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Inspection visit

Routine inspection (multi-day)

SPYGLASS SENIOR VILLA IIILicense 07920060714 citations on this visit
14 citations recorded

Inspector’s narrative

What the inspector wrote

On 1/28/2026 at 10:15 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this Case Management Annual Continuation Inspection. Upon entry, the LPA stated the purpose of the visit to Caregiver Jake Lapuz, shortly thereafter the LPA spoke with Administrator Shahid Siddiqui by phone. The LPA reviewed facility documents, 5 resident records, and 5 staff records. 14 Type B citations were issued during the inspection. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 809-D. Failure to submit Proof of Corrections (POCs) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. The Required Annual Inspection is complete. Exit interview conducted and a copy of this report provided.

Citations

14 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.618(a)Type B

    Based on observation, interview, and record review, the licensee did not comply with the section cited above. Shahid Siddiqui is not conducting administrative duties at the facility a minimum of 20 hours per week during normal working hours, which poses a potential health, safety and personal rights risk to persons in care.

  • 1569.625(b)(2)Type B

    Based on record review, the licensee did not comply with the section cited above. 0 of 2 staff completed 20 hours of training. Medication training is a separate requirement and is not included in the 20 hours, which poses a potential health, safety or personal rights risk to persons in care.

  • 1569.69(a)(2)Type B

    Based on record review, the licensee did not comply with the section cited above. 1 staff assisting residents with medication never had medication training, which poses a potential health, safety or personal rights risk to persons in care.

  • 1569.695(c)Type B

    Based on record review, the licensee did not comply with the section cited above in 2025, which poses a potential safety risk to persons in care.

  • 87208(a)Type B

    Based on record review, the licensee did not comply with the section cited above. No Plan of Operation at facility, so no description of the ways in which the Licensee will address resident behavioral expression as defined in Section 87101 and no infection control plan LIC 9282 at facility, which poses a potential health, safety and personal rights risk to persons in care.

  • 87219(a)Type B

    Based on observation and interview, the licensee did not comply with the section cited above in 5 out of 5 residents, which poses a potential health risk to persons in care.

  • 87412(e)Type B

    Based on record review, the licensee did not comply with the section cited above. The posted LIC 500 has hours for Administrator who is not at the facility during those times and prospective caregiver who has not yet been cleared to care for residents, which poses a potential health, safety and personal rights risk to persons in care.

  • 87413(a)(1)Type B

    Based on interview, the licensee did not comply with the section cited above with a staff shortage for more than two weeks, which poses a potential health, safety or personal rights risk to persons in care.

  • 87457(c)Type B

    Based on record review, the licensee did not comply with the section cited above in 5 out of 5 residents by using the wrong form. He needs to use LIC 603A RESIDENT APPRAISAL and LIC 9172 FUNCTIONAL CAPABILITY ASSESSMENT instead to conduct Pre-Admission Appraisals, which poses a potential health, safety or personal rights risk to persons in care.

  • 87463(a)Type B

    Based on record review, the licensee did not comply with the section cited above. 2 of 3 residents living at facility more than 12 months did not have their annual reappraisal, which poses a potential health, safety or personal rights risk to persons in care.

  • 87463(h)Type B

    Based on record review, the licensee did not comply with the section cited above. 2 of 3 residents living at facility more than 12 months did not have their annual routine visits, which poses a potential health risk to persons in care.

  • 87506(a)Type B

    Based on record review, the licensee did not comply with the section cited above. A majority of the required resident documents are missing: LIC 621 2 of 5 missing, LIC 601 5 of 5 missing, LIC 627C 5 of 5 missing, and LIC 613C-2 2 of 5 missing, which poses a potential health, safety or personal rights risk to persons in care.

  • 87507(l)Type B

    Based on record review, the licensee did not comply with the section cited above.2 of the 5 resident files had no Personal Rights (LIC 613C) in them, which poses a potential personal rights risk to persons in care.

  • 87608(a)(5)(A)Type B

    Based on observation, the licensee did not comply with the section cited above in no physician's orders for 2 of the 5 residents which posed a potential safety risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the January 28, 2026 inspection of SPYGLASS SENIOR VILLA III?

This was a other inspection of SPYGLASS SENIOR VILLA III on January 28, 2026. 14 citations were issued: 14 Type B.

Were any citations issued to SPYGLASS SENIOR VILLA III on January 28, 2026?

Yes, 14 citations were issued (0 Type A, 14 Type B). The first citation was for: "Based on observation, interview, and record review, the licensee did not comply with the section cited above. Shahid Sid..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.