Villa Scalabrini Retirement Center

Type of visit: Required - 1 Year

At approximately 09:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual visit. LPA met with the Co-Administrator and disclosed the reason for the visit. At 09:45am LPA and the Co-Administrator toured the facility inside and out. This is a one-story building with an office, waiting room, one large activity room, conference room, file room, break room, storage rooms and a MedTech room. The waiting area provided hand sanitizer. The main living room has seating and a grand piano for entertainment. There is a reading room and private dining area for family or visitors to use. Facility maintains a comfortable temperature of 72°F. LPA observed postings such as personal rights, building permits, and the facility’s license. The facility is licensed to accommodate 130 non-ambulatory residents of which 16 can be in a memory care unit. The facility also has an approved hospice waiver for a maximum of 8 residents. At 10:00am, resident rooms were observed to be clean and sanitary. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and sufficient lighting. The bathrooms were checked for the resident private and shared rooms and the public area of the facility. LPA observed all bathrooms are clean and in good repair and contained fully stocked liquid soap and trash cans. The water temperature was measured between 105.4°F-114.3°F. The kitchen that prepares all the meals for the facility was observed to be fully stocked with perishable and non-perishable foods.The kitchen work area surface appeared clean, and no food items are stocked with cleaning supplies. Food is restocked regularly at least 2 times a week. The residents with special dietary needs are posted in the kitchen prep area with pictures of the resident and their food choices or required preparation. Continue on LIC809-C LPA observed seven (7) fire extinguishers throughout the facility which were last services on 08/23/2024. Emergency exit plans were posted in each room and throughout the facility. Emergency exit plan’s had current location and exit routes labeled clearly. All exit paths were free from hazards and obstructions. A fire inspection is conducted every year on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide detector and smoke detector. Copy of the inspection report was given to LPA. LPA observed appropriate outdoor furniture, with a covered shaded area for the residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents.. Between 10:30am to 11:30am, LPA reviewed records of ten (10) residents and three (3) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documents. Annual fee is paid in full. LPA collected Certificate of Liability Insurance, and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced case management visit to this facility to address the noted deficiencies. LPA had originally arrived to conduct a required annual continuation visit. LPA met with Alicia Avila. Based on the information obtained from the incident report that occurred at the above facility, it was concluded that LPA's review of the incident which occurred on 9/12/2024 that, -Facility failed to submit the SIR, LIC624 for occurrence dates of 10/14/22 and 3/12/24 regarding R1's aggressive behavior towards residents. -The facility staff intervened with R1's personal rights on 9/12/24. All noted deficiencies were discussed with the Administrator. Under Title 22 Division 6; Chapter 8 following citations were issued and recorded on LIC809D. Exit interview was conducted. Copy of report was provided to the administrator.the state’s words, verbatim · CDSS document, Sep 19, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 3, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This is not met as evidenced by; Facility staff intervened in R1's personal rights. This poses a potential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Sep 19, 2024

Plan of correction: The Administrator will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to this regulation. The Administrator will also submit proof of training for all staff. All proof must be sent to the LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Sep 26, 2024

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. This is not met as evidenced by, Facility failed to submit the SIR, LIC624 for occurrence dates of 10-14-22 and 3-12-24 regarding R1.the state’s words, verbatim · CDSS document, Sep 19, 2024

Plan of correction: Licensee will fill out an incident report for the incident involving resident #1(R1) that was said to have occured on 10/14/22 and 3/12/24 and provide a statement of understanding of the cited regulation to LPA by POC due date 9/26/24.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst, (LPA) Leizl de la Cerra, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 09/04/2024. LPA met with assistant administrator, Alicia Avila, and the purpose of visit was disclosed. The following remaining inspection domains were observed, reviewed and inspected: Medications: Residents medication are centrally stored in the medication room which is inaccessible to residents. Three (3) centrally stored resident medications were reviewed; containing 30-day supply of medications. First Aid kit complete. Common Areas: Activity rooms, dining room and gym room observed to be clean. Furnishings observed to be in good condition. No obstructions, nor tripping hazards observed. Laundry Rooms: LPA observed all three 3 laundry rooms throughout the facility. Residents have access to do their own laundry. Laundry area is clean and clear from obstruction. Cleaning supplies, and other toxins, are securely stored and inaccessible to residents. Outdoor: There is large sitting area located at the back of the facility observed to have more than adequate shade, with sufficient tables and seats for the residents. There are also 10 smaller sized patio area with sufficient shade and seating for residents. All outdoor furniture observed to be in good condition. There are no bodies of water in the facility. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 19, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 09/04/2024, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced annual inspection. LPA met with assistant administrator, Alicia Avila and disclosed the reason for the visit. There are currently 75 residents who reside at this facility. This facility has a hospice waiver for 6 residents. At approximately 1:00pm, administrator toured the facility with LPA. In the assisted living unit area, LPA inspected one (1) vacant resident bedroom, kitchen, dining area, 2 activity rooms, a guest room for families, a chapel and a gym. Fire extinguishers are located all throughout the facility and were last serviced 08/08/2024. Fire Drill was last conducted on 7/22/2024. Fire alarms, smoke detectors and carbon monoxide detectors observed through out the facility and were recently tested on 8/28/2024. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Kitchen has three (3) industrial refrigerators, one (1) walk-in freezer, and two (2) pantries. All kitchen foods are labeled and dated. Resident bedrooms and bathrooms: Bathrooms and bedrooms were clean and in good repair. LPA observed clean beds, lamp, night stand, chair and a desk with a desk chair. Hot water temperature was tested in vacant resident bathrooms and ranged from 106.7 degrees F - 113.7 degrees F. Emergency alert system checked and observed operable during visit. System is with an audio intercom where staff can communicate with resident when alert system is activated from residents room for any reason. Continued to LIC809C Memory Care Unit: This facility has a Memory Care section within the assisted living unit. Inside the Memory Care section, LPA observed the activity area, dining area and one (1) resident room out of ten (10) resident rooms. Memory Care section currently have 10 residents with dementia, there are a total of 3 caregivers for each eight (8) hour shift. All doors for backyard access are equipped with an operational bell/buzzer system to alert staff when door is being opened. At 12:00pm to 1:00pm and 2:30pm to 4:00pm LPA conducted a facility files review, program plan, infection control plan, liability insurance, surety bond, emergency/disaster plan, fire clearance review, fire drill report and fire alarm/carbon monoxide report. Surety bond effective on 2/05/2024. Liability insurance policy expires on 6/15/2025. Resident/Staff File Review: LPA reviewed records of eight (8) random residents file and eight (8) staff files. Due to time constraints LPA was unable to complete the Required 1 year visit. Alicia Avila was informed that a follow up visit will be made to complete the required annual visitthe state’s words, verbatim · CDSS document, Sep 4, 2024

Type of visit: Required - 1 Year

On 12/20/20/23 at around 10:00 AM Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – 1 Year Inspection to Villa Scalabrini Retirement and Special Care Unit and met with Co-Administrator Alicia Avila and Administrator Ardy Afshar. LPA was greeted upon arrival and screened for COVID-19 symptoms. Screening area is located immediately upon entrance. The facility is a single-story building. There are currently 73 residents who reside at this facility. This facility has a hospice waiver for 1 resident. LPA conducted a tour of the facility with the assistance of Ms. Avila between 11:00AM to 12:15PM. This facility has a memory care area within the assisted living unit. LPA inspected the interior and the exterior of the facility including the common living spaces, 10 resident bedrooms, 10 bathrooms, kitchen, dining area, activity room, library, family gathering and medication room and multi-purpose room. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 74°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 01/19/23. Facility is also equipped with microphone system throughout the entire facility. This Facility also has a call signal system. LPA tested call button. Call system is triggered in Administrators Office and Medication Room. Fire extinguishers are located all throughout the facility and were last serviced 08/22/2023. Fire Drill was last conducted on 10/26/23. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Kitchen has three (3) industrial refrigerators, one (1) walk-in freezer, and Two (2) pantries. All kitchen foods are labeled and dated. (Contd. from LIC 809) Bedrooms: LPA inspected random resident rooms. The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 112.5°F to 117.9°F and observed to be within the required limit. LPA observed all facility restrooms are equipped with hand washing signage and cleaning schedule. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications: LPA met with medical technician Elias Larios and toured the Medication Room facility medications. The Medication room was observed to be locked at the time of visit. There are two (2) sets of first aid kit in the Medication room. LPA randomly inspected medication log all resident medications are documented and labeled and placed inside a resident cubby hole. At 2:00pm LPA conducted a facility file review Resident/Staff File Review: LPA reviewed records of ten (10) random residents and six (10) staff. Resident and staff records appeared to be complete and updated. Laundry room located in the hallway no, 2 observed to be locked during visit. There is no immediate health and safety hazard during this visit. Pursuant to Title 22 Division 6 of the CA Code of Regulations, Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued to Administrator Ardy Shafar & Co- Administrator Alicia Avila.the state’s words, verbatim · CDSS document, Dec 20, 2023