A & V Senior Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jose Tan conducted an unannounced Required One (1) year visit to this facility. LPA met with staff Rosaivlla Lagayada who called the Administrator designee Susan Nuguid and explained the reason for the visit. Ms. Nuguid designated Ms. Lagayada to sign the report. There is only one entrance being utilized at the facility. The facility had submitted and approved Infection Control and Mitigation plan. The screen door however has a broken handle. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. At 12:31 PM, tour of the physical plant was conducted with the staff. This facility is a single storey house and has five (5) bedrooms and two (2) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) ambulatory residents, four (4) of which may be non-ambulatory and one (1) maybe bedridden in Room #5, hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. The smoke detector is hardwired, tested and observed to be operational. There are two (2) fire extinguishers located in the kitchen. Both extinguishers are observed to be full and last checked on 10/23/25. There is carbon monoxide detector installed at the facility. (continued on LIC 809-C) (continued from LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a shed located in the other side of the backyard currently being used as an old equipment storage and observed to be locked and inaccessible to residents. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, laundry detergents, pesticides or toxins were stored in the kitchen cabinet and observed to be locked and inaccessible to residents. All sharps and knives were also observed to be locked in a kitchen cabinet. Laundry area is located adjacent to the kitchen. Laundry detergent and other cleaning agents are observed to be locked in a cabinet in the laundry area. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was observed to be locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.1°F to 116.8°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There are two (2) complete first aid kits located in the medication cabinet. Client and Staff records all residents and staff present records were reviewed. Residents and staff record appeared to be complete and updated. Disaster drill was last conducted on 09/12/26. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Sep 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Delinda Cawile for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 03:00 PM and the following was noted: There is one entrance being utilized at the facility. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The facility has a total of four (04) bedrooms and two (02) bathrooms for residents and one (01) staff room. The facility is fire cleared for two (02) ambulatory, four (04) non-ambulatory of which one (01) may be bedridden in Room #5. Facility has a hospice waiver for six (06). The facility is currently occupying five (05) residents. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. Laundry detergents, cleaning agents and other toxins are locked away. (continued on LIC 809-C) The living and dining room are neat and clean. The facility maintains a comfortable temperature at 77°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 112.9°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 11, 2025

Type of visit: Case Management - Other

On 7/1/2025 at approximately 12:35 PM Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced Case Management visit to the facility. LPA was greeted by the Caregiver and stated the reason for their visit. The facility’s acting Administrator Johnna Pocoroba was called over the telephone. The Administrator stated they were unable to report to the facility. The House-Manager, Susan Nuguid arrived shortly after to assist with today’s visit. The Community Care Licensing Division (CCLD) received a report that the facility’s Air-conditioning system was broken. LPA's interview with the Administrator revealed that they are in the process of getting the air-conditioning fixed and are "...working on installing individual air conditioning units for the bedrooms". LPA observed the thermostat to read 80 °F. When LPA asked the caregiver to move the dials from off to on to see if the air-condition unit would work, the thermostat did not indicate any change in temperature. There were no other immediate health and safety hazard observed during the day of inspection. Citation issued, please refer to LIC 809-D. Exit interview conducted, Appeals Rights given, and a copy of this report was provided to the House-Manager.the state’s words, verbatim · CDSS document, Jul 1, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(2) · Plan of correction due date: Jul 8, 2025

87303(b)(2) Maintenance and Operation. (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range...This requirement is not met as evidenced by: Based on LPA's interview and observation the facility's air conditioning system was observed to be broken which poses an potential Health, Safety or Personal Rights risks to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: The Administrator will email LPA Segovia the receipt of service showcasing the air-conditioning system was fixed and/or photos of individual air-conditioning systems installed throughout the facility including the bedrooms.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovie conducted an unannounced Required One (1) year visit at this facility. LPA met with Florence Peregrino, facility administrator designee and explained the reason for the visit. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The screen door however has a broken handle. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside and inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. At 12:52 PM, tour of the physical plant was conducted with the staff. This facility is a single storey house and has five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) ambulatory residents, four (4) of which may be ambulatory and one (1) maybe bedridden in Room #5, hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. The smoke detector is hardwired, tested and observed to be operational. There are two (2) fire extinguishers located in the kitchen. Both extinguishers are observed to be full and last checked on 06/03/24. There is carbon monoxide detector installed at the facility. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a shed located in the other side of the backyard currently being used as an old equipment storage and inaccessible to residents. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, laundry detergents, pesticides or toxins were stored in the kitchen cabinet and observed to be locked and inaccessible to residents. All sharps and knives were also observed to be locked in a kitchen cabinet. At this time, there is no laundry or dryer machine at the facility. Per the designee, it was taken a week ago and no delivery yet to date. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was observed to be locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 108.2°F to 117.3°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There are two (2) complete first aid kits located in the medication cabinet. Client and Staff records all residents and staff present records were reviewed. Residents and staff record appeared to be complete and updated. Disaster drill was last conducted on 08/15/24. Required posting are observed to be complete and current and displayed properly at the facility. Citation issued. Appeal rights discussed and given. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Sep 26, 2024