Inspection Report Summary
Most inspections found no deficiencies, including the most recent report dated July 1, 2025, which had no deficiencies after a case management visit involving two residents with dementia. Earlier complaint investigations were largely unsubstantiated, with only a few substantiated issues primarily related to resident safety, supervision, and hygiene from 2021 and early 2022. These substantiated findings included illegal evictions, failure to respond to resident calls for assistance, inadequate supervision leading to resident elopement, and unsanitary conditions in a resident’s room. Since those earlier issues, the facility appears to have improved, with no deficiencies cited in annual inspections or complaint investigations after mid-2022. No fines, license suspensions, or enforcement actions were listed in the available reports.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Census Over Time
Census
Capacity
Inspection Report
Census: 115
Capacity: 131
Deficiencies: 0
Jul 1, 2025
Visit Reason
An unannounced case management visit was conducted following a self-reported incident involving two dementia residents who were observed yelling and hitting each other.
Findings
Staff intervened and redirected the residents, observed no injuries, and no deficiencies were cited during the visit. An exit interview was conducted and a copy of the report was provided.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Met with Licensing Program Analyst during the visit. |
| Daisy Panlilio | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 113
Capacity: 131
Deficiencies: 0
Jan 16, 2025
Visit Reason
An unannounced required one year inspection was conducted to evaluate the facility's compliance with licensing regulations and infection control measures.
Findings
The facility was observed to be in compliance with all regulations, including infection control and safety measures. No deficiencies were noted during the visit.
Report Facts
Food supply duration: 2
Food supply duration: 7
PPE supply duration: 30
Hot water temperature: 116
Facility temperature: 71
Fire extinguisher last inspection date: Jan 2, 2025
Staff files reviewed: 5
Resident files reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met with Licensing Program Analyst during inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 131
Deficiencies: 0
Nov 7, 2024
Visit Reason
An unannounced Case Management visit was conducted regarding an incident reported on 2024-11-04 involving a resident hitting another resident with a cane.
Findings
The incident involved a resident striking another resident due to a misunderstanding about stolen jewelry. Both residents have a history of conflict and have agreed to stay away from each other. No deficiencies were issued during the visit.
Complaint Details
The visit was triggered by a reported incident on 2024-11-04 where resident R1 hit resident R2 with a cane. The allegation was investigated and found to be related to a misunderstanding; no deficiencies were cited.
Report Facts
Facility capacity: 131
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Met with Licensing Program Analyst during the visit and provided information about the incident. |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Sep 26, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that staff did not honor a restraining order for a resident.
Findings
The investigation found no preponderance of evidence to prove the alleged violation occurred, and the allegation that staff did not honor the restraining order was unsubstantiated. No deficiencies were cited during the visit.
Complaint Details
The complaint alleged that staff did not honor a restraining order for a resident. The investigation reviewed multiple documents including restraining orders, physician reports, and sign-out records. Despite some events involving residents leaving the facility together, the evidence did not substantiate the allegation.
Report Facts
Facility capacity: 131
Census: 113
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Alberto Maldonado | Executive Director/Administrator | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Jul 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation that the facility retained a resident with a restricted health condition.
Findings
The investigation found the allegation to be unsubstantiated based on observations, interviews, and record reviews. The resident had a slow-healing wound and was transferred to a skilled nursing facility for continued care. No deficiencies were cited.
Complaint Details
The complaint alleged that the facility retained a resident with a restricted health condition. The investigation was unsubstantiated as there was insufficient evidence to prove the violation occurred.
Report Facts
Complaint Control Number: 15-AS-20240510155002
Facility Capacity: 131
Census: 113
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Alberto Maldonado | Administrator | Facility administrator met during the investigation |
Inspection Report
Complaint Investigation
Census: 118
Capacity: 131
Deficiencies: 0
Jul 23, 2024
Visit Reason
The inspection was an unannounced case management visit conducted due to an incident report received on 2024-07-03 regarding aggressive behaviors between a resident and staff.
Findings
The investigation found that on 2024-07-02, a resident became aggressive towards a staff member, resulting in the staff holding the resident's wrist in self-defense. The resident had bruising and swelling but denied pain. The staff member was suspended and completed retraining. No deficiencies were cited.
Complaint Details
The complaint involved aggressive behavior by resident R1 towards staff S1, substantiated by the incident report and police report filed. Staff S1 was suspended and retrained.
Report Facts
Facility capacity: 131
Resident census: 118
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met during inspection and provided information about the incident and staff actions |
| Daisy Panlilio | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Annual Inspection
Census: 116
Capacity: 131
Deficiencies: 0
Feb 27, 2024
Visit Reason
An unannounced required one year inspection was conducted to evaluate the facility's compliance with licensing regulations.
Findings
The inspection found no deficiencies. The facility was observed to have proper infection control measures, emergency plans, and safety equipment in place. Staff and resident files were reviewed and interviews conducted without issue.
Report Facts
Fire extinguisher last inspection date: Jan 7, 2024
Hot water temperature: 115
Facility temperature: 72
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Staff files reviewed: 5
Resident files reviewed: 5
Staff interviews conducted: 5
Resident interviews conducted: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met with Licensing Program Analyst during inspection and identified as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection visit |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Census: 112
Capacity: 131
Deficiencies: 0
Dec 14, 2023
Visit Reason
An unannounced case management visit was conducted regarding a SOC 341 self-reported incident that occurred on 2023-11-25 involving a resident hitting another resident while in the community.
Findings
The incident was resolved with no injuries reported. The resident involved was placed on hospice and medication compliance was ensured. No deficiencies were cited during the visit.
Report Facts
Police report number: Day of incident police report number: E23066740
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Spoke with Licensing Program Analyst regarding the incident |
| Kelly Nguyen | Licensing Program Analyst | Conducted the unannounced case management visit |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 131
Deficiencies: 0
Aug 11, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2022-04-04 regarding staff leaving a resident in soiled sheets, unmet resident care needs, and short staffing at the facility.
Findings
All allegations investigated were found to be unsubstantiated after review of resident records, care plans, and observations. The facility was found to provide appropriate care, adequate staffing, and proper hygiene practices.
Complaint Details
The complaint investigation addressed three allegations: 1) Staff left resident in soiled sheets for an extended period of time, 2) Staff are not meeting resident's care needs, and 3) Facility is short staffed. All allegations were found unsubstantiated based on interviews, record reviews, and observations.
Report Facts
Capacity: 131
Census: 115
Residents in memory care unit: 24
Staff in memory care unit per shift: 4
Bathing frequency: 2
Nail care frequency: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Met with Licensing Program Analyst during investigation and provided statements regarding care practices |
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 131
Deficiencies: 2
Aug 11, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2022-06-21 regarding unsanitary conditions, unmet hygiene needs, inadequate care and supervision, inadequate food service, unmet laundry needs, and restroom disrepair at Trevista Antioch facility.
Findings
The investigation substantiated allegations that a resident's room was unsanitary and that the resident's hygiene needs were not being met, posing potential health and safety risks. Other allegations including inadequate care and supervision resulting in weight loss, inadequate food service, unmet laundry needs, and restroom disrepair were found to be unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations that a resident's room was unsanitary and that the resident's hygiene needs were not being met. The investigation included review of photos, interviews with witnesses and staff, and record reviews. Other allegations related to care, food service, laundry, and restroom conditions were unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of timely cleaning, sanitation and handling of residents’ dirty personal belongings in compliance with Title 22 Section 87303 regulations. This requirement was not met as evidenced by resident’s unsanitary room which posed a potential health & safety risk to resident in care. | Type B |
| A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by resident’s hygiene needs not being met which posed a potential health & safety risk to resident in care. | Type B |
Report Facts
Capacity: 131
Census: 115
Deficiencies cited: 2
POC Due Date: Sep 8, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Met with Licensing Program Analyst during inspection and involved in findings delivery |
| Daisy Panlilio | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager overseeing investigation |
Inspection Report
Routine
Census: 113
Capacity: 131
Deficiencies: 0
Feb 23, 2023
Visit Reason
The visit was an unannounced infection control inspection conducted as part of the required 1-year routine inspection.
Findings
The Licensing Program Analyst observed compliance with infection control protocols including staff wearing face masks, proper screening procedures, and adequate supplies of PPE and food. No deficiencies were cited during the visit.
Report Facts
Capacity: 131
Census: 113
Inspection duration: 105
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met with Licensing Program Analyst during inspection and identified as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the infection control inspection |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Capacity: 131
Deficiencies: 0
Sep 13, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff were not able to adequately communicate with residents and that staff were not cleaning up after residents were done eating.
Findings
The investigation found that staff communicated effectively in English with residents and were observed cleaning up after meals. There was insufficient evidence to substantiate the allegations, and no deficiencies were cited during the visit.
Complaint Details
The complaint was unsubstantiated due to lack of preponderance of evidence to prove the alleged violations occurred.
Report Facts
Facility capacity: 131
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Jun 22, 2022
Visit Reason
The inspection was conducted as a Health and Safety check following receipt of a priority 1 complaint by the department.
Findings
The facility was observed to be in good repair with clear pathways and no fire hazards. Residents appeared comfortable and safe with no imminent health or safety concerns. No deficiencies were cited during the health and safety check.
Complaint Details
The visit was triggered by a priority 1 complaint. No deficiencies were found and residents were safe with no imminent health or safety concerns.
Report Facts
Staff observed: 8
Residents observed: 24
Residents having snack: 10
Residents relaxing: 8
Facility temperature: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met with Licensing Program Analyst during the inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the health and safety check |
| Bennett Fong | Licensing Program Manager | Named in the report |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 1
Jan 5, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that a resident was attacked by another resident while in care and that a resident sustained multiple injuries while in care.
Findings
The allegation that a resident was attacked by another resident was substantiated based on interviews and record reviews, with evidence of injury and hospital transport. The allegation that a resident sustained multiple injuries was unsubstantiated due to lack of preponderance of evidence despite reported unwitnessed falls and hospital evaluations.
Complaint Details
The complaint investigation was substantiated for the allegation that a resident was attacked by another resident while in care. The allegation that a resident sustained multiple injuries was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide safe, healthful and comfortable accommodations, furnishings and equipment as evidenced by a resident being attacked by another resident posing a potential health and safety risk. | Type B |
Report Facts
Capacity: 131
Census: 109
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
| Alberto Maldonado | Administrator | Facility administrator met during the investigation |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 2
Jan 5, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations including illegal eviction of a resident and incorrect billing of an SSI resident.
Findings
Both allegations were substantiated. The facility illegally evicted a resident despite being informed of the resident's SSI status, and the facility incorrectly billed the resident at the market rate instead of the SSI rate.
Complaint Details
The complaint investigation was substantiated. The resident was illegally evicted despite SSI status, and the facility incorrectly billed the resident at the market rate rather than the SSI rate.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Improper eviction of resident (R1) which posed a potential health & safety risk to resident in care. | Type B |
| Resident being charged the market rate despite SSI eligibility, posing a potential health & safety risk to resident in care. | Type B |
Report Facts
Capacity: 131
Census: 109
Deficiencies cited: 2
Plan of Correction Due Date: 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Alberto Maldonado | Administrator/Executive Director | Facility administrator involved in investigation and findings |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 1
Jan 5, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 07/15/2021 regarding staff not responding to a resident's call for assistance and alleged staff retaliation against a resident for making a complaint.
Findings
The investigation substantiated that staff failed to respond to a resident's call for assistance, resulting in a potential health and safety risk, and the involved staff was terminated. The allegation of staff retaliation against the resident was unsubstantiated based on the evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not respond to a resident's call for assistance, with staff admitting to leaving the resident unattended for over 2 hours. The retaliation allegation was unsubstantiated as staff denied retaliation and no evidence supported the claim.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff did not respond to resident's calling for assistance, posing a potential health & safety risk to residents in care. | Type B |
Report Facts
Capacity: 131
Census: 109
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator/Executive Director | Met with during the investigation and involved in internal investigation |
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Annual Inspection
Census: 109
Capacity: 131
Deficiencies: 0
Jan 5, 2022
Visit Reason
The visit was an unannounced required 1-year annual infection control inspection to evaluate the facility's COVID-19 mitigation plan and infection control practices.
Findings
The facility had a completed COVID-19 mitigation plan and implemented infection control practices including symptom screening, PPE usage, and social distancing. No deficiencies were observed during the visit, and safety equipment such as fire extinguishers and detectors were operational.
Report Facts
Nonperishable food supply days: 7
Perishable food supply days: 2
Administrator onsite hours per week: 20
Facility room temperature: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator/Executive Director | Met with Licensing Program Analyst during inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the infection control annual inspection |
| Bennett Fong | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 131
Deficiencies: 3
Apr 14, 2021
Visit Reason
The inspection was an unannounced complaint investigation conducted due to allegations including illegal eviction of a resident, lack of supervision resulting in resident wandering away multiple times, and a non-working facility alarm system.
Findings
The investigation substantiated that the facility failed to issue a proper eviction notice, did not provide adequate supervision leading to resident elopement, and lacked proper alarm systems to monitor exits. Some allegations, such as failure to notify the responsible party promptly and unmet bathing needs, were unsubstantiated.
Complaint Details
The complaint investigation was substantiated for illegal eviction, lack of supervision causing resident wandering and elopement, and non-working alarm system. The facility was found to have failed in issuing proper eviction notice and providing adequate supervision. Some allegations such as failure to notify responsible party timely and unmet bathing needs were unsubstantiated.
Severity Breakdown
Type A: 2
Type B: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to issue a required eviction notice and notice to quit to resident's responsible party. | Type A |
| Failure to ensure adequate supervision to meet resident's needs, resulting in elopement. | Type A |
| Failure to have auditory device or staff alert feature to monitor Memory Care stairwell exits. | Type B |
Report Facts
Capacity: 131
Census: 77
Deficiencies cited: 3
Plan of Correction Due Date: Apr 15, 2021
Plan of Correction Due Date: Apr 21, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Praveen Singh | Licensing Program Analyst | Conducted the complaint investigation and tele-visit |
| Julio Montes | Licensing Program Manager | Oversaw the complaint investigation report |
| Erika Mendez | Wellness Coordinator | Facility staff member who met with the Licensing Program Analyst during the investigation |
| Neal Torres | Administrator | Facility administrator named in the report |
Loading inspection reports...
