La Casa Della Nonna

Type of visit: Required - 1 Year

On 7/13/26 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Elvira Flores. LPA was granted entry. 6 residents were present during inspection. Licensee (L1) Nina Garcia arrived shortly after LPA’s arrival. Per staff roster and verification of Guardian, 2 staff were found not associated with facility. LPA toured facility with L1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were checked and observed locked in cabinet. Clients’ MARS was reviewed. Fire extinguisher reviewed with a purchase date of: 6/11/26. Fire drill completed on 6/10/26. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Resident bathrooms observed to have a non-skid mats in shower. Hot water temperature was tested at a range of 124.7 to 129.3 degrees in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at 8 degrees F and refrigerator temperature maintained at 48 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. Staff files reviewed to have 1 missing required document. All client files reviewed to have all of the required documents. The following deficiencies are being cited and immediate civil penalty assessed on the attached 809D and LIC421IM in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/27/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A) A copy of this report with Appeal Rights were provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 13, 2026

Type of visit: Case Management - Health Checks

On 11/14/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced health and safety check on residents in care. This visit is being conducted due to the facility being on increased monitoring. LPA met with Direct Care Staff, Maria Avendano-Nicolas, explained reason for visit and was permitted entry into the facility. House Manager, Hilda Deroux was contacted and arrived some time later. During visit LPA completed a tour of the facility and observed residents in care in dining area and in rooms. There are currently 2 residents receiving hospice services. 1 resident is bedridden at this time. On 9/9/25 the Department received notification the Administrator, Phoeun Marez was no longer acting as the Administrator at the facility. Licensee was notified on 9/26/25 a complete packet had not been received naming a new Administrator. At this time the facility does not have an active Administrator. During an NCC on 2/6/25, Licensee was notified their hospice wavier was being decreased to 1 and could not accept any new residents without an exception. Interviews conducted and records reviewed identified there are currently 2 residents on hospice. Both do not have a current hospice care plan. 1 of 2 was admitted on 11/7/25. The Department has not received an exception request for this resident. LPA observed hallway fire door propped open with a wedge door stop. Record review identified S1 was not fingerprint cleared. Deficiencies cited per California Code of Regulations, Title 22. Deficiencies cited on attached 809D. If not corrected, these deficiencies will have a direct impact to residents in care. Exit interview conducted with House Manager, Hilda. A plan of correction was developed by Licensee via telephone and House Manager, Hilda and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Nov 17, 2025

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by: LPA observation. The licensee did not comply with the section cited above in that the hallway fire door was being propped open with a wedge door stop. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Staff immediately removed and closed the door. House Manager stated they will provide training to all staff. An in-service sign in sheet and training material will be provided to CCL as proof of correction.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(a) · Plan of correction due date: Nov 17, 2025

(a) All facilities shall have a qualified and currently certified administrator... This requirement was not met as evidence by: record review and interviews conducted. The licensee did not comply with the section cited above in that the facility does not have an active administrator since 9/9/25. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Licensee stated they will provide a complete packet and submit to CCL for the new Administrator by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.73(d) · Plan of correction due date: Nov 17, 2025

1569.73 Terminally ill residents; or terminally ill persons to be accepted as a resident; transferring hospice care and waivers; resident care and supervision (a) Notwithstanding Section 1569.72 or any other provision of law, a residential care facility for the elderly may obtain a waiver...(d) Nothing in this section is intended to expand the scope of care and supervision for a residential care facility for the elderly as defined in this act, nor shall a facility be required to alter or extend its license in order to retain a terminally ill resident or allow a terminally ill person to become a resident of the facility as authorized by this section. This requirement was not met as evidence by: record review and interviews conducted. The licensee did not comply with the section cited above in that the facility has a hospice wavier for 1resident and currently has 2 residents on hospice. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Licensee stated they will submit an exception request to CCL for last resident accepted into the facility on hospice.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87633(a)(4) · Plan of correction due date: Nov 17, 2025

87633 Hospice Care of Terminally Ill Residents (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met:(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness...prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). This requirement was not met as evidence by: record review. The licensee did not comply with the section cited above in that 2 of 2 residents receiving hospice services did not have a care plan. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Licensee stated they will reach out to hospice agency to get care plan for resident receiving hospice services and send a copy to CCL by POC date as proof of correction.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Nov 17, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidence by:LPA observations and records review. The licensee did not comply with the section cited above in that S1 was observed to be working with residents in care and to not have a fingerprint clearance. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Staff was immediately removed from the facility and schedule. Staff was sent to be fingerprint cleared. Licensee stated they understand staff can not return to the facility or be on the schedule until they are cleared to return.

Type of visit: Required - 1 Year

On 7/17/2025 Licensing Program Analyst (LPA) M. Garza arrived at the facility to complete an unannounced annual visit. LPA met with Care Giver, Fabian Luna, explained reason for visit and was permitted entry into the facility. Administrator, Phoeun Marez was contacted and arrived some time later. LPA completed a tour of the facility inside and out. Residents observed in common areas and in rooms. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher present and fully charged (receipt with purchase date not present). Resident rooms observed to have the required furnishings and with adequate lighting. Sharps and chemical were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio area. The following issues were observed during today’s visit: Bedroom 1 observed with bed rails on 1 of 2 beds without a physicians orders. Bathroom #1 in hallway observed with molded mat in shower and dirty shower chair in need of cleaning/replacement. Fire doors (2) in hallway observed propped open. Bathroom #2 observed with medication unlocked and accessible to residents in care in bathroom drawer. Sliding lock observed on back patio door and garage door preventing residents from opening. Deficiencies cited per title 22. If not corrected, deficiencies pose a directed and potential impact to residents in care. LPA requested the following documents to be submitted to CCL by 8/01/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview was conducted with Administrator, Phoeun. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided.the state’s words, verbatim · CDSS document, Jul 17, 2025

Allegation investigated: Staff did not prevent a resident from entering another resident's bedroom Staff did not prevent a resident from attacking another resident Staff did not properly report an incident involving a resident Staff do not communicate effectively with the residents

On 1/9/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit. Visit is being conducted to deliver complaint findings. LPA met with Administrator, Phoeun Marez, explained reason for visit and was permitted entry into the facility. A health and safety check on residents in care. Residents observed in living room watching television and in rooms. During investigation LPA completed interviews and requested documentation (Resident roster, staff roster with contact information, staff schedule for October 2024, physician’s reports, SIRs for residents in the month of Sept/October 2024, needs and service plans). Interviews with staff indicated an physical altercation occurred with R1 and R2. Review of SIR’s did not show the facility reported this incident to CCL or other appropriate parties. During interviews with staff S1, an interpreter had to translate the conversation with S2. Interviews conducted indicated staff utilize a translating device to communicate and expressed concern of “staff not being able to communicate with emergency services ” or “meet the residents needs”. The Department has found this allegation has met the preponderance of evidence standard per Title 22. This allegations listed abover are SUBSTANTIATED.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 24-AS-20241017122456

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 17, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidence by: LPA observation and interviews conducted. Observation of S1 and S2 utilizing a translation device to communicate with residents, visitors and other staff.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Administrator stated they will provided a new schedule with staff that is able to communicate with residents in care. Schedule will be submitted to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jan 17, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: interviews conducted and review of SIR’s. Interview with staff indicated an incident with R1 and R2 in a physical altercation. Review of SIR’s did not show the facility reported this incident to CCL or other appropriate parties. This poses a potential health, safety and or personal right risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Administrator stated they will complete training with all staff on reporting requirements. In-service sign in sheet and training material will be provided to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.619(c)(2) · Plan of correction due date: Jan 17, 2025

1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (2) Ensure the health, safety, comfort, and supervision of the residents. This requirement was not met as evidence by: interviews conducted. Interviews indicated staff did not prevent R2 from going into R1’s bedroom and physically attacking R1. This poses a potential health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Admnistrator stated they will provide all staff training on personal rights, monitoring residents and redirecting residents. 2 staff will be placed on the schedule at all times. In-service sign in sheet and training material will be provided to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 1/9/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. LPA met with Administrator, Phoeun Marez, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety on residents in care. Residents observed in common area and in rooms. This case management visit is being completed due to observations made during a complaint visit. The following issues were observed: Facility does not have the required 2-day perishable and 7-day non-perishable supply of food. Facility was observed with a candle that was previously used. Chemicals/medication and items that pose a danger to residents in care observed in unlocked garage accessible to residents in care. Deficiencies given per Title 22. Exit interview completed with Administrator, Phoeun. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a) · Plan of correction due date: Jan 10, 2025

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidence by: LPA observation of food stored in the facility was not of the quantity for the residents in care. This poses an immediate health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Administrator stated they will purchase groceries today. Receipt will be provided to CCL by POC date

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(h) · Plan of correction due date: Jan 10, 2025

87303 Maintenance and Operation (h)... Open-flame lights shall not be used. This requirement was not met as evidence by: LPA observation of candles previously used at the facility.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Administrator immediately threw away. Administrator stated they will provide training on oxygen use, open flames, fire safety to all staff. In-service sign in sheet and training material will be provided to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Jan 17, 2025

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidence by: Chemicals, medication and items that pose a danger to residents in care observed in unlocked garage accessible to residents.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Administrator stated all staff will be trained. In-service sign in sheet and training material will be provided to CCL by POC date.

Type of visit: Prelicensing

On 4/12/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Administrator, Leticia Rodriguez and was permitted entry into the facility. Facility is in the process of pre-licensing. Currently 5 residents are residing in the facility and receiving care. No residents with dementia currently residing at the facility. Facility does not have any residents receiving hospice services. 1 resident receiving home health services. LPA completed a health and safety check on residents in care. Residents observed in common area watching television and in rooms. Tour of facility inside and out was completed to follow up on the following issues: 1) Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground and a brick missing. Walkway tripping hazards have been filled in with landscaping rocks. 2) Right side fence has 2 boards loose that need to be nailed in and leaning to neighbors yard. Fence boards were nailed in and fence is no longer leaning. 3) Water temperature in master bedroom measured at 124.2 degrees F. Water temperature measured at 123.9 during todays visit. Bathroom #1 measured at 116.9 degrees F. Water temperature was lowered at the water heater. A temperature regulator was ordered and pending delivery. Temperature readings will be taken twice daily in 2 separate bathrooms for the next 2 weeks. Temperature log will be sent to CCL no later than 4/29/24. All other corrections have been made. The Component III conducted with Administrator. LPA will send notification facility is ready to be licensed. Exit interview completed with Licensee, Nina Kunzler and Administrator, Leticia Rodriguez. A copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 12, 2024

Type of visit: Prelicensing

On 3/28/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Administrator, Leticia Rodriguez and was permitted entry into the facility. Facility is in the process of pre-licensing. Currently 6 residents are residing in the facility and receiving care. 1 resident with dementia currently residing at the facility. Facility has 1 resident currently receiving hospice services and 1 resident receiving home health services. LPA completed a health and safety check on residents in care. Residents observed in common area watching television and in rooms. Tour of facility inside and out was completed to follow up on the following issues: 2 of 4 bedrooms observed without box springs. 1 of 4 resident bedrooms observed with a shared dresser. Water temperature measured at 131.2 degrees F and in need of warning signs. Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground. Water accumulating around/in planters and in need of correction. Box springs were purchased and placed on residents beds. Residents with shared dresser each have their own currently. Water accumulating around/in planters, have rocks and plants placed inside as correction. The following issues were observed during todays visit. Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground and a brick missing. Right side fence has 2 boards loose that need to be nailed in and leaning to neighbors yard. Water temperature in master bedroom measured at 124.2 degrees F. The Component III was not conducted during this pre-licensing visit due to corrections to facility needing to be completed. This pre-licensing visit was re-schedule for a re-inspection on 4/12/24 at 1pm. Administrator was informed that if at this time the facility is not ready to be licensed civil penalties will begin. At this time the facility is not ready to be licensed. Exit interview completed with Administrator, Leticia Rodriguez. A copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 28, 2024

Type of visit: Prelicensing

On 1/22/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Administrator, Leticia Rodriguez. LPA introduced self, reason for visit and was permitted entry into the facility. Facility is in the process of pre-licensing. Currently 5 residents are residing in the facility and receiving care. No dementia, no hospice or home health services are being provided to residents currently. LPA completed a health and safety check on residents in care. Residents observed in common area watching television. Tour of facility inside and out. All required postings are posted. Common areas observed with adequately furnishings and lighting. LPA observed an extra supply of linens and personal hygiene/grooming products. Kitchen observed with dishes, plates and utensils. Cleaning supplies/chemicals observed in a locked garage off living room. Medications observed in hallway closet locked and inaccessible to residents in care. Fire extinguishers present. Receipt taped to sides and shows date of purchase of 1/17/24. Fire alarm and carbon monoxide detectors are present and operational at time of visit. Outside of the facility toured. Exits open free of obstruction. Facility has a functioning phone. Phone number is: (559) 400-6700. First aid kits observed with required items. The following issues were observed during todays visit. 2 of 4 bedrooms observed without box springs. 1 of 4 resident bedrooms observed with a shared dresser. Water temperature measured at 131.2 degrees F and in need of warning signs. Outside walkway observed to be a tripping hazard and having a 2-4 inch drop to level ground. Water accumulating around/in planters and in need of correction. Due to corrections being needed, the Component III was not conducted during this pre-licensing visit. Administrator will contact CCL and reschedule for a re-inspection once corrections have been made. At this time the facility is not ready to be licensed. Exit interview completed with Administrator, Leticia Rodriguez. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 22, 2024

Type of visit: Prelicensing

On 1/16/2024 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete a Pre-Licensing visit. Upon arrival LPA met with Administrator, Leticia Rodriguez. Per Administrator, they would like to reschedule the pre-licensing visit. Facility is currently having maintenance/housekeeping completed and is not currently ready for the inspection to be done. Visit was rescheduled for Monday, January 22, 2024 at 1pm. No deficiencies cited during visit. Exit interview completed with Administrator, Leticia. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 16, 2024