needs accommodations, health-related services, staffing, personnel training, infection control, and operational requirements were all observed to meet regulatory standards.
Report Facts
Hospice residents: 6
Hospice resident limit: 20
Personnel records reviewed: 5
Personnel records with required training: 3
Resident files reviewed: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Jakini | Administrator | Administrator certificate expiration date noted |
| Kimberly Ramirez | Licensing Program Analyst | Conducted the annual inspection |
| Mark Chisum | Environmental Director of Services | Met with Licensing Program Analyst during inspection |
| Tony Vasallo | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 60
Deficiencies: 2
Jul 1, 2024
Visit Reason
The inspection was conducted as part of an investigation of complaint #28-AS-20240304141910 regarding unlocked medications and personal items posing a risk to a resident.
Findings
Deficiencies were observed and cited related to unlocked medications and personal grooming items accessible to a resident at risk, violating California Code of Regulations, Title 22.
Complaint Details
Investigation of complaint #28-AS-20240304141910 found deficiencies related to unlocked medications and personal items accessible to a resident at risk. The complaint was substantiated by observations during the visit.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Medications were unlocked in resident #1's room, violating storage requirements for persons with dementia. | Type A |
| Scissors, shaving razors, perfumes, deodorants, and other hygiene items were unlocked in resident #1's bathroom cabinet, posing a risk. | Type A |
Report Facts
Capacity: 60
Census: 36
Plan of Correction Due Date: Jul 2, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Jakini | Administrator/Director | Facility administrator met during inspection and provided with report and appeal rights |
| Wei Siew Ho | Supervisor | Supervisor named in report |
| Nune Margaryan | Licensing Evaluator | Evaluator who conducted inspection and signed report |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 0
Jul 1, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that staff mismanaged residents' medication, including medication administered without proper sign-offs and medication being shared between residents.
Findings
The investigation found no preponderance of evidence to substantiate the allegation. Staff and administrator denied the claims, and medication administration records were reviewed and found to be properly documented. Residents confirmed medication administration but could not provide further details due to their diagnoses.
Complaint Details
The complaint was unsubstantiated as the investigation did not find sufficient evidence to prove the alleged medication mismanagement occurred.
Report Facts
Facility capacity: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation and visit |
| Robert Jakini | Administrator met during the investigation and exit interview | |
| Wei Siew Ho | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 60
Deficiencies: 1
Jun 14, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-08-18 regarding multiple allegations including failure to notify the appropriate doctor of a resident's change in condition.
Findings
The investigation substantiated the allegation that the facility did not notify the appropriate doctor of a resident's change in condition, specifically notifying the wrong physician. Other allegations including resident fracture due to lack of supervision, failure to notice change in condition, wound development, medication administration issues, and failure to ensure home health care were found unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that the facility notified the wrong physician of a resident's change in condition. Other allegations were unsubstantiated due to lack of preponderance of evidence. The investigation included interviews, record reviews, and medical record subpoenas.
Deficiencies (1)
| Description |
|---|
| Facility did not notify appropriate doctor of resident's change in condition. |
Report Facts
Capacity: 60
Census: 35
Medications listed: 21
Medications started on 6/7/22: 9
Medications listed at SNF discharge: 17
Weight loss: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Tony Vasallo | Licensing Program Manager | Oversaw the complaint investigation. |
| Robert Jakini | Executive Director | Facility representative met during the investigation and exit interview. |
| Deborah Higgins | Administrator | Facility administrator mentioned in the report header. |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 1
Jun 11, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2022-08-18 concerning resident care issues at the facility.
Findings
The investigation substantiated that the facility failed to notify the appropriate doctor of a resident's change in condition, posing a potential risk to the resident's health and safety. Other allegations including resident fracture due to lack of supervision, failure to notice change in condition, wound development, medication administration, medication ordering, and provision of home health care were found to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that the facility did not notify the appropriate doctor of the resident's change in condition. Other allegations were unsubstantiated due to lack of preponderance of evidence.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility did not ensure staff notified the correct physician of resident's change in condition, violating CCR 87468.2(a)(4) regarding residents' personal rights to care and supervision. | Type B |
Report Facts
Facility capacity: 60
Number of medications listed: 21
Number of medications started on 6/7/22: 9
Number of medications listed at SNF discharge: 17
Weight loss: 12
Plan of Correction due date: Jun 18, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Tony Vasallo | Licensing Program Manager | Oversaw the complaint investigation |
| Deborah Higgins | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 60
Deficiencies: 0
May 23, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff mismanaged residents' medication.
Findings
The investigation found no preponderance of evidence to substantiate the allegation. Staff and administrator denied the claim, and medication administration records and procedures were reviewed and found to be properly documented and followed.
Complaint Details
The allegation was that staff mismanaged residents' medication, including administering medication without proper sign-offs and sharing medication between residents. The allegation was unsubstantiated after investigation.
Report Facts
Capacity: 60
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Wei Siew Ho | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Robert Jakini | Facility representative met during the investigation and exit interview | |
| Deborah Higgins | Administrator | Administrator interviewed during the investigation |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 60
Deficiencies: 0
Apr 23, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to multiple allegations received on 07/14/2022 concerning questionable deaths, severe UTIs, failure to seek medical attention, failure to follow prescribed meals, failure to report incidents, and failure to document resident falls at the facility.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Records showed residents who passed away had underlying conditions and were on hospice care. Staff interviews and observations indicated proper care was provided, including incontinence assistance and adherence to prescribed diets. No immediate health or safety concerns were observed, and no documentation or reporting violations were confirmed.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included questionable deaths of residents, severe UTIs, staff not seeking medical attention, not following prescribed meals, not reporting incidents to Community Care Licensing, and not documenting resident falls. The investigation included record reviews, interviews with staff and residents, and facility tours. No evidence was found to prove the alleged violations occurred.
Report Facts
Facility Capacity: 60
Resident Census: 36
Number of Allegations: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation |
| Robert Jakini | Executive Director | Met with Licensing Program Analyst during investigation and provided information |
Inspection Report
Complaint Investigation
Census: 36
Capacity: 60
Deficiencies: 1
Mar 5, 2024
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation that unqualified staff were administering insulin injections to residents.
Findings
The investigation substantiated the allegation that two staff members without the required license administered insulin injections to a resident who has since passed away. The facility did not comply with Health and Safety Code 1569.69 regarding medication administration by unlicensed personnel.
Complaint Details
The complaint alleged that unqualified staff were administering insulin. The investigation found this allegation substantiated based on file review, interviews, and observations. Two staff members administered insulin without the required license, posing a potential health and safety risk.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to meet training requirements for direct care staff to administer medications, specifically unlicensed personnel administering insulin injections. | Type B |
Report Facts
Resident count: 36
Total capacity: 60
Staff administering insulin without license: 2
Staff members administering insulin: 7
Plan of Correction due date: Apr 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Jakini | Executive Director | Met with Licensing Program Analyst during inspection and interviewed |
| Jewel Baptiste | Licensing Program Analyst | Conducted the complaint investigation |
| Lisa Hicks | Licensing Program Manager | Named in report as Licensing Program Manager overseeing investigation |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 60
Deficiencies: 0
Feb 13, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 07/14/2022 regarding staff not following COVID protocol, not aiding residents with incontinence and hygiene needs, not observing changes in residents' conditions, and not feeding bedridden residents.
Findings
The investigation found that staff and residents interviewed denied all allegations and no immediate health or safety concerns were observed. The shower schedule and care plans were reviewed and residents' needs appeared to be met. There was insufficient evidence to substantiate the allegations, resulting in an unsubstantiated finding.
Complaint Details
The complaint investigation was unsubstantiated as there was no preponderance of evidence to prove the alleged violations occurred. Staff denied the allegations and residents interviewed could not corroborate them.
Report Facts
Capacity: 60
Census: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation |
| Robert Jakini | Executive Director | Met with Licensing Program Analyst during investigation |
| Deborah Higgins | Administrator | Named as facility administrator |
| Wei Siew Ho | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Annual Inspection
Census: 37
Capacity: 60
Deficiencies: 1
Sep 15, 2023
Visit Reason
The inspection was a required unannounced annual inspection to evaluate compliance with licensing regulations for the memory care community facility.
Findings
The facility was found to have appropriate infection control practices, sufficient staffing, and adequate physical plant safety features. However, a deficiency was cited for not maintaining a sufficient supply of non-perishable food for seven days as required.
Deficiencies (1)
| Description |
|---|
| Facility did not have enough 7 day non-perishable food which poses/posed a potential health, safety or personal rights risk to persons in care. |
Report Facts
Deficiency due date: Sep 18, 2023
Residents' medication files reviewed: 6
Fire drill date: Sep 5, 2023
Hospice waiver capacity: 20
Resident rooms inspected: 7
Bedrooms: 43
Bathrooms: 31
Hot water temperature range: 110.0-114.8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Vicky Torres | Administrator | Assisted with the inspection and was given the report and appeal rights |
| Alberto Lopez | Licensing Program Analyst | Conducted the inspection |
| Lisa Hicks | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 26
Capacity: 60
Deficiencies: 0
Aug 30, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations regarding staff assistance with residents' hygiene, laundry, cleanliness of rooms, provision of toiletries, safeguarding personal items, and adequacy of food services.
Findings
The investigation included interviews with residents and staff, facility tours, and document reviews. Despite some allegations possibly being valid, there was insufficient evidence to substantiate any violations. All allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not assisting residents with hygiene and laundry needs, not maintaining cleanliness, not providing toiletries, not safeguarding personal items, and inadequate food services. Interviews and observations did not provide a preponderance of evidence to prove violations.
Report Facts
Residents interviewed: 6
Staff interviewed: 5
Residents present: 26
Facility capacity: 60
Resident meal roster checked: 24
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
| Vicky Torres | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Deborah Higgins | Administrator | Named as facility administrator |
| Stefanie Coronel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 25
Capacity: 60
Deficiencies: 0
Aug 17, 2022
Visit Reason
Licensing Program Analysts conducted an annual required visit to evaluate the facility using an infection control tool and to inspect various aspects including physical plant, COVID-19 procedures, resident medications and records, food supply, and staff records.
Findings
No deficiencies were observed during the visit. The facility met all regulatory requirements including proper medication documentation, adequate physical plant conditions, and sufficient PPE supply.
Report Facts
Hospice residents: 2
Resident records reviewed: 6
Staff records reviewed: 6
Residents' medications reviewed: 6
Hot water temperature range: 105.3 - 117.1
PPE supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Vicky Torres | Administrator | Met with Licensing Program Analysts during the inspection |
Inspection Report
Complaint Investigation
Census: 26
Capacity: 60
Deficiencies: 0
Jul 21, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-11-30 regarding multiple allegations including pressure injuries, delayed medical attention, medication administration issues, hygiene neglect, and inappropriate resident retention.
Findings
The investigation found no evidence to substantiate any of the allegations. The resident with pressure injuries received appropriate care including wound treatment and hospice involvement. Medication administration and hygiene needs were met despite some resident aggression. The resident was deemed appropriate for the facility's level of care.
Complaint Details
The complaint involved allegations that a resident sustained multiple pressure injuries, staff did not seek timely medical attention, did not administer medications as prescribed, did not meet hygiene needs, and that the facility retained a resident requiring a higher level of care. All allegations were found unsubstantiated based on interviews, record reviews, and observations.
Report Facts
Facility capacity: 60
Resident census: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Vasallo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Vicky Torres | Administrator | Facility administrator met during the investigation |
Inspection Report
Complaint Investigation
Census: 25
Capacity: 60
Deficiencies: 0
May 4, 2022
Visit Reason
An unannounced case management visit was conducted to perform a health and safety check due to an incident report received on 2022-04-18.
Findings
The Licensing Program Analyst toured the facility and found no path obstructions or health and safety hazards. Food supply, toxins, and sharps were secured and inaccessible to residents. No deficiencies were cited during the visit.
Complaint Details
Visit was triggered by an incident report received on 2022-04-18. No deficiencies were found, indicating no substantiated issues.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the unannounced case management visit and health and safety check. |
| Vicky Torres | Administrator | Met with the Licensing Program Analyst during the visit. |
Inspection Report
Original Licensing
Capacity: 60
Deficiencies: 0
Jul 29, 2021
Visit Reason
A prelicensing visit was conducted for a new construction building that has never been licensed. The applicant requested to care for dementia residents and a hospice waiver for 20 hospice residents.
Findings
The facility was toured and inspected, including the physical plant and kitchen. The building meets Title 22 Regulations with appropriate safety features, adequate rooms, bathrooms, and functional call light systems. The walk-in refrigerator was not operating but other refrigeration was available. No major hazards were observed.
Report Facts
Capacity: 60
Hospice waiver: 20
Bedrooms: 43
Bathrooms: 31
Hot water temperature range: 108.5-114.1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Vasallo | Licensing Evaluator | Conducted prelicensing visit and inspection |
| Wei Siew Ho | Supervisor | Supervised the licensing evaluation |
| Nikolas Kavayiotidis | Applicant | Met with LPAs during prelicensing visit |
| Vicky Torres | Administrator | Met with LPAs during prelicensing visit |
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