Inspection Report Summary
Most inspections found no deficiencies, showing the facility generally maintained compliance with health and safety regulations. Several complaint investigations were unsubstantiated, including serious allegations such as abuse and neglect. However, there were substantiated deficiencies related to staff response times, supervision, and care that contributed to a resident’s death, resulting in civil penalties totaling $15,000 issued in 2024 and 2025. The most recent inspection on August 12, 2025, found the facility in substantial compliance with no deficiencies. This indicates improvement in compliance following earlier serious findings, though some minor documentation issues were noted in mid-2025.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Census Over Time
Census
Capacity
Inspection Report
Census: 95
Capacity: 130
Deficiencies: 0
Aug 12, 2025
Visit Reason
The visit was an unannounced case management – legal/non-compliance inspection to ensure the facility is maintaining substantial compliance with Title 22 Regulations and to check for any health and safety hazards.
Findings
The inspection found the facility to be in substantial compliance with no immediate health and safety concerns. Resident rooms and common areas were clean and well-maintained, medication storage and administration were proper, and required postings and emergency equipment were in place.
Report Facts
Resident files reviewed: 5
Hot water temperature range: 105
Hot water temperature range: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Madison Lewis | Executive Director | Met with Licensing Program Analyst during the inspection |
| Brian Balisi | Licensing Program Analyst | Conducted the unannounced case management – legal/non-compliance visit |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Follow-Up
Census: 93
Capacity: 130
Deficiencies: 0
Jun 13, 2025
Visit Reason
An unannounced inspection was conducted to follow up on a substantiated allegation from a previous complaint investigation regarding neglect and lack of supervision that resulted in a resident's death.
Findings
The Department concluded that a civil penalty is warranted due to the facility's failure to provide proper care and supervision, which resulted in a resident's death from intracranial hemorrhage caused by a fall. A civil penalty of $14,500 was issued following a prior immediate penalty of $500.
Complaint Details
The complaint investigation concluded on February 21, 2024, substantiating allegations of questionable death due to neglect and lack of supervision, and failure to respond to the resident in a timely manner.
Report Facts
Civil penalty amount: 14500
Immediate civil penalty amount: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Madison Lewis | Administrator/Director | Met with during the inspection and named in the report. |
| Zabel Chochian | Licensing Program Analyst | Conducted the unannounced inspection and signed the report. |
| Desaree Perera | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 130
Deficiencies: 1
May 12, 2025
Visit Reason
The inspection was an unannounced visit conducted in conjunction with an investigation of complaint control #29-AS-20240912104318.
Findings
During the investigation, deficiencies unrelated to the complaint allegation were observed, specifically the failure to complete a new service plan for Resident #1 after admission to hospice care and hospitalization.
Complaint Details
The visit was triggered by a complaint investigation under control #29-AS-20240912104318. Deficiencies unrelated to the complaint allegation were also found.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to complete a new service plan for Resident #1 after admission to hospice care and hospitalization, violating the requirement to update the pre-admission appraisal to note significant changes in condition. | Type B |
Report Facts
Census: 92
Total Capacity: 130
Plan of Correction Due Date: May 27, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the unannounced visit and investigation |
| Madison Lewis | Administrator/Director | Facility administrator met during the inspection |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 130
Deficiencies: 0
May 12, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not prevent a resident from developing pressure injuries.
Findings
The investigation found insufficient evidence to substantiate the allegation that the facility failed to prevent a resident from developing a stage 3 pressure injury. The resident was independent for most care needs, hospice provided assistance, and facility staff were unaware of any pressure injuries during the resident's stay. No citations were issued.
Complaint Details
The complaint alleged that Resident #1 developed a stage 3 pressure injury due to lack of proper care. The allegation was deemed unsubstantiated due to insufficient evidence to prove the violation occurred.
Report Facts
Complaint control number: 29-AS-20240912104318
Number of facility staff interviewed: 4
Resident admission date: Resident #1 moved into the facility on 07/07/2023
Hospice visits documented: 2
Pressure injury assessment delay: 15
Facility capacity: 130
Facility census: 92
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the unannounced subsequent complaint visit and investigation |
| Madison Lewis | Executive Director | Met with Licensing Program Analyst during inspection and provided information |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on report |
| Brian Balisi | Licensing Program Analyst | Conducted initial complaint visit on 09/13/2024 |
Inspection Report
Census: 90
Capacity: 130
Deficiencies: 0
May 6, 2025
Visit Reason
The visit was an unannounced case management – legal/non-compliance inspection to ensure the facility is maintaining substantial compliance and there are no health and safety hazards.
Findings
The inspection found the facility to be in compliance with Title 22 Regulations with no immediate health and safety concerns. Resident rooms and common areas were clean and safe, emergency equipment and postings were in place, and records reviewed were in order.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Madison Lewis | Executive Director | Met with during the inspection and involved in the visit focused on compliance. |
| Brian Balisi | Licensing Program Analyst | Conducted the unannounced case management – legal/non-compliance visit. |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 130
Deficiencies: 0
Mar 20, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2025-02-12 regarding untimely re-ordering of incontinent supplies and lack of staff leading to pressure injuries.
Findings
The investigation found insufficient evidence to substantiate the allegations. Staff interviews and physical inspections showed that incontinent supplies were generally sufficient and ordered timely. Staffing levels were typically adequate, and pressure injuries were managed with appropriate care and support.
Complaint Details
The complaint included two allegations: 1) Staff do not re-order incontinent supplies timely resulting in residents not having incontinent supplies; 2) Due to lack of staff, residents are developing pressure injuries. Both allegations were deemed unsubstantiated based on interviews, documentation review, and observations.
Report Facts
Staff interviewed: 8
Resident rooms inspected: 11
Residents with pressure injuries: 5
Caregivers scheduled per shift: 3
Caregivers scheduled on heavy shower days: 4
Caregivers on night shift: 3
Additional staff assisting during understaffed shift: 3
Date complaint received: Feb 12, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Madison Lewis | Administrator / Executive Director | Facility administrator present during the investigation |
| Desaree Perera | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 93
Capacity: 130
Deficiencies: 0
Jan 23, 2025
Visit Reason
The visit was an unannounced case management – legal/non-compliance inspection to ensure the facility is maintaining substantial compliance with Title 22 Regulations and to check for health and safety hazards.
Findings
The facility was found to be in compliance with no immediate health and safety concerns. The environment was clean and safe, resident bedrooms and restrooms were appropriately furnished and sanitary, emergency equipment was in place and functional, and resident records were in order.
Report Facts
Resident files reviewed: 5
Fire extinguisher last serviced: Aug 13, 2024
Hot water temperature range: 105
Hot water temperature range: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Madison Lewis | Administrator | Met with Licensing Program Analyst during the inspection |
| Brian Balisi | Licensing Program Analyst | Conducted the unannounced case management – legal/non-compliance visit |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 130
Deficiencies: 0
Nov 20, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 05/07/2024 concerning sexual abuse, rough handling, injury, soiled diapers causing rash, and disturbance of residents' sleep at the facility.
Findings
After interviews with staff, residents, family members, and review of records including a police report, there was insufficient evidence to substantiate any of the allegations. All allegations including sexual abuse, rough handling, injury, leaving residents in soiled diapers, and disturbing residents' sleep were deemed unsubstantiated.
Complaint Details
The complaint investigation was initiated due to multiple allegations including sexual abuse by staff, rough handling causing injury, leaving residents in soiled diapers resulting in rash, and disturbing residents' sleep. The investigation included interviews with staff, residents, family members, and review of police and medical reports. The allegations were found to be unsubstantiated based on lack of evidence and resident/family/staff statements.
Report Facts
Capacity: 130
Census: 93
Complaint received date: May 7, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Brian Balisi | Licensing Program Analyst | Conducted subsequent complaint visit to deliver findings |
| Madison Lewis | Executive Director | Met with investigators during the complaint visit |
| Brimen Vivar | Administrator | Facility administrator named in the report |
Inspection Report
Annual Inspection
Census: 93
Capacity: 130
Deficiencies: 0
Nov 20, 2024
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with regulations and ensure health and safety standards.
Findings
The facility was found to be in compliance with health and safety regulations, including proper food storage, clean and safe resident rooms, adequate emergency preparedness, and proper medication management. All reviewed resident and personnel records were in order.
Report Facts
Resident files reviewed: 10
Personnel files reviewed: 10
Fire extinguishers last serviced: Dec 17, 2023
Last fire drill date: Oct 10, 2024
Temperature range: 110.4-119.6
Facility temperature: 73
Cameras observed: 3
Resident bedrooms observed: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Madison Lewis | Administrator | Met with LPAs during inspection |
| Brian Balisi | Licensing Program Analyst | Conducted inspection and signed report |
| Martha Arroyo | Licensing Program Analyst | Conducted inspection |
| Brima | Resident Care Director | Accompanied LPAs during physical plant tour |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 130
Deficiencies: 0
Aug 28, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 02/15/2024 that an unknown individual in the facility drugged and raped a resident in care.
Findings
After reviewing records, interviewing staff, residents, and the resident in question, and considering police involvement, the allegations were found to be unsubstantiated due to insufficient evidence to support that a violation occurred.
Complaint Details
The complaint alleged that an unknown individual drugged and raped Resident #1. The resident has dementia and a history of hallucinations. Police interviewed the resident and staff but no police report was generated. Random resident interviews indicated they felt safe. The investigation concluded the allegations were unsubstantiated.
Report Facts
Facility capacity: 130
Resident census: 93
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation and issued findings |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
| Madison Lewis | Managing Director | Facility representative met during the investigation |
| Brimen Vivar | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 93
Capacity: 130
Deficiencies: 0
Aug 28, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2024-02-13 that staff did not address a resident's change in health condition and did not take precautions to prevent a scabies outbreak.
Findings
The investigation included record reviews, staff and resident interviews, and found insufficient evidence to substantiate the allegations. The resident was regularly observed and changes communicated timely, and no scabies outbreak was confirmed at the facility. The allegations were deemed unsubstantiated.
Complaint Details
The complaint was unsubstantiated. Allegations included failure to address a resident's change in condition and failure to prevent a scabies outbreak. Investigation found no evidence supporting these claims.
Report Facts
Complaint Control Number: 29-AS-20240213083220
Number of residents interviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
| Madison Lewis | Managing Director | Met with the Licensing Program Analyst during the investigation. |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 130
Deficiencies: 2
Feb 21, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following allegations of neglect, lack of care and supervision, and questionable death of a resident due to neglect.
Findings
The investigation substantiated that the facility staff failed to respond to the resident in a timely manner, resulting in neglect and lack of supervision that contributed to the resident's death. A $500 immediate civil penalty was assessed.
Complaint Details
The complaint was substantiated. The allegations included questionable death due to neglect and lack of supervision, and failure to respond to the resident in a timely manner. The investigation found sufficient evidence to support these allegations.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Basic services shall at a minimum include care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c)(5) Regular observation of the resident's physical and mental condition. Facility staff failed to assess R1 completely for fall prevention and develop a service plan as R1 had a history of falls. | Type A |
| Residents have the right to care, supervision, and services that meet their individual needs and are delivered by staff sufficient in numbers, qualifications, and competency. Facility staff did not respond to R1 in a timely manner when notified multiple times by R1’s resident representative, resulting in harm. | Type A |
Report Facts
Civil penalty amount: 500
Deficiency count: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report. |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Brimen Vivar | Administrator | Facility Administrator met during the investigation and was informed of findings. |
| Douglas Rice | Administrator | Named as facility administrator in report header. |
| Lorraine Patterson | Investigator | Conducted interviews and investigations related to the complaint. |
Inspection Report
Complaint Investigation
Census: 94
Capacity: 130
Deficiencies: 0
Feb 21, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2023-12-08 regarding bed bug issues, inadequate staffing, staff mistreatment, and medication distribution at the facility.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Bed bug issues were addressed promptly, staffing levels were sufficient, residents denied mistreatment by staff, and medications were being distributed properly.
Complaint Details
The complaint included allegations of delayed response to bed bug issues, inadequate staffing, staff yelling and mocking residents, and failure to distribute medications. After inspection, interviews, and records review, all allegations were deemed unsubstantiated due to insufficient evidence.
Report Facts
Residents interviewed: 10
Resident rooms inspected: 10
Residents interviewed: 6
Caregivers total: 6
Med-techs total: 2
Caregivers for NOC shift: 1
Med-techs for NOC shift: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Desaree Perera | Licensing Program Manager | Oversaw the complaint investigation |
| Brimen Vivar | Administrator | Facility administrator met during the investigation and provided information |
Inspection Report
Annual Inspection
Census: 91
Capacity: 130
Deficiencies: 0
Nov 22, 2023
Visit Reason
The inspection was a required annual unannounced visit to evaluate the facility's compliance with regulations and ensure health and safety standards were met.
Findings
The facility was found to be in compliance with Title 22 regulations with no health or safety hazards observed. Rooms and common areas were clean, appropriately furnished, and in good condition. Fire safety equipment was inspected and functioning properly. The kitchen was clean and well-stocked. The inspection will continue on a later date due to time constraints.
Report Facts
Hot water temperature range: 113
Hot water temperature range: 116
Room temperature: 81
Fire extinguisher last inspection date: Aug 1, 2023
Fire safety system last test date: Sep 29, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the annual inspection |
| Madison Lewis | Managing Director | Met with Licensing Program Analyst during inspection |
| Precious Gardner | Staff who toured the physical plant areas with the Licensing Program Analyst |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 130
Deficiencies: 2
Jun 7, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2022-08-25 regarding resident care issues including bathing and pendant call response times.
Findings
The investigation substantiated that the facility did not bathe the resident as scheduled and was not responding timely to the resident's pendant calls for help. Two other allegations related to medication changes and assistance with self-administration were found unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations that the facility did not bathe the resident as scheduled and did not respond timely to the resident's pendant calls for help. The allegations that the facility changed the resident's medication without permission and did not assist with self-administration of medication were unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide care, supervision, and services that meet residents' individual needs, specifically regarding timely response to pendant calls. | Type B |
| Failure to provide basic services including personal assistance with bathing as indicated in the resident's needs and services plan. | Type B |
Report Facts
Capacity: 130
Census: 82
Deficiencies cited: 2
Plan of Correction Due Date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation report |
| Brimen Vivar | Administrator met with during investigation and discussed complaint findings | |
| Maddi Lewis | Executive Director | Met with Licensing Program Analyst to discuss complaint reason |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 130
Deficiencies: 0
Jun 7, 2023
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by allegations received on 2022-06-17 regarding staff response times to residents' call buttons and residents' room air conditioner temperature issues.
Findings
The investigation found both allegations unsubstantiated. Interviews and observations indicated that staff usually respond timely to call buttons and that the HVAC system was working as designed, with residents having preferences for room temperature and arrangements made to adjust thermostats remotely.
Complaint Details
The complaint investigation was unsubstantiated based on interviews with residents and staff, observations of the HVAC system, and review of call response practices. The administrator was unable to provide pendant call records for June 2022.
Report Facts
Capacity: 130
Census: 82
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report signature and oversight |
| Brimen Vivar | Administrator met during investigation | |
| Maddi Lewis | Executive Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 130
Deficiencies: 0
May 12, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 01/19/2022 regarding failure to provide proper hygiene/bathing, incontinence care, and timely emergency medical services to a resident.
Findings
The investigation found that the resident was resistant to incontinence care and bathing, and staff provided sponge baths and ensured skin integrity. Staff called 9-1-1 in a timely manner when the resident showed signs of fever. All allegations were deemed unsubstantiated and no deficiencies were observed.
Complaint Details
The complaint involved allegations that the facility failed to provide proper hygiene/bathe resident, proper incontinence care, and timely emergency medical services. After interviews and record reviews, all allegations were found unsubstantiated.
Report Facts
Capacity: 130
Census: 83
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation visit |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report as Licensing Program Manager |
| Brimen Vivar | Facility representative met during investigation |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 130
Deficiencies: 2
Feb 16, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-02-07 regarding staff response times to resident call buttons and facility temperature maintenance.
Findings
The investigation substantiated that staff response times to resident call buttons were excessively delayed, ranging from 10 minutes to one hour, and that the facility was not maintaining a comfortable temperature, with observed room temperatures between 58 and 69 degrees Fahrenheit.
Complaint Details
The complaint investigation was substantiated based on interviews, record reviews, and observations confirming delayed staff response times and inadequate temperature control in the facility.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Response times to calls for assistance have taken from 10 minutes to an hour in some instances, posing a potential health, safety or personal rights risk to persons in care. | Type B |
| Facility failed to maintain a comfortable temperature for residents; observed temperature inside resident room was 58 degrees Fahrenheit, posing a potential health, safety and personal rights risk. | Type B |
Report Facts
Facility census: 69
Facility capacity: 130
Temperature range: 58
Temperature range: 69
Response time range: 10
Response time range: 60
Plan of Correction due date: Feb 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Dan Zaharoni | Licensee | Met with Licensing Program Analyst during investigation |
| Brimen Vivar | Administrator | Met with Licensing Program Analyst during investigation and agreed to corrective actions |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 130
Deficiencies: 0
Jan 13, 2023
Visit Reason
The visit was conducted as a complaint investigation regarding an allegation that the facility was operating without a certified administrator.
Findings
The investigation found that the allegation was unsubstantiated. The acting administrator, Briman Vivar, holds a current administrator certification, and the licensee is in the process of obtaining certification and plans to name Vivar as the administrator by 1/20/2023.
Complaint Details
The complaint alleged that the facility was operating without a certified administrator. The allegation was deemed unsubstantiated based on the investigation findings.
Report Facts
Capacity: 130
Census: 66
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation visit |
| Dan Zaharoni | Licensee met with during the investigation | |
| Briman Vivar | Acting Administrator | Confirmed to have current administrator certification |
Inspection Report
Annual Inspection
Census: 59
Capacity: 130
Deficiencies: 1
Nov 10, 2022
Visit Reason
The visit was an unannounced required annual inspection with a specific emphasis on infection control practices and procedures.
Findings
The facility was generally found to be in compliance with health and safety regulations, including clean and well-maintained physical areas and proper infection control measures. However, deficiencies were cited related to unsafe storage of over-the-counter medications and toxic substances in unlocked cabinets in resident rooms.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Over-the-counter medication and room deodorizer were stored in unlocked cabinets in three out of ten resident rooms, posing an immediate health, safety, or personal rights risk to persons in care. | Type A |
Report Facts
Resident rooms observed: 10
Deficiency count: 1
Plan of Correction due date: Nov 18, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manuel Hernandez | Resident Care Director, LVN | Met with Licensing Program Analyst during inspection |
| Teresa Camara | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 130
Deficiencies: 0
Sep 1, 2022
Visit Reason
The visit was a case management - incident investigation regarding an incident that took place on 07/28/2022.
Findings
The Licensing Program Analyst conducted interviews and reviewed records but stated that further investigation is required prior to issuing findings.
Complaint Details
The visit was triggered by an incident reported on 07/28/2022. No findings were issued yet as further investigation is needed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Chad Boeddeker | Executive Director | Met with Licensing Program Analyst during the incident investigation visit. |
| Teresa Camara | Licensing Program Analyst | Conducted the case management - incident visit and interviews. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 130
Deficiencies: 0
Jun 3, 2022
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation that Resident #1 sustained unexplained pressure injuries due to lack of adequate care and supervision.
Findings
The investigation found insufficient evidence to support the allegation of lack of care and supervision causing the pressure injuries. The resident's pressure injuries were documented and treated, and home health care was provided. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that Resident #1 sustained unexplained pressure injuries on the left heel, right Achilles tendon, and underneath the left breast due to lack of care and supervision. The allegation was investigated through interviews, medical record review, and observation. The complaint was found to be unsubstantiated.
Report Facts
Facility capacity: 130
Resident census: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Chad Boeddeker | Executive Director | Met with Licensing Program Analyst during the visit |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Edward Hector | CCLD Investigations Branch Investigator | Assisted in complaint investigation and interviews |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 130
Deficiencies: 2
Feb 10, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-01-25 regarding staff response times, resident room safety, cleanliness, and disrepair.
Findings
The investigation substantiated that staff did not respond timely to calls for assistance, with some response times over an hour. Resident room safety and disrepair issues were substantiated due to a bathroom door with protruding screws and inability to lock. Cleanliness issues were substantiated due to a soiled diaper left on the bathroom floor. Other allegations regarding urine on bathroom floors, laundry not being done, and malodorous conditions were unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations that staff were not responding timely to calls for assistance, and that a resident's room was unsafe, in disrepair, and not clean. Other allegations about urine on bathroom floors, laundry not being done, and facility malodor were unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Response times to calls for assistance have taken over an hour in some instances, posing a potential health, safety or personal rights risk. | Type B |
| Resident's room was unsafe due to protruding screws, bathroom door not closing/locking properly, and motion sensor malfunction. | Type B |
Report Facts
Facility Capacity: 130
Census: 52
Deficiencies cited: 2
Plan of Correction Due Date: Feb 17, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Carol Ann LeRose | Administrator | Facility administrator met during the investigation |
| Debbie Doering | Business Office Manager | Met with Licensing Program Analysts during the investigation |
| Brimen Viver | Resident Care Director | Commented on cleanliness deficiency regarding soiled diaper |
| Elsie Campos | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 55
Capacity: 130
Deficiencies: 0
Nov 5, 2021
Visit Reason
An unannounced Required - 1 Year inspection was conducted to evaluate compliance with licensing regulations including building and grounds, resident rooms, bathrooms, kitchen, food and first aid supplies, emergency preparedness, and infection control practices.
Findings
The facility was found to be in compliance with no deficiencies observed. The environment was clean, safe, and well-maintained with proper emergency supplies, medication storage, and infection control practices.
Report Facts
Hot water temperature: 112.5
Hot water temperature: 113.9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol Ann LeRose | Executive Director | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Teresa Camara | Licensing Program Analyst | Conducted the unannounced Required - 1 Year inspection |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named in report header |
Inspection Report
Original Licensing
Capacity: 130
Deficiencies: 0
Nov 23, 2020
Visit Reason
The visit was an announced pre-licensing inspection to evaluate the facility's compliance with regulations prior to licensing approval.
Findings
The facility was found to be in compliance with Title 22 regulations, with clean and safe common areas, operational safety systems, and appropriate physical plant conditions. Some Assisted Living bathrooms require additional grab bar installation, which has been ordered with an estimated delivery date of 11/23/2020.
Report Facts
Maximum bedridden residents capacity: 10
Rooms in Memory Care Unit: 20
Water temperature range: 106
Water temperature range: 116
Food delivery frequency: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Smith | Licensing Program Analyst | Conducted the pre-licensing inspection and signed the report. |
| Carol Ann LeRose | Executive Director | Met with the Licensing Program Analyst during the inspection. |
| Jeralyn Ann Pfannenstiel | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Original Licensing
Capacity: 130
Deficiencies: 0
Nov 16, 2020
Visit Reason
Initial licensing evaluation of the facility Vista at Simi Valley to assess compliance with regulatory requirements and confirm understanding of Title 22 regulations.
Findings
The applicant and administrator successfully completed Component II via telephone call, demonstrating understanding of facility operation, staff qualifications, program policies, grievance procedures, physical plant, and application document review including criminal record clearance and other licensing requirements.
Report Facts
Capacity: 130
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan ZaharonI | Participant in COMP II telephone call confirming understanding of Title 22 | |
| Carol Ann LeRose | Participant in COMP II telephone call confirming understanding of Title 22 | |
| Mirella Quaranta | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Stefania Fonteno | Licensing Program Analyst | Named as Licensing Program Analyst on the report |
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