Inspection Reports for The Vincent
1 Las Gallinas Ave, San Rafael, CA 94903, United States, CA, 94903
Back to Facility ProfileInspection Report Summary
Most inspections found deficiencies related primarily to medication management, including recurrent medication errors, failure to assist residents with self-administered medications, and documentation issues. The facility also had isolated problems with reporting incidents and maintaining resident confidentiality, with one substantiated incident involving a resident sent to the hospital with another resident’s medical paperwork. A civil penalty of $1,000 was issued in December 2024 for repeated medication violations, but no license suspensions or revocations were noted. Several complaint investigations were unsubstantiated, and the facility showed some improvement with no deficiencies cited in the most recent report on June 5, 2025. Overall, while medication-related issues have been a recurring theme, recent inspections indicate progress in addressing these concerns.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 83
Capacity: 126
Deficiencies: 0
Jun 5, 2025
Visit Reason
The visit was conducted to deliver an "Order to Licensee/Facility of Immediate Exclusion From Facility" notice for Staff Member 1 (S1), prohibiting S1 from working, being present, or having contact with clients at the facility.
Findings
No deficiencies were cited during the visit. The facility representatives acknowledged understanding the immediate exclusion notice delivered by the Department.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sammy Howeidy | Journey Director | Met with during the visit and acknowledged the immediate exclusion notice. |
| Raymond Rodarte | Business Office Director | Met with during the visit and acknowledged the immediate exclusion notice. |
| Caitlynn Felias | Licensing Program Analyst | Conducted the unannounced visit and delivered the immediate exclusion notice. |
Inspection Report
Complaint Investigation
Census: 86
Capacity: 126
Deficiencies: 0
May 22, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation of unexplained injury involving a resident.
Findings
The investigation found that Resident 1 sustained a shoulder fracture requiring a sling, but there was insufficient evidence to determine how the injury occurred. The allegation was determined to be unsubstantiated.
Complaint Details
Allegation of unexplained injury to Resident 1. The complaint was unsubstantiated due to lack of preponderance of evidence to prove the alleged violation.
Report Facts
Complaint Control Number: 21
Complaint Control Number Suffix: 20241204092912
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation and delivered findings. |
| Victoria Bertozzi | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Pari Manouchehri | Executive Director/Administrator | Met with Licensing Program Analyst during the investigation. |
Inspection Report
Complaint Investigation
Census: 86
Capacity: 126
Deficiencies: 1
May 22, 2025
Visit Reason
The inspection was conducted as a Case Management - Deficiencies Visit triggered by a complaint investigation regarding the facility's failure to submit an incident report about a resident's observed change in condition.
Findings
The facility failed to submit a timely incident report to Community Care Licensing regarding a resident's shoulder fracture observed on 10/29/2024. This deficiency was cited under California Code of Regulations section 87211(a)(1)(D).
Complaint Details
Complaint Investigation 21-AS-20241204092912 revealed the facility did not report an incident involving resident R1's swollen shoulder and subsequent fracture as required.
Deficiencies (1)
| Description |
|---|
| Failure to submit an incident report for a resident's shoulder fracture in a timely manner. |
Report Facts
Census: 86
Total Capacity: 126
Plan of Correction Due Date: Jun 2, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pari Manouchehri | Executive Director/Administrator | Met with Licensing Program Analyst during inspection |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection and signed the report |
| Victoria Bertozzi | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 126
Deficiencies: 1
Apr 21, 2025
Visit Reason
The visit was an office informal meeting to address recurrent medication errors at the facility and to deliver findings for Complaint 21-AS-20241217093631.
Findings
Findings for Complaint 21-AS-20241217093631 were delivered, highlighting recurrent medication errors cited on multiple previous dates and a recent medication error incident on 04/07/2025. The facility discussed plans to conduct competency checks and shadowing to ensure quality assurance.
Complaint Details
Complaint 21-AS-20241217093631 was the basis for the visit. Findings were delivered and discussed. The complaint involved recurrent medication errors, with citations issued on multiple prior dates. The facility reported an incident of a medication error on 04/07/2025. The facility must submit a written plan by 05/01/2025 to address these issues.
Deficiencies (1)
| Description |
|---|
| Recurrent medication errors cited on case management visits or complaint investigations with citations issued on 11/02/2023, 2/8/2024, 3/1/2024, 3/8/2024, 7/24/2024, and 12/5/2024. |
Report Facts
Deficiency citations: 6
Facility capacity: 126
Census: 78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pari Manouchehri | Executive Director | Named in relation to the medication error findings and meeting. |
| Sammy Howeidy | Journey Director | Named in relation to the medication error findings and meeting. |
| Rochelle Factor | Regional Health and Wellness Director | Named in relation to the medication error findings and meeting. |
| Mariam Perez | Vice President of Clinical Operations | Named in relation to the medication error findings and meeting. |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 126
Deficiencies: 2
Apr 21, 2025
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations that staff did not assist with self-administration of medications as needed and falsely recorded medication as being dispensed to a resident.
Findings
The investigation substantiated that the facility failed to assist a resident with self-administered medications, administered expired medications, and falsified medication records. Another allegation regarding failure to follow a resident's care needs related to hearing aids was unsubstantiated.
Complaint Details
The complaint was substantiated regarding medication administration and documentation issues, including expired medications and falsified records. The allegation that the facility did not follow the resident's care needs related to hearing aids was unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Licensee did not assist residents with self-administered medications as needed; resident was administered expired medications and medications were left unattended in resident rooms. | Type A |
| Licensee did not maintain a current, written definitive plan of operation for the facility; medication records were documented as given when medication was not available. | Type B |
Report Facts
Civil penalty amount: 250
Deficiency last cited date: 12/05/2024
Medication audit date: 02/21/2025
Medication training dates: February 2025 and March 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Victoria Bertozzi | Licensing Program Manager | Delivered findings and managed complaint investigation. |
| Caitlynn Felias | Licensing Program Analyst | Conducted complaint investigation and interviews. |
| Pari Manouchehri | Executive Director | Met with investigators during complaint investigation. |
| Sammy Howeidy | Journey Director | Met with investigators during complaint investigation. |
| Rochelle Factor | Regional Health and Wellness Director | Met with investigators and conducted medication training. |
| Mariam Perez | Vice President of Clinical Operations | Met with investigators during complaint investigation. |
Inspection Report
Annual Inspection
Census: 80
Capacity: 126
Deficiencies: 1
Mar 5, 2025
Visit Reason
The visit was an unannounced Case Management - Annual Continuation inspection conducted to evaluate compliance with licensing requirements.
Findings
No deficiencies were cited during the visit, although a technical violation was issued for one resident whose medications were not centrally stored or documented as required.
Deficiencies (1)
| Description |
|---|
| Medications for 1 of 6 residents were not centrally stored or documented as required (technical violation). |
Report Facts
Residents in care: 80
Total capacity: 126
Staff on-site: 22
Client files spot checked: 8
Resident medications spot checked: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pari Manouchehri | Administrator | Met with Licensing Program Analysts during the inspection |
| Elias Magdaleno | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Annual Inspection
Census: 74
Capacity: 126
Deficiencies: 0
Feb 13, 2025
Visit Reason
The visit was an unannounced required 1-year annual inspection of the assisted living and memory care facility to evaluate compliance with regulations and review facility operations.
Findings
The facility was found to be generally compliant with no deficiencies cited during the visit. Observations included proper fire safety equipment, safe food storage, adequate supplies, and appropriate resident room furnishings. A death report was followed up on, and additional documentation was requested for a change of administrator. The annual inspection was not completed and will be continued at a later date.
Report Facts
Residents in care: 74
Staff members on-site: 19
Resident rooms temperature samples: 14
Memory care kitchen sink samples: 1
Sinks out of compliance: 4
Facility capacity: 126
Hospice waiver capacity: 15
Non-ambulatory capacity: 126
Bedridden capacity: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pari Manouchehri | Administrator | Met with Licensing Program Analysts during inspection and named in relation to facility operations and documentation |
| Victoria Bertozzi | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Elias Magdaleno | Licensing Program Analyst | Conducted inspection and signed report |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 126
Deficiencies: 1
Dec 5, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that the facility mismanaged medications and staff were not administering medications per physician orders.
Findings
The investigation substantiated the allegations that residents received medications late, sometimes over two hours, or were given the wrong medication intended for other residents. Medication records falsification could not be determined. An immediate civil penalty was issued for repeated violations.
Complaint Details
Complaint was substantiated based on incident reports and interviews. The facility received six self-submitted incident reports documenting medication errors for five residents and one incident of administering another resident's medication. A civil penalty of $1,000 was assessed for a third violation of the cited regulation within 12 months.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with CCR 87465(a)(4) requiring assistance with self-administered medications, resulting in missed, late, or incorrect medication administration posing immediate health and safety risks. | Type A |
Report Facts
Civil penalty amount: 1000
Incident reports received: 6
Interviews conducted: 7
Interviews confirming medication issues: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Corrine Bianco | Administrator/Executive Director | Met with Licensing Program Analyst during investigation. |
| Sammy Howeidy | Memory Care Director | Met with Licensing Program Analyst during investigation. |
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation. |
| Victoria Bertozzi | Licensing Program Manager | Named in report as Licensing Program Manager overseeing investigation. |
Inspection Report
Follow-Up
Census: 68
Capacity: 126
Deficiencies: 0
Jul 24, 2024
Visit Reason
The visit was an unannounced Case Management - Incident follow-up to review a self-reported incident involving alleged staff misconduct reported on 07/19/2024.
Findings
No deficiencies were cited during the visit. The facility had appropriately notified authorities and suspended the involved staff member, who subsequently resigned. The facility planned elder abuse training for staff.
Complaint Details
The visit followed up on an incident report alleging that a staff member placed their hand over a resident's mouth with soap suds during a shower due to agitation. The staff member was suspended pending investigation and resigned. The facility made all required notifications and planned elder abuse training.
Report Facts
Incident report date: Jul 19, 2024
Incident date: Jul 6, 2024
Facility capacity: 126
Facility census: 68
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Corrine Bianco | Executive Director | Met with Licensing Program Analysts during the visit |
| Ashley Perrone | Health and Wellness Director | Met with Licensing Program Analysts during the visit |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 126
Deficiencies: 1
Jul 24, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-03-08 regarding medication management and other care concerns at the facility.
Findings
The investigation substantiated that staff did not ensure medications were properly managed for a resident, resulting in missed doses of Ativan due to delayed refills. Other allegations including lack of communication to responsible parties, unexplained injuries, restraint use, dressing assistance, and meal service needs were found to be unsubstantiated based on document review, interviews, and observations.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not ensure medications were properly managed, specifically that Resident 1 did not receive Ativan medication during specified timeframes due to delayed refills. Other allegations related to communication, injuries, restraint, dressing assistance, and meal service were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with CCR 87465(a)(4) requiring assistance with self-administered medications as needed; resident did not receive medication as prescribed due to facility running out of medication, posing immediate health and safety risk. | Type A |
Report Facts
Capacity: 126
Census: 68
Civil penalty amount: 250
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Victoria Bertozzi | Licensing Program Manager | Oversaw the complaint investigation |
| Corrine Bianco | Executive Director/Administrator | Met with investigators during the complaint investigation |
| Ashley Perrone | Health and Wellness Director | Met with investigators during the complaint investigation |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 126
Deficiencies: 1
Jul 9, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to allegations of personal rights violations and staff mismanagement of medications, as well as staff training concerns.
Findings
The investigation substantiated allegations that facility staff posted videos containing resident care information and failed to ensure narcotic medication confidentiality, posing a potential health and safety risk. Another allegation of staff mismanaging medications was substantiated based on narcotic medication handling errors. The allegation that staff were not adequately trained was unsubstantiated.
Complaint Details
Complaint investigation was substantiated for allegations of personal rights violations and medication mismanagement. The allegation of inadequate staff training was unsubstantiated.
Deficiencies (1)
| Description |
|---|
| Facility staff posted a video with resident care information and failed to ensure narcotic medication confidentiality, violating CCR 87468.2(a)(2). |
Report Facts
Capacity: 126
Census: 68
Civil penalty amount: 250
Plan of Correction Due Date: Jul 19, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Perrone | Health and Wellness Director | Met with Licensing Program Analyst during investigation. |
| Shawn Mooney | Administrator | Facility administrator named in report header. |
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation. |
| Victoria Bertozzi | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Staff Member 1 | Interviewed regarding video recording incident and medication handling. |
Inspection Report
Annual Inspection
Census: 70
Capacity: 126
Deficiencies: 1
Jun 12, 2024
Visit Reason
The inspection was an unannounced annual case management continuation visit to evaluate compliance with regulatory requirements for an assisted living and memory care facility.
Findings
The inspection found that 5 of 11 staff members did not complete their required annual 2023 training, posing a potential health, safety, or personal rights risk to residents. Medication technicians had appropriate certification, but some direct care staff had first aid certification not through a qualified medical agency.
Deficiencies (1)
| Description |
|---|
| Licensee did not ensure that 5 of 11 staff completed their annual 2023 training, violating Health and Safety Code 1569.625(b)(2). |
Report Facts
Staff not completing annual training: 5
Total staff on-site: 23
Total residents in care: 70
Total licensed capacity: 126
Hospice waiver capacity: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sam Faye | Executive Director | Met with Licensing Program Analyst during inspection |
| Roschelle Factor | Regional Health and Wellness Director | Met with Licensing Program Analyst during inspection |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection and signed the report |
| Victoria Bertozzi | Licensing Program Manager | Supervisor of Licensing Program Analyst |
Inspection Report
Annual Inspection
Census: 71
Capacity: 126
Deficiencies: 0
May 17, 2024
Visit Reason
The visit was an unannounced annual continuation inspection to evaluate the facility's compliance with regulations related to care and assistance for older adults in assisted living and memory care.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst reviewed staff rosters and resident files, finding all documentation thorough and compliant. The annual visit was not completed and will continue at a later date.
Report Facts
Staff on-site: 25
Hospice waiver capacity: 15
Non-ambulatory capacity: 118
Bedridden capacity: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sam Faye | Executive Director | Met with Licensing Program Analyst during inspection |
| Roschelle Factor | Regional Health and Wellness Director | Met with Licensing Program Analyst during inspection |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection visit |
| Victoria Bertozzi | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 69
Capacity: 126
Deficiencies: 0
Mar 28, 2024
Visit Reason
The inspection was an unannounced Required 1 Year visit to evaluate compliance with regulations for an assisted living and memory care facility.
Findings
The facility was found to be clean, well-maintained, and compliant with regulations including infection control, food supply, safety equipment, and resident file documentation. The annual inspection was not completed and a continuation visit will be conducted later.
Report Facts
Staff on-site: 23
Sample sinks tested: 10
Fire extinguisher last inspection: 2023
Fire sprinkler last inspection: 2024
Last emergency drill: 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sam Faye | Executive Director | Met with Licensing Program Analysts during inspection |
| Roschelle Factor | Regional Health and Wellness Director | Met with Licensing Program Analysts during inspection |
Inspection Report
Census: 72
Capacity: 126
Deficiencies: 1
Feb 8, 2024
Visit Reason
The visit was an unannounced Case Management - Other visit to follow up on self-reported incidents submitted to Community Care Licensing (CCL).
Findings
Three incidents involving medication errors were reported where residents were not given medications as prescribed, including extra doses and PRN medication. The facility conducted in-service training for medication technicians and made all appropriate notifications. A deficiency was cited for failure to comply with medication administration regulations, posing an immediate health and safety risk, but was cleared during the visit after training documentation was provided.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with medication administration regulations; Residents R1, R2, and R3 were not given medications as prescribed and R3 was given PRN medication, posing an immediate health, safety, or personal rights risk. | Type A |
Report Facts
Capacity: 126
Census: 72
Plan of Correction Due Date: Feb 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection and signed the report |
| Kimberley Mota | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the inspection |
| Shawn Mooney | Administrator | Facility Administrator at time of inspection |
| Sam Faye | Executive Director | New Executive Director of the facility, documents requested for processing |
| Roschelle Factor | Regional Health and Wellness Director | Met with Licensing Program Analyst during the visit |
| Sahar Mosalla | Regional Operations Specialist | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 126
Deficiencies: 1
Feb 8, 2024
Visit Reason
An unannounced complaint investigation was conducted regarding allegations that staff did not administer a resident's medication as prescribed and did not maintain accurate resident records.
Findings
The investigation substantiated that the facility failed to have a physician's order verifying a medication change for a resident, posing a health and safety risk. However, the allegation that staff did not maintain accurate resident records was unsubstantiated as the resident's medication was administered by the responsible party while off-site. The facility conducted in-service training on medication management and cleared the cited deficiency during the visit.
Complaint Details
The complaint investigation was substantiated regarding medication administration without a physician's order, but unsubstantiated regarding inaccurate resident records. The allegation about medication administration was validated based on document review, interviews, and observations.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to assist residents with self-administered medications as needed due to lack of physician's order verifying medication change. | Type A |
Report Facts
Capacity: 126
Census: 72
Deficiency Type A: 1
Plan of Correction Due Date: Feb 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kimberley Mota | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Sahar Mosalla | Regional Operations Specialist and Administrator | Facility Administrator and Regional Operations Specialist involved in the investigation and plan of correction |
| Roschelle Factor | Regional Health and Wellness Director | Met with Licensing Program Analyst during investigation and plan of correction |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 126
Deficiencies: 1
Jan 5, 2024
Visit Reason
The visit was an unannounced Case Management - Deficiencies visit conducted to investigate a complaint regarding a resident going to the hospital with another resident's confidential medical paperwork, which was not reported or documented as required.
Findings
The investigation found that the licensee failed to report the incident to Community Care Licensing and did not document it on the required Unusual Incident Report Form, constituting a deficiency related to reporting requirements under California Code of Regulations.
Complaint Details
The visit was complaint-related, investigating an incident where a resident went to the hospital with another resident's confidential medical paperwork. The deficiency was substantiated as the licensee did not report or document the incident as required.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit required reports to the licensing agency within seven days of an incident threatening the welfare, safety, or health of a resident. | Type B |
Report Facts
Capacity: 126
Census: 83
Deficiencies cited: 1
Plan of Correction Due Date: Jan 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mildred Santos | Health and Wellness Director | Met with Licensing Program Analyst during the visit |
| Scott Bissey | Corporate Director of Operations | Available by telephone during the visit |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection and complaint investigation |
| Kimberley Mota | Licensing Program Manager | Supervisor and Licensing Program Manager overseeing the visit |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 126
Deficiencies: 1
Jan 5, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that the facility did not keep a resident's information confidential.
Findings
The investigation substantiated the allegation that a resident was sent to the hospital with another resident's medical paperwork and information, violating confidentiality requirements.
Complaint Details
The complaint allegation that the facility did not keep resident's information confidential was substantiated based on evidence that a resident was sent to the hospital with another resident's medical paperwork.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to keep residents' personal and medical information confidential, as evidenced by a resident going to the hospital with another resident's medical paperwork. | Type A |
Report Facts
Capacity: 126
Census: 83
Plan of Correction Due Date: Jan 6, 2024
Plan of Correction Training Due Date: Jan 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Kimberley Mota | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Mildred Santos | Health and Wellness Director | Met with Licensing Program Analyst during investigation and involved in Plan of Correction |
| Scott Bissey | Corporate Director of Operations | Available by telephone during investigation and involved in Plan of Correction |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 126
Deficiencies: 0
Nov 7, 2023
Visit Reason
The visit was an unannounced Case Management - Incident visit to follow up on self-reported incidents submitted to Community Care Licensing (CCL).
Findings
The facility reported multiple incidents involving residents, including falls, alleged inappropriate staff behavior, and resident altercations. The facility conducted investigations, made appropriate notifications, reassigned staff, provided in-service training, and increased supervision as needed. No deficiencies were cited during the visit.
Complaint Details
The visit was complaint-related, following up on incidents including a resident fall with hip fracture, allegations of staff misconduct involving Resident 2, and physical altercations between residents. The facility conducted internal investigations and took corrective actions such as staff reassignment and increased supervision. The complaint involving staff misconduct was addressed with in-service training and no further occurrences were reported.
Report Facts
Incident Report Dates: Incident reports received on 08/21/2023, 09/07/2023, 09/19/2023, 10/03/2023, and 11/02/2023
Medication Change Monitoring: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shawn Mooney | Executive Director/Administrator | Met with Licensing Program Analyst during visit and provided information on incidents |
| Caitlynn Felias | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit |
| Kimberley Mota | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 126
Deficiencies: 0
Jul 21, 2023
Visit Reason
The visit was conducted to follow up on self-reported incidents submitted to Community Care Licensing and to follow up on Facility Administrator paperwork.
Findings
The facility conducted an internal investigation following reports of staff members allegedly striking residents. Staff member S2 was suspended and subsequently terminated. An in-service training on Mandated Reporting, Elder Abuse, and Documentation was scheduled. No deficiencies were cited during the visit.
Complaint Details
The visit was complaint-related due to two incident reports: one involving S2 allegedly slapping a resident's face and another involving S2 striking a resident's hands. Both incidents were reported late by another staff member. The facility took corrective action by suspending and terminating S2.
Report Facts
Incident Report Date: Jul 11, 2023
Incident Report Date: Jul 13, 2023
Incident Dates: Jul 6, 2023
Incident Dates: Jul 10, 2023
Training Submission Deadline: Jul 31, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Scott Bissey | Corporate Director of Operations | Met with Licensing Program Analyst during visit and involved in investigation |
| Sahar Mosalla | Interim Executive Director | Interim Executive Director overseeing facility until new Executive Director is hired |
Inspection Report
Census: 77
Capacity: 126
Deficiencies: 0
Jun 22, 2023
Visit Reason
The visit was conducted as a Case Management - Other unannounced visit to follow up on a self-reported incident involving a resident injury and to request Administrator paperwork.
Findings
The facility reported an incident where a resident sustained an arm fracture after hitting their arm during a shower. The resident was transported to the hospital and is now observed to be at baseline and doing well. No deficiencies were cited during the visit. Administrator paperwork was requested to be submitted by 07/03/2023.
Report Facts
Capacity: 126
Census: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sahar Mosalla | Interim Executive Director | Met with Licensing Program Analyst during the visit and discussed incident and management changes |
| Melon Rivera | Administrator | Named as facility administrator |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection visit |
| Kimberley Mota | Licensing Program Manager | Named in report header |
Inspection Report
Census: 81
Capacity: 126
Deficiencies: 0
Apr 28, 2023
Visit Reason
The visit was an unannounced Case Management - Incident visit to follow up on a self-reported incident involving a resident found outside the community with a head wound.
Findings
No deficiencies were cited during the visit. The resident involved was found to be at baseline and doing well after returning from the hospital. The facility continued communication with the resident, their responsible party, and physician regarding care needs.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melon Rivera | Administrator/Executive Director | Met with Licensing Program Analyst during the incident case management visit and discussed the resident incident. |
| Caitlynn Felias | Licensing Program Analyst | Conducted the unannounced Case Management - Incident visit. |
| Kimberley Mota | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 126
Deficiencies: 0
Apr 25, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation regarding Personal Rights at the facility.
Findings
The complaint allegation of Personal Rights was found to be unsubstantiated due to lack of preponderance of evidence. No deficiencies were cited during the visit.
Complaint Details
The complaint alleged that the facility allowed an individual to visit a resident who was not permitted to do so. The investigation found no legal or medical documentation restricting visitation and confirmed the facility followed its visitation policy appropriately.
Report Facts
Capacity: 126
Census: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melon Rivera | Administrator/Executive Director | Met with Licensing Program Analyst during the complaint investigation |
| Caitlynn Felias | Licensing Program Analyst | Conducted the complaint investigation |
| Kimberley Mota | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 81
Capacity: 126
Deficiencies: 0
Apr 14, 2023
Visit Reason
The visit was an unannounced Case Management - Incident visit to follow up on self-reported incidents submitted to Community Care Licensing.
Findings
The Licensing Program Analyst reviewed three incident reports involving residents who experienced fractures or falls. The facility made all appropriate notifications and communicated with residents' responsible parties and physicians. No deficiencies were cited during the visit.
Complaint Details
The visit was triggered by self-reported incidents involving Resident 1 with a knee fracture, Resident 2 found on the floor with a fracture, and Resident 3 found on the floor with a change in mental status. All incidents were investigated and appropriate actions taken. Residents 1 and 3 have returned to the community; Resident 2 moved out due to changes in care needs.
Report Facts
Incident Report Date: Mar 24, 2023
Incident Report Date: Apr 3, 2023
Incident Report Date: Apr 13, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melon Rivera | Administrator/Executive Director | Met with Licensing Program Analyst during visit and discussed incidents |
| Caitlynn Felias | Licensing Program Analyst | Conducted the Case Management - Incident visit |
| Kimberley Mota | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Capacity: 126
Deficiencies: 0
Feb 24, 2023
Visit Reason
The inspection visit was an unannounced Required 1 Year Visit focused on Infection Control procedures and practices at the facility.
Findings
The facility was found to be clean, with proper COVID-19 signage, handwashing signs, mask usage, and adequate PPE and medication supplies. Staff and residents are screened daily for COVID-19 symptoms. Fire safety equipment and drills were up to date. No deficiencies were cited during the visit.
Report Facts
Facility Capacity: 126
Incident Date: Jan 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melon Rivera | Administrator and Executive Director | Named as facility administrator, unavailable during visit |
| Cat Tomboc | Health Services Director | Met with Licensing Program Analyst during inspection and discussed infection control and other protocols |
| Vanessa Augusta | Regional Sales Director | Arrived during visit |
| Caitlynn Felias | Licensing Program Analyst | Conducted the inspection visit |
| Kimberley Mota | Licensing Program Manager | Named in report |
Inspection Report
Census: 58
Capacity: 126
Deficiencies: 0
Aug 16, 2022
Visit Reason
The visit was an unannounced Case Management - Incident visit to follow up on two self-reported incidents submitted to Community Care Licensing.
Findings
The facility responded appropriately to two incidents: one involving a resident found outside after an alarmed egress door was triggered, and another involving an altercation between two residents. No deficiencies were cited during the visit.
Report Facts
Capacity: 126
Census: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol Dowell | Administrator | Met with Licensing Program Analyst during the visit and discussed incidents |
| Caitlynn Felias | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Kimberley Mota | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 126
Deficiencies: 5
Jun 24, 2022
Visit Reason
The inspection was an unannounced complaint investigation initiated on April 29, 2022, to investigate multiple allegations including staff not following Covid-19 masking protocols, medication administration errors, failure to respond to call bells timely, and unqualified staff.
Findings
The investigation substantiated several deficiencies including improper mask wearing by staff, missed medication administration and inaccurate documentation, delayed response to a resident call bell, and nine staff members lacking required training hours. Other allegations such as resident personal rights violations, facility disrepair, medication management, operable keys, and staffing levels were unsubstantiated.
Complaint Details
The complaint investigation was substantiated. Allegations included staff not following Covid-19 masking protocols, medication errors, failure to respond to call bells timely, and unqualified staff. Other allegations regarding resident personal rights, facility disrepair, medication management, operable keys, and staffing were unsubstantiated.
Severity Breakdown
Type A: 3
Type B: 2
Deficiencies (5)
| Description | Severity |
|---|---|
| Facility failed to protect the personal rights of residents due to staff not properly wearing face coverings while providing care. | Type A |
| Facility missed medication administration on April 17, 2022, and failed to document the missed medication properly. | Type A |
| Resident records were incomplete and not properly maintained, including medication documentation. | Type B |
| Nine staff members lacked required dementia care training hours as mandated by Health and Safety Code. | Type B |
| Facility failed to respond to a resident call bell for 1 hour and 40 minutes. | Type A |
Report Facts
Staff lacking required training: 9
Medication missed: 1
Call bell response time: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Farhaan Sarangi | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Linda Nguyen | Resident Relations Director | Met with Licensing Program Analyst during the investigation and exit interview. |
Inspection Report
Original Licensing
Census: 55
Capacity: 126
Deficiencies: 0
Jun 17, 2022
Visit Reason
The inspection was an unannounced Post Licensing Inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was observed to be clean, well-maintained, and compliant with regulations including proper food storage, safe water temperatures, and secured hazardous areas. No deficiencies were observed or cited during the inspection.
Report Facts
Water temperature: 114.6
Water temperature: 109.4
Fire extinguisher service date: 2022
Tables in Memory Care dining room: 8
Tables in activity room: 7
Tables in third floor dining room: 12
Facility capacity: 126
Facility census: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol Dowell | Administrator | Met with Licensing Program Analyst during inspection and involved in facility tour |
| Farhaan Sarangi | Licensing Program Analyst | Conducted the Post Licensing Inspection |
| Hope DeBenedetti | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Original Licensing
Capacity: 126
Deficiencies: 0
Mar 11, 2022
Visit Reason
The inspection was conducted as a Pre-Licensing visit to evaluate the facility for initial licensing approval.
Findings
The facility was observed to be clean, well-maintained, and compliant with regulations including proper food storage, safe water temperatures, emergency preparedness, and secured areas for medications and hazardous materials. No deficiencies were explicitly noted in the report.
Report Facts
Capacity: 126
Census: 0
Water temperature: 114.6
Water temperature: 111.2
Water temperature: 109.4
Fire extinguisher last serviced: Mar 22, 2021
Fire extinguisher next service due: Mar 22, 2022
Lounge/bar operating hours: 4
Tables in Memory Care Unit dining room: 8
Tables in activity room: 7
Tables in dining room: 12
Emergency water containers: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jill Libhart | Administrator | Met with Licensing Program Analysts during the Pre-Licensing inspection. |
| Tamara Fernandez | Regional Vice President | Met with Licensing Program Analysts during the Pre-Licensing inspection. |
| Farhaan Sarangi | Licensing Program Analyst | Conducted the Pre-Licensing inspection and signed the report. |
| Dina Alviso | Licensing Program Analyst | Participated in the Pre-Licensing inspection. |
| Hope DeBenedetti | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Original Licensing
Capacity: 126
Deficiencies: 0
Feb 4, 2022
Visit Reason
Initial licensing evaluation conducted due to a change in administrators and to assess the applicant's understanding of regulatory requirements.
Findings
The applicant and administrator successfully completed Component II via telephone, confirming understanding of facility operation, staff qualifications, program policies, and other licensing requirements. No clients were in care at the time of the evaluation.
Report Facts
Capacity: 126
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jill Libhart | Administrator | Participated in Component II telephone call and confirmed understanding of Title 22 requirements |
| Jude De La Concepcion | Licensing Program Manager | Named as Licensing Program Manager on report |
| Victoria Christiansen | Licensing Program Analyst | Named as Licensing Program Analyst on report |
Inspection Report
Original Licensing
Capacity: 126
Deficiencies: 0
Oct 12, 2021
Visit Reason
Initial licensing evaluation conducted via telephone call to assess applicant and administrator understanding of licensing requirements and facility operation.
Findings
Applicant and administrator successfully completed Component II, confirming understanding of Title 22 regulations including facility operation, staff qualifications, program policies, and application document requirements.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melon Rivera | Administrator | Administrator participated in licensing evaluation and confirmed understanding of Title 22. |
| Susan McPherson | Applicant Representative | Applicant representative participated in licensing evaluation. |
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