Alpine View Lodge

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) David Roman conducted an unannounced Case Management Inspection. LPA D. Roman identified himself to Administrator, Helen Qian and discussed the purpose of the visit. While conducting an unrelated investigation LPA D. Roman reviewed resident and staff records, observing the files were in need of additional information. These deficiencies were cited in an LIC 809 D form and POCs were jointly formulated with Administrator, Helen Qian. LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected bedrooms. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. An exit interview was conducted with Facility Administrator, Helen Qian.the state’s words, verbatim · CDSS document, Jul 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506 · Plan of correction due date: Jul 16, 2026

87506 Resident Records -Each resident’s record shall contain at least the following information...Dates of admission and discharge...The admission agreement and pre-admission appraisal... Based on LPA observation and record review the Licensee did not have complete resident records which posed a health and safety risk for 1 of 26 persons in care.the state’s words, verbatim · CDSS document, Jul 2, 2026

Plan of correction: The licensee is to review Title 22 Regulation for Resident Records for Admissions 87506 by POC date and agreed not to accept anyone until admissions agreements are complete.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412 · Plan of correction due date: Jul 16, 2026

87412 Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following... Based on LPA observation and records review the Licensee did not have complete personnel records which posed a health and safety risk for 1 of 26 persons in care.the state’s words, verbatim · CDSS document, Jul 2, 2026

Plan of correction: Licensee is to review the Title 22 Regulation for Personnel Records for employment 87412 by POC date and agreed to have all documents completed prior to personnel employment.

Allegation investigated: Licensee did not report fire at facility.

Licensing Program Analyst (LPA), David Roman, conducted an unannounced inspection visit to initiate a complaint investigation. LPA was met by Licensee, Helen Qian and was granted entry into the facility. The purpose of the visit was discussed with Licensee. During today's visit, LPA D. Roman along with facility staff, conducted a tour inside and outside of the facility. LPA D. Roman observed the area in which the alleged fire occurred. Staff reported that a ceiling fan was beginning to smoke, was immediately turned off, fire department contacted, and the fan was removed. LPA D. Roman took pictures of the area where the fan was located, LPA observations proved a ceiling fan malfunctioned causing smoke and no fire. Based on evidence obtained, the preponderance of evidence standard was not met, therefore, the allegation was unsubstantiated. An exit interview was conducted with Facility Licensee, Helen Qian, to whom a copy of this report and Licensee/Appeals Rights (LIC 9058) were provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 5, 2025 · control 08-AS-20251029165145

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Roman conducted an unannounced Case Management Inspection. LPA D. Roman identified himself to Licensee, Helen Qian, and discussed the purpose of the visit. LPA D. Roman reviewed the unusual incident report with the licensee, identified the resident was having self harming behaviors. LPA D. Roman conducted a staff interview which revealed the resident was attempting to elope, and exhibited SP, in which law enforcement was contacted and the resident was transferred to UCSD Senior MHS. Staff reported to have a family meeting with the residents responsible party to inform that the resident is in need of a higher level of care. The family was in agreement as the resident reported not wanting to return to the facility. LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected bedrooms and bathrooms. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. The facility has sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents, medication cart is locked. No pools or bodies of water on the premises. An exit interview was conducted with Facility Licensee, Helen Qian.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alyssa Ramirez, made an unannounced visit to conduct the required One-Year Inspection. LPA was granted entry into the facility by Licensee Helen Qian, after identifying herself and stating the purpose of the inspection. Facility serves elderly residents ages 60 and above; approved for thirty-eight (38) bedridden residents and approved hospice waiver for fifteen (15) residents. The facility is also approved for a secured perimeter with no water feature on the premise. Facilities current census is thirty-one (31). LPA was accompanied by staff during a tour of the facility. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. PPE supplies are on-site. Passageways were free from obstructions. Resident rooms were equipped with required furnishings. Hot water temperature accessible to clients were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) and first aid kit (s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Facility has sufficient food supply. Centrally stored medications were properly stored and locked in cabinets. LPA reviewed staff and resident files. Files were complete and secured in a locked area. An exit interview was conducted with Licensee Qian, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt and a copy of the report was given to Licensee Qian.the state’s words, verbatim · CDSS document, Dec 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Manager Carmen Hall, after identifying herself and stating the purpose of the inspection. Licensee Helen Qian later joined the visit. Facility Profile: Facility serves elderly residents ages 60 and above; approved for thirty-eight (38) bedridden residents and approved hospice waiver for fifteen (15) residents. The facility is also approved for a secured perimeter with no water feature on the premise. LPA was accompanied by Manager Carmen Hall during a tour of the facility. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. PPE supplies are on-site. Passageways were free from obstructions. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars and Non-skid mats. Hot water temperature accessible to clients were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit (s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA observed several different types of activities that the residents were participating. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors as well as personal shopping. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room not assessable to residents. Centrally stored medications were properly stored and locked in cabinets. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. LPA reviewed the theft and loss policy and procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted with Licensee Qian, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt and a copy of the report was given to Licensee Qian.the state’s words, verbatim · CDSS document, Dec 19, 2023