Inspection Report Summary
Most inspections found no deficiencies, with several complaint investigations unsubstantiated, reflecting generally consistent compliance over time. The most recent report from March 28, 2025, did cite a deficiency for failing to safeguard a resident’s dentures, which were lost and required replacement valued at $4,480. Earlier substantiated issues included lack of supervision leading to resident elopement in August 2024 and refusal to readmit a resident after hospitalization in August 2022, both posing potential health and safety risks. Infection control concerns arose in April 2022 when staff were found not properly wearing masks during a COVID-19 outbreak. While some deficiencies have occurred, recent reports show mostly isolated issues without fines or enforcement actions listed, and no clear worsening or improving trend is evident.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
1.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
55% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
82% occupied
Based on a March 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 117
Capacity: 143
Deficiencies: 1
Date: Mar 28, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff did not safeguard a resident's personal belongings, specifically the loss of Resident #1's dentures.
Complaint Details
The complaint was substantiated based on observations, interviews, and records review. The resident's dentures were lost around January 25, 2025, and staff admitted possible misplacement. The facility was found responsible and a citation will be issued.
Findings
The investigation substantiated the allegation that staff failed to safeguard the resident's dentures, which were lost and believed to have been accidentally thrown away by staff. The facility agreed to replace the dentures valued at $4,480.00.
Deficiencies (1)
The licensee failed to make reasonable efforts to safeguard resident property, resulting in lost dentures of Resident #1.
Report Facts
Replacement cost: 4480
Plan of Correction due date: Apr 11, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Jessica Playa | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Shawna Emery | Resident Care Coordinator | Interviewed during investigation; provided information about the lost dentures |
Inspection Report
Complaint Investigation
Census: 111
Capacity: 143
Deficiencies: 0
Date: Feb 13, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that facility staff left residents in soiled clothing and did not keep the facility free of odors.
Complaint Details
The complaint was unsubstantiated. Allegations included residents left in soiled clothing and facility odors. The resident refused care and showers, and staff documented refusals. Observations and interviews did not support the allegations.
Findings
The investigation included observations, interviews, and record reviews, and found that the resident in question refused care and that staff documented these refusals. No issues were observed during the visit, and the complaint was determined to be unsubstantiated.
Report Facts
Capacity: 143
Census: 111
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kathleen Banrasavong | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Amy Banaga | Administrator | Facility administrator mentioned in report header |
| Carline Callaghan | Sales Director | Met with Licensing Program Analyst during investigation and exit interview |
| Shaun McGuirk | Executive Director | Provided information regarding resident refusals during investigation |
| Jazmond D Harris | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 107
Capacity: 143
Deficiencies: 0
Date: Feb 6, 2025
Visit Reason
Unannounced complaint investigation visit conducted in response to allegations including residents' incontinence care needs not being met, staff chemically restraining a resident, and a facility infestation of bed bugs.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included unmet incontinence care needs, chemical restraint of a resident, and bed bug infestation. Interviews and documentation did not support these claims, and the facility was found to be taking appropriate corrective actions regarding bed bugs.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Residents and staff interviews, physician statements, and documentation review indicated appropriate care and medication administration. The facility acknowledged past bed bug issues and demonstrated ongoing treatment efforts including professional pest control and heat treatments.
Report Facts
Capacity: 143
Census: 107
Number of mattresses purchased: 14
Dates of bed bug heat treatments: Heat treatments conducted on 8/22/23, 11/13/23, and 11/27/23
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Shaun McGuirk | Executive Director | Facility representative interviewed during investigation |
| Roy Hayes | Maintenance Director | Interviewed regarding bed bug treatments and facility pest control measures |
Inspection Report
Complaint Investigation
Census: 113
Capacity: 143
Deficiencies: 0
Date: Nov 25, 2024
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging illegal eviction of a resident from the facility.
Complaint Details
The complaint alleged that Resident #1 was illegally evicted after receiving a text message to move out due to safety concerns. Records showed changes in the resident's condition and recommendations for emergency evaluation, which were not followed. The facility implemented 1:1 caregiver support and sought alternative placement. Resident #1 moved out on 04/17/23. The allegation was found unsubstantiated.
Findings
The investigation included observations, interviews, and records review, concluding that the allegation of illegal eviction was unsubstantiated due to insufficient evidence to prove the violation occurred.
Report Facts
Capacity: 143
Census: 113
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Tricia Danielson | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Shaun McGuirk | Executive Director | Met with Licensing Program Analyst during the visit |
| Cherryrose Gajo | Resident Services Director | Met with Licensing Program Analyst during the visit and involved in investigation |
Inspection Report
Annual Inspection
Census: 113
Capacity: 143
Deficiencies: 1
Date: Nov 6, 2024
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing regulations at the facility.
Findings
The facility was found to be generally compliant with regulations, including adequate staffing, proper medication storage, clean environment, operable safety equipment, and sufficient food supply. However, some deficiencies were observed and cited per Title 22, Division 6 of the California Code of Regulations.
Deficiencies (1)
Deficiencies observed and/or cited per Title 22, Division 6 of the California Code of Regulations.
Report Facts
Capacity: 143
Census: 113
Staff files reviewed: 5
Resident files reviewed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shaun McGuirk | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| Venus Mixson | Licensing Program Analyst | Conducted the annual inspection and authored the report. |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 143
Deficiencies: 1
Date: Aug 28, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that a resident eloped from the facility due to lack of supervision.
Complaint Details
The complaint was substantiated based on interviews and records review. Resident #1 eloped from the facility twice, once found by the Executive Director nearby and a second time found by law enforcement confused and lost in a different city.
Findings
The investigation substantiated the allegation that Resident #1 eloped from the facility twice due to lack of supervision, posing a potential health and safety risk. The licensee did not ensure supervision was provided to the resident as required.
Deficiencies (1)
HSC 1569.312(d) Basic services requirements: Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by the licensee not ensuring supervision was provided to 1 out of 101 residents [R1], posing a potential health and safety risk.
Report Facts
Resident count: 115
Total capacity: 143
Residents involved: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Liliana Silveira | Licensing Program Analyst | Conducted the complaint investigation visit |
| Denise Powell | Licensing Program Manager | Named in report as Licensing Program Manager |
| Cherryrose Gajo | Resident Services Director | Met with during investigation and received report |
| Amy Banaga | Administrator | Facility Administrator named in report |
Inspection Report
Annual Inspection
Census: 110
Capacity: 143
Deficiencies: 0
Date: Dec 12, 2023
Visit Reason
The inspection was an unannounced annual inspection conducted by Licensing Program Analyst Chinwe Nwogene to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be in good repair, clean, and operating safely within its approved capacity. No deficiencies were cited during the visit. Resident rooms, bathrooms, kitchen, common areas, and safety equipment were inspected and found compliant.
Report Facts
Staff records reviewed: 3
Resident records reviewed: 3
Staff interviewed: 3
Residents interviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shaun McGuirk | Executive Director | Met with Licensing Program Analyst during inspection and received report copy |
| Chinwe Nwogene | Licensing Program Analyst | Conducted the annual inspection |
| Rikesha Stamps | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 143
Deficiencies: 0
Date: Aug 16, 2023
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that staff did not keep the facility free from bed bugs.
Complaint Details
The complaint alleged that staff did not keep the facility free from bed bugs. The investigation found ongoing bed bug issues but appropriate mitigation steps were in place. The allegation was unsubstantiated.
Findings
The facility has been battling bed bugs for several years and has ongoing treatment and mitigation efforts including contracts with an extermination company and use of heat treatments. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 143
Census: 109
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during investigation |
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Roy Hayes | Maintenance Director | Interviewed regarding bed bug treatment |
| Daniel Slaughter | Regional Director of Operations | Interviewed regarding ongoing extermination services |
Inspection Report
Complaint Investigation
Census: 108
Capacity: 143
Deficiencies: 0
Date: Jul 21, 2023
Visit Reason
The visit was an unannounced case management visit conducted in conjunction with complaint control #18-AS-20230703125256 to amend the findings of a prior facility visit on 07/13/2023 from UNSUBSTANTIATED to UNFOUNDED.
Complaint Details
The visit was related to complaint control #18-AS-20230703125256. The original findings from the 07/13/2023 visit were amended from UNSUBSTANTIATED to UNFOUNDED.
Findings
The amended LIC9099 report was provided during the visit, and the findings from the previous visit were changed from UNSUBSTANTIATED to UNFOUNDED. An exit interview was conducted and a copy of the report was provided.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during the visit and explained the purpose of the visit. |
| Tricia Danielson | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report. |
| Shawna Emery | Resident Care Coordinator | Involved in the prior facility visit on 07/13/2023. |
Inspection Report
Complaint Investigation
Census: 110
Capacity: 143
Deficiencies: 0
Date: Jul 12, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that a resident's room was unsanitary.
Complaint Details
The complaint alleged that Resident #1's room was unsanitary, including odors and feces. The investigation found the complaint unfounded as the resident refused housekeeping services and was responsible for pet care. The resident was served a 30-day termination notice for failing to comply with pet policy.
Findings
The investigation found the complaint to be unfounded after observing the resident's room and interviewing staff and the resident. Although unsanitary conditions were initially reported, the resident regularly refused housekeeping services and the facility was not responsible for cleaning after the resident's pet.
Report Facts
Capacity: 143
Census: 110
Complaint control number: 18-AS-20230703125256
Housekeeping refusal dates: 5
30 Day Termination Notice: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Amy Banaga | Administrator | Facility administrator mentioned as off duty during visit |
| Shawna Emery | Resident Care Coordinator | Met with Licensing Program Analyst during investigation |
| Carline Callaghan | Marketing Director | Met with Licensing Program Analyst during investigation |
| Roy Hayes | Maintenance Director | Reported by resident as responsible for weekly housekeeping |
| Jazmond D Harris | Licensing Program Manager | Named on report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 108
Capacity: 143
Deficiencies: 0
Date: Mar 22, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 03/09/2023 regarding bed bug issues, food quality, and availability of snacks at the facility.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included improper handling of bed bug issues, poor food quality, and lack of snack availability. Interviews with residents and facility tours did not support these allegations.
Findings
The investigation found that the facility has an ongoing bed bug issue but is taking appropriate mitigation steps. Food quality concerns were not substantiated as residents reported good quality and variety of food. Snacks were available to residents upon request. Overall, the allegations were unsubstantiated due to lack of preponderance of evidence.
Report Facts
Residents interviewed: 10
Capacity: 143
Census: 108
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Amy Banaga | Administrator | Facility administrator mentioned in relation to bed bug issue |
| Jessica Playa | Business Office Manager | Met with Licensing Program Analyst during the investigation |
| Deborah Mullen | Licensing Program Manager | Named in report signature and oversight |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 143
Deficiencies: 0
Date: Sep 21, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 09/19/2022 regarding visitor restrictions and staff responsiveness at Pacifica Senior Living Escondido.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included a resident not being allowed visitors and staff not responding in a timely manner. Interviews with staff and the resident, as well as record reviews, did not support the allegations.
Findings
The investigation found no preponderance of evidence to substantiate the allegations that a resident was not allowed visitors or that staff failed to respond timely to resident needs. The visitor was escorted off the premises but the facility acknowledged an erroneous understanding of the reason. The resident was observed to be independent and had no issues with staff assistance.
Report Facts
Capacity: 143
Census: 103
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Amy Banaga | Executive Director | Facility administrator met during investigation |
| Deborah Mullen | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 143
Deficiencies: 0
Date: Sep 21, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 07/05/2022 regarding staff not wearing masks, a resident having bed bugs, and improper medication administration.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not wearing masks, a resident having bed bugs, and improper medication administration. Interviews and records did not support these allegations.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and resident interviews, as well as record reviews, did not corroborate the claims. The facility is addressing a bed bug incident with appropriate extermination measures.
Report Facts
Capacity: 143
Census: 103
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during investigation |
| Deborah Mullen | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 101
Capacity: 143
Deficiencies: 1
Date: Aug 2, 2022
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 07/25/2022 regarding staff refusal to accept a resident back into the facility after hospitalization.
Complaint Details
The complaint was substantiated based on the preponderance of evidence that staff refused to accept Resident #1 back into the facility after hospitalization, violating residents' personal rights.
Findings
The investigation substantiated the allegation that staff refused to accept Resident #1 back into the facility upon discharge from the hospital on July 21, 2022, due to safety concerns. This refusal was found to pose a potential health, safety, and personal rights risk to residents.
Deficiencies (1)
Failure to protect residents from involuntary transfers, discharges, and evictions as evidenced by refusal to accept Resident #1 back into the facility upon hospital discharge.
Report Facts
Capacity: 143
Census: 101
Deficiencies cited: 1
Plan of Correction Due Date: Aug 12, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Amy Banaga | Executive Director | Interviewed during investigation regarding the refusal to accept resident back |
| Deborah Mullen | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 143
Deficiencies: 0
Date: Jun 22, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff hit residents and yelled at residents at the facility.
Complaint Details
The complaint alleged that staff hit residents and yelled at residents. After investigation, the complaint was determined to be unfounded, meaning the allegations were false or without reasonable basis.
Findings
The investigation included interviews with residents and staff and a review of records. All interviewed residents denied experiencing staff hitting or yelling at them. The complaint was found to be unfounded with no evidence supporting the allegations.
Report Facts
Residents interviewed: 7
Staff interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during the investigation |
| Tricia Danielson | Licensing Program Analyst | Conducted the complaint investigation |
| Deborah Mullen | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 143
Deficiencies: 1
Date: Apr 8, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-02-14 alleging staff were not following infection control masking guidance.
Complaint Details
The complaint was substantiated. Staff were observed not following infection control masking guidance during a COVID-19 outbreak, exposing residents to potential health risks.
Findings
The investigation found that staff members were observed not wearing face masks properly during a COVID-19 outbreak, posing a potential health and safety risk to residents. The allegation was substantiated based on observations, interviews, and record reviews.
Deficiencies (1)
Failure to protect the personal rights of residents by not ensuring staff wore face masks properly during a COVID-19 outbreak, posing a potential health and safety risk.
Report Facts
Capacity: 143
Census: 103
Plan of Correction Due Date: Apr 22, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met during investigation and named in findings |
| John Rante | Licensing Program Manager | Conducted facility tour and involved in investigation |
| Iby Strong | Licensing Program Analyst | Conducted investigation and authored report |
| Icela Estrada | Interim Assistant Program Administrator | Participated in unannounced visit and investigation |
Inspection Report
Follow-Up
Census: 103
Capacity: 143
Deficiencies: 0
Date: Feb 25, 2022
Visit Reason
The visit was an unannounced case management follow-up regarding an incident report received for Resident 1 on 2022-02-23.
Findings
No immediate health or safety issues were observed during the visit, and no deficiencies were cited.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met with during the visit and participated in the exit interview. |
| Iby Strong | Licensing Program Analyst | Conducted the unannounced case management visit. |
| John Rante | Licensing Program Manager | Named in the report header. |
Inspection Report
Census: 103
Capacity: 143
Deficiencies: 0
Date: Jan 25, 2022
Visit Reason
The visit was an unannounced Case Management visit conducted in response to the self-reported death of Resident 1, who passed away at a hospice house on 12/31/21.
Findings
A wellness check was conducted at the facility with no health or safety issues identified. All staff had current criminal record clearances and residents appeared appropriate for the facility. No deficiencies were cited or observed during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during the visit and received a copy of the report. |
| Iby Strong | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| John Rante | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 102
Capacity: 143
Deficiencies: 0
Date: Nov 30, 2021
Visit Reason
An unannounced annual required licensing inspection was conducted to verify compliance with statutes, regulations, and infection control practices, including COVID-19 mitigation measures.
Findings
The facility was found to be in compliance with all relevant regulations and infection control practices, including COVID-19 mitigation. No deficiencies were observed during the visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Named in relation to receipt of report and licensing rights. |
| Carline Callaghan | Sales Director | Met with Licensing Program Analyst during inspection and exit interview. |
| Jessica Lane | Resident Service Director | Participated in review of COVID-19 mitigation plan. |
| Liliana Silveira | Licensing Program Analyst | Conducted the inspection. |
| Denise Powell | Licensing Program Manager | Named as Licensing Program Manager on report. |
Inspection Report
Census: 102
Capacity: 143
Deficiencies: 0
Date: Oct 28, 2021
Visit Reason
The visit was an unannounced case management visit conducted by the Licensing Program Analyst following a self-reported incident where a resident left the facility and was returned by police.
Findings
The Licensing Program Analyst toured the facility, conducted a health and safety check, interviewed the Executive Director, and reviewed records. No deficiencies were cited during this visit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Banaga | Executive Director | Interviewed during the case management visit and recipient of the report and appeal rights. |
| Liliana Silveira | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Denise Powell | Licensing Program Manager | Named in the report header. |
Inspection Report
Capacity: 143
Deficiencies: 4
Date: Jan 26, 2021
Visit Reason
The visit was a virtual case management inspection conducted via video conference due to COVID-19 to inspect an ancillary facility building recently granted fire clearance by the local fire authority and to observe compliance with Title 22 and Health and Safety Code regulations.
Findings
The Licensing Program Analyst observed that grab bars were installed, showers had non-skid surfaces, and safety equipment such as fire extinguishers and detectors were present. However, water temperature was measured between 65-68 degrees Fahrenheit, which is not compliant with regulations. Additional items such as resident bedroom furniture, clean linens, and proper water temperature for grooming need to be provided prior to approval.
Deficiencies (4)
Water temperature measured between 65-68 degrees Fahrenheit, not in compliance with Title 22 regulations.
Resident accommodations - bedroom furniture including a chair, night stand, lamp or light sufficient for reading should be available for each resident’s use.
Clean linens, including blankets, bedspreads, top bedsheets, bottom bedsheets, pillowcases, mattress pads, bath towels, hand towels and wash cloths shall be available.
Water temperature in faucets used for grooming shall measure between 105 – 120 degrees Fahrenheit.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Carmen Lopez | Licensing Program Analyst | Conducted the virtual inspection visit and observations. |
| Karen Enciso | Executive Director | Participated in the virtual visit and exit interview. |
| Diana Rezkalla | Memory Care Director | Participated in the virtual visit. |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 143
Deficiencies: 0
Date: Jan 22, 2021
Visit Reason
An unannounced complaint investigation was conducted following allegations received on 06/05/2020 regarding failure to observe changes in resident condition, inadequate incontinence care, improper staff training, and insufficient planned activities for residents.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included failure to observe resident condition changes, inadequate incontinence care, improper staff training, and insufficient planned activities. Interviews, record reviews, and third-party sources did not confirm violations.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Medication administration and observation were conducted per physician orders, incontinence care was provided adequately despite some staffing challenges, staff training was completed as required, and planned activities were scheduled daily though participation varied.
Report Facts
Capacity: 143
Census: 88
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Raymond Wu | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during investigation |
| Rebecca Hedgecock | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 88
Capacity: 143
Deficiencies: 0
Date: Jan 22, 2021
Visit Reason
An unannounced complaint investigation was conducted following allegations that a resident was not included in decision-making and was isolated upon admission to the facility.
Complaint Details
The complaint was unsubstantiated. Allegations included that the licensee did not include the resident in decision-making and that the resident was isolated. The resident was quarantined for 14 days per facility policy due to COVID-19, with access to outdoor areas and digital communication. No evidence of rights violations was found.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews and records indicated the resident was aware of the move-in, had decision-making capacity, and was quarantined per COVID-19 policy rather than isolated against their will.
Report Facts
Capacity: 143
Census: 88
Quarantine duration: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Raymond Wu | Licensing Program Analyst | Conducted the complaint investigation visit |
| Amy Banaga | Executive Director | Met with Licensing Program Analyst during the investigation |
| Rebecca Hedgecock | Licensing Program Manager | Named as Licensing Program Manager on the report |
Report
November 7, 2025
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