Deficiencies (last 6 years)
Deficiencies (over 6 years)
3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
25% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
88% occupied
Based on a January 2026 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy over time
Inspection Report
Complaint Investigation
Census: 115
Capacity: 131
Deficiencies: 0
Date: Jan 21, 2026
Visit Reason
The visit was conducted as a case management incident investigation related to a self-reported sexual abuse incident involving a caregiver and a resident.
Complaint Details
The complaint involved allegations by resident R1 that caregiver S1 touched her genital area inappropriately during shower assistance on two occasions. The facility notified police and conducted an internal investigation, interviewing multiple residents and the caregiver. The complaint was not substantiated and no deficiencies were cited.
Findings
The investigation found no deficiencies; the caregiver denied inappropriate touching, and interviews with other residents indicated no concerns with staff. A police report was filed and an internal investigation was conducted.
Report Facts
Police report number: 26385
Residents interviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator/Director | Facility administrator named in the report header. |
| Erika Mendez | Wellness Director | Met with during the inspection and provided information regarding the incident. |
| Daisy Panlilio | Licensing Program Analyst | Conducted the investigation and authored the report. |
| Bennett Fong | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 131
Deficiencies: 0
Date: Jan 21, 2026
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff do not accord resident privacy.
Complaint Details
Allegation: Staff do not accord resident privacy. Investigation finding: Unsubstantiated. The facility uses AI fall detection motion devices in resident bedrooms, but these do not record audio or continuous live monitoring. Residents may opt out by having devices covered and inactive.
Findings
The investigation found the allegation unsubstantiated after interviews and review of the Sage Fall Detection System, which are motion detectors and not surveillance cameras. No deficiencies were cited during the visit.
Report Facts
Capacity: 131
Census: 115
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Alberto Maldonado | Administrator | Facility administrator named in report header |
| Teresa Glenn | Manager on Duty | Met with Licensing Program Analyst during investigation |
| Erika Mendez | Wellness Director | Met with Licensing Program Analyst during investigation |
| Bennett Fong | Supervisor | Supervisor named in report |
Inspection Report
Annual Inspection
Census: 115
Capacity: 131
Deficiencies: 0
Date: Jan 14, 2026
Visit Reason
An unannounced required one year inspection was conducted to evaluate compliance with licensing requirements and facility conditions.
Findings
The inspection found the facility to be in compliance with no deficiencies observed. The facility maintained proper infection control measures, safety equipment, and adequate supplies.
Report Facts
Hot water temperature: 117
Facility temperature: 70
Fire extinguisher last inspection date: Nov 10, 2026
Staff files reviewed: 5
Resident files reviewed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection and authored the report |
| Erika Mendez | Wellness Director | Met with Licensing Program Analyst during inspection |
| Alberto Maldonado | Administrator | Facility administrator mentioned as infection control leader |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 116
Capacity: 131
Deficiencies: 2
Date: Nov 7, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that a resident sustained multiple pressure injuries due to lack of care from staff and that staff did not ensure resident needs were met while in care.
Complaint Details
The complaint investigation was substantiated. The resident sustained multiple pressure injuries due to lack of care from staff, and staff did not ensure that resident needs were met while in care. Immediate civil penalty of $500 was assessed during the visit, with additional penalties pending related to the resident's serious bodily injury.
Findings
The investigation substantiated both allegations, finding that the resident developed multiple stage 3 infected pressure injuries due to inadequate care and supervision by staff. The facility failed to perform required skin treatment routines and did not meet the resident's care needs, resulting in hospitalization. Immediate civil penalties were assessed.
Deficiencies (2)
Failure to provide adequate care and supervision to resident resulting in hospitalization and sustaining multiple pressure injuries while in care.
Failure to provide care, supervision, and services that meet residents' individual needs delivered by competent staff.
Report Facts
Civil penalty amount: 500
Capacity: 131
Census: 116
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Alberto Maldonado | Administrator | Facility administrator involved in the investigation. |
| Erika Mendez | Manager on Duty | Met with the evaluator during the unannounced visit. |
| Bennett Fong | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Census: 115
Capacity: 131
Deficiencies: 0
Date: 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 promptly, redirected the residents, and observed no injuries. No deficiencies were cited during the visit.
Report Facts
Incident date: Jun 28, 2025
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 in the report |
Inspection Report
Census: 115
Capacity: 131
Deficiencies: 0
Date: 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
Date: 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, emergency preparedness, and safety standards. 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 and identified as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 113
Capacity: 131
Deficiencies: 0
Date: 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
Capacity: 131
Deficiencies: 0
Date: Nov 7, 2024
Visit Reason
The visit was an unannounced Case Management inspection conducted regarding an incident reported to the Community Care Licensing Division on 11/04/2024 involving a resident hitting another resident.
Findings
The incident involved one resident striking another with a cane due to a misunderstanding about stolen jewelry. Both residents have a history of personal conflict. No deficiencies were issued during the visit, and corrective actions including contacting a physician and notifying a responsible party were underway.
Report Facts
Incident date: Nov 4, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Interviewed regarding the resident incident and corrective actions |
Inspection Report
Complaint Investigation
Capacity: 131
Deficiencies: 0
Date: 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.
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.
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.
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
Date: Sep 26, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff did not honor a restraining order for a resident.
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. The allegation was determined unsubstantiated.
Findings
The investigation found the allegation unsubstantiated due to lack of preponderance of evidence. The facility staff were found to have discussed the restraining order with the involved resident and observed compliance. No deficiencies were cited during the visit.
Report Facts
Capacity: 131
Census: 113
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director/Administrator | Met with Licensing Program Analyst during investigation and discussed restraining order compliance |
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit |
| Bennett Fong | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Date: 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.
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.
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.
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: 118
Capacity: 131
Deficiencies: 0
Date: Jul 23, 2024
Visit Reason
The inspection was conducted as an unannounced case management visit following receipt of an incident report regarding aggressive behaviors between a resident and staff.
Complaint Details
The complaint involved an incident on 07/02/24 where a resident became aggressive towards staff, resulting in bruising. The complaint was investigated and substantiated by the facility's actions including suspension and retraining of the staff member.
Findings
The investigation found that a staff member held a resident's wrist in self-defense after the resident became aggressive. The resident had bruising and swelling but denied pain. The staff member was suspended and retrained. No deficiencies were cited.
Report Facts
Incident report reference number: 24038542
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator | Met during inspection and provided information about the incident and staff actions |
| Daisy Panlilio | Licensing Evaluator | Conducted the unannounced case management visit |
| Bennett Fong | Supervisor | Named as supervisor in the report |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Date: Jul 23, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility retained a resident with a restricted health condition.
Complaint Details
The complaint alleged that the facility retained a resident with restricted health conditions. The investigation concluded the allegation was unsubstantiated due to lack of preponderance of evidence.
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.
Report Facts
Capacity: 131
Census: 113
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Alberto Maldonado | Administrator | Facility administrator met during the investigation |
| Bennett Fong | Supervisor | Supervisor named in the report |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Date: 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.
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.
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.
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
Date: 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.
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.
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.
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
Date: Feb 27, 2024
Visit Reason
An unannounced required one year inspection was conducted to evaluate compliance with licensing requirements and facility standards.
Findings
The inspection found the facility to be in compliance with no deficiencies observed. The facility maintained proper infection control measures, safety equipment, and documentation.
Report Facts
Food supply duration: 2
Food supply duration: 7
PPE supply duration: 30
Hot water temperature: 115
Comfortable temperature: 72
Fire extinguisher last inspection date: Jan 7, 2024
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 |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 116
Capacity: 131
Deficiencies: 0
Date: 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
Complaint Investigation
Census: 112
Capacity: 131
Deficiencies: 0
Date: 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 in the community.
Complaint Details
The complaint involved a resident hitting another resident. The situation was resolved, with the victim checked for injuries and the aggressor placed on hospice. No injuries were found and no deficiencies were cited.
Findings
The incident was resolved with no injuries reported. The resident involved was placed on hospice and medication compliance was established. 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 | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Census: 112
Capacity: 131
Deficiencies: 0
Date: 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
Date: Aug 11, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2022-04-04 regarding resident care and staffing at Trevista Antioch facility.
Complaint Details
The complaint investigation was unsubstantiated. Allegations investigated were: staff left resident in soiled sheets for extended period, staff not meeting resident's care needs, and facility short staffed. Evidence did not support these allegations.
Findings
All allegations including staff leaving a resident in soiled sheets, not meeting resident care needs, and facility being short staffed were found to be unsubstantiated after review of records, observations, and interviews.
Report Facts
Capacity: 131
Census: 115
Residents in memory care unit: 24
Staff in memory care unit: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Executive Director | Met with Licensing Program Analyst during investigation and named in report |
| Daisy Panlilio | Licensing Program Analyst | Conducted complaint investigation visit |
| Bennett Fong | Supervisor | Named as supervisor in report |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 131
Deficiencies: 0
Date: 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.
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.
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.
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
Date: 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.
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.
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.
Deficiencies (2)
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.
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.
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
Date: Feb 23, 2023
Visit Reason
The visit was an unannounced infection control inspection conducted as part of the required 1-year evaluation.
Findings
The inspection found no deficiencies. The facility demonstrated compliance with infection control protocols including universal screening, PPE availability, and mitigation plans.
Report Facts
PPE supply duration: 30
Food supply duration - perishable: 2
Food supply duration - non-perishable: 7
Facility temperature: 74
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 | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Routine
Census: 113
Capacity: 131
Deficiencies: 0
Date: 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
Date: 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.
Complaint Details
The complaint was unsubstantiated based on the investigation findings.
Findings
The investigation found that staff communicated effectively in English with residents and cleaned up meal trays promptly after residents finished eating. There was no preponderance of evidence to substantiate the allegations, and no deficiencies were cited during the visit.
Report Facts
Facility capacity: 131
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation visit |
| Alberto Maldonado | Administrator | Facility administrator mentioned in the report |
| Bennett Fong | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Capacity: 131
Deficiencies: 0
Date: 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.
Complaint Details
The complaint was unsubstantiated due to lack of preponderance of evidence to prove the alleged violations occurred.
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.
Report Facts
Facility capacity: 131
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Date: Jun 22, 2022
Visit Reason
The inspection was conducted as a result of the department receiving a priority 1 complaint, leading to a 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.
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.
Report Facts
Staff observed: 8
Residents observed: 24
Facility temperature: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the health and safety check |
| Alberto Maldonado | Administrator | Facility administrator who accompanied the Licensing Program Analyst during the inspection |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 131
Deficiencies: 0
Date: 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.
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.
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.
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
Date: Jan 5, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to complaints received on 2020-10-20 regarding resident safety and injuries.
Complaint Details
The complaint investigation was substantiated for the allegation that a resident was attacked by another resident on 2020-04-08, resulting in injury and hospital transport. The allegation that a resident sustained multiple injuries was unsubstantiated due to insufficient evidence.
Findings
One allegation that a resident was attacked by another resident was substantiated, with evidence of injury and hospital transport. Another allegation regarding multiple injuries sustained by a resident was unsubstantiated due to lack of sufficient evidence. One deficiency was cited related to failure to provide safe accommodations, which was corrected by the administrator.
Deficiencies (1)
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by R1 being attacked by another resident which posed a potential health & safety risk to resident in care.
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 |
| Alberto Maldonado | Administrator | Facility administrator met during inspection and involved in findings |
| Bennett Fong | Supervisor | Supervisor named in report |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 2
Date: Jan 5, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including illegal eviction of a resident and incorrect billing of an SSI resident.
Complaint Details
The complaint investigation was substantiated. The resident was illegally evicted despite SSI status and was incorrectly billed at the market rate rather than the SSI rate.
Findings
Both allegations were substantiated. The facility improperly evicted a resident despite knowledge of the resident's SSI status and billed the resident at the market rate instead of the SSI rate. Deficiencies were cited related to these violations.
Deficiencies (2)
Improper eviction of resident (R1) which posed a potential health & safety risk to resident in care.
Resident being charged the market rate despite being an SSI/SSP recipient, violating the requirement to provide basic services at the basic rate.
Report Facts
Capacity: 131
Census: 109
Deficiencies cited: 2
Plan of Correction Due Date: Jan 5, 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 |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 1
Date: 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.
Complaint Details
The complaint investigation substantiated that staff (S1) left resident (R1) unattended in the toilet for more than 2 hours on 07/12/2021. The allegation of staff retaliation against the resident was unsubstantiated.
Findings
The investigation substantiated that staff failed to respond to a resident's call for assistance, resulting in a deficiency citation. The allegation of staff retaliation against the resident was unsubstantiated based on interviews and record reviews.
Deficiencies (1)
Staff did not respond to resident's calling for assistance, posing a potential health and safety risk.
Report Facts
Capacity: 131
Census: 109
Deficiency Type: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Maldonado | Administrator/Executive Director | Met with during investigation and mentioned in findings |
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 131
Deficiencies: 1
Date: 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.
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.
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.
Deficiencies (1)
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.
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
Date: 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.
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.
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.
Deficiencies (2)
Improper eviction of resident (R1) which posed a potential health & safety risk to resident in care.
Resident being charged the market rate despite SSI eligibility, posing a potential health & safety risk to resident in care.
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
Date: 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.
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.
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.
Deficiencies (1)
Staff did not respond to resident's calling for assistance, posing a potential health & safety risk to residents in care.
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
Date: 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
Date: Apr 14, 2021
Visit Reason
This was an unannounced complaint investigation visit triggered by allegations including illegal eviction of a resident, lack of supervision resulting in resident wandering away multiple times, and a non-working facility alarm system.
Complaint Details
The complaint investigation was substantiated based on evidence that the resident was illegally evicted without proper notice, lacked adequate supervision leading to multiple wandering incidents and elopement, and the facility alarm system was not functioning properly. Some allegations such as failure to notify the responsible party immediately and unmet bathing needs were unsubstantiated.
Findings
The investigation substantiated that the facility failed to issue a proper eviction notice when a resident eloped and was sent home with the responsible party without prior notice. The facility also failed to provide adequate supervision to prevent the resident from wandering away multiple times and lacked proper alarm systems to monitor exits. Some allegations such as failure to notify the responsible party immediately and unmet bathing needs were found unsubstantiated.
Deficiencies (3)
Licensee’s failure to issue a required eviction notice and notice to quit to resident’s responsible party.
Licensee’s failure to ensure adequate supervision was maintained to meet resident’s needs resulting in elopement.
Licensee’s failure for alert features that monitor Memory Care stairwell exits.
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 |
| Erika Mendez | Wellness Coordinator | Facility staff member met during investigation |
| Neal Torres | Administrator | Facility administrator named in the report |
| Julio Montes | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 131
Deficiencies: 3
Date: 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.
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.
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.
Deficiencies (3)
Failure to issue a required eviction notice and notice to quit to resident's responsible party.
Failure to ensure adequate supervision to meet resident's needs, resulting in elopement.
Failure to have auditory device or staff alert feature to monitor Memory Care stairwell exits.
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 |
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